EVLWI联合IBVI在严重肺部感染合并感染性休克患者液体管理中的临床价值研究

Study of clinical value of EVLWI and IBVI in the fluid management of patients with severe pulmonary infection complicated with septic shock

目的：探讨血管外肺水指数（EVLWI）和胸腔内血容积指数（IBVI）在严重肺部感染合并感染性休克患者液体管理中的应用价值。方法：回顾性分析2011年3月至2014年10月期间在我院ICU治疗的56例严重肺部感染合并感染性休克患者，采用随机对照研究方法分为观察组和对照组，每组各28例，对照组患者仅依据常规中l心静脉压进行液体管理，观察组患者在此基础上合并PICCO监测技术获得的血管外肺水指数及胸腔内血容积指数进行液体管理，比较并分析两组患者的临床疗效。结果：（1）两组患者APACHE Ⅱ评分、SOFA评分、去甲肾上腺素用量以及患者血浆乳酸水平均明显下降（P〈0．05），但观察组患者低于对照组（P〈0．05）；（2）治疗后对照组患者血浆肌酐水平均明显上升，但观察组患者明显低于对照组（P〈0.05）；观察组患者机械通气率、机械通气的时间、ICU病房时间以及病死率均明显低于对照组患者（P〈0.05）；上述差异均具有统计学差异。结论：在中0静脉压基础上，联合应用EVLWI和IBVI评估严重肺部感染合并感染性休克患者的液体管理，可提升液体管理效果，提升患者预后。

Objective：To investigate the application value of extravascular lung water index （EVLWI） and intrathoracic blood volume index （IBVI） in the fluid management cff patients with severe puhnonary infection complicated with septic shock, nethods：A t-etrospective analysis was conducted of 56 patients with severe pulmonary infection complicated with septic shock who were admitted to ICUs in our hospital from March 2011 through October 2014. Patients were divided into two grgups using a randomized controlled triM： observation group （ n = 28 ） and control group （ n = 28 ）. Liquid management was conducted in patients of the control group based on routine central venous pressure （CVP） and in those of the observation group based on this with EVLWI and IBVI obtained by PiCCO monitoring. Clinical effects were compared and analyzed for both groups of patients. Results ： （I） APACHE II score, SOFA score, dose of norepinephrine and plasma lactate level markedly decreased in both groups of patients （ P 〈 0. 05 ） , but those were lower in the observation group than in the control group （P 〈 0. 05 ）. （II） The post -treatment plasma creatinine level markedly increased in the control group compared with the observation group （P 〈 0. 05 ）. Mechanical ventilation rates, durations of mechanical ventilation, ICU stays and mortalities were markedly lower in the observation group than in the control group （P 〈 0. 05 ）. Above differences were statistically significant. Conclusion：On the basis of CVP, combination of EVLWI and IBVI in assessment of the fluid management of patients with severe pulmonary inteetion complicated with septic shock can improve the effect of the fluid management and patient outcome.