高血管外肺水持续时间对脓毒性休克患者预后的评价

Prognostic evaluation on septic shock patients affected duration of high extravascular lung water

目的探讨高血管外肺水（EVLW）持续时间对脓毒性休克患者预后判断的价值。方法收集2008年6月一2014年6月入住海南省农垦总医院ICU55例脓毒性休克患者的高EVLW持续时间、急性生理学及慢性健康状况评分Ⅱ（APACHEⅡ评分）、初始EVLWI值和预后的相关资料。根据预后分为存活组（n=35）和死亡组（n=20）；以高EVLW持续时间72h为界将患者分为A组（〈72h，n=31）和B组（≥72h，n=24）。比较存活组与死亡组、A组与B组之间相关数值的差异。结果各组人住ICU时的一般情况、APACHEl／评分、初始EVLWI值比较差异均无统计学意义（P〉0．05）。存活组高EVLW持续时间为（38．7±14．6）h，明显低于死亡组（63．5±16．2）h（P〈19．05）；A组病死率（12．9％）明显低于B组（66．7％）（P〈0．01）。结论高EVLW持续时间可用于评估脓毒性休克患者治疗效果和预后。

Objective To explore how duration of high extravascular lung water （EVLW） affects the prognosis of patients with septic shock. Methods Clinical data of 55 patients with septic shock who were admitted at Intensive Care Unit （ICU） in our hospital in between June 2008 and June 2014 were collected and analyzed for duration of high EVLW, APACHE 11 score, the level of EVLWI at admission to ICU and prognosis. According to prognosis result, the patients were divided into survival group （S-group, n=35） and non-survival group （NS-group, n=20）. Based on duration of high EVLW （72 hours as an average）, the patients were divided into group A （〈72 h, n=31） and group B （≥72h, n=24）. Data were compared between the S-group and the NS-group, as well as between the group A and the group B. Results While admitted at ICU, it reflected no significant difference in the patients＂ general condition, APACHE Ⅱ score and the level of EVLWI between S-group and NS-group, or between group A and group B （P 〉0.05）. The duration of high EVLW of S-group was 38.7 ± 14.6 hours, which was significantly lower than that of NS-group＇ s 63.5 ± 16.2 hours （P 〈0.05）. The mortality of the group A （12.9%） was significantly lower than that of the group B （66.7%）, （P 〈0.01）. Conclusion Duration of high EVLW may be used to evaluate the effect of the treatment and predict the prognosis for patients with septic shock.