强离子隙在急性呼吸窘迫综合征患者中的水平改变及临床意义

The Level Changes and Clinical Significance of Strong Ion Gap in Patients with Acute Respiratory Distress Syndrome

目的探讨强离子隙(SIG)水平在急性呼吸窘迫综合征(ARDS)患者血清中的改变及其与呼吸功能和平均住院时间的相关性。方法选择2013年1月至2014年1月枣阳市第一人民医院收治的ARDS患者60例,根据肺氧合水平分为轻度组(14例)、中度组(25例)和重度组(21例),另外选取20例健康志愿者作为对照组。各组受试者在测定血气、电解质等的基础上,应用StewartFigge方程式计算SIG。结果治疗前ARDS患者的SIG水平和肺损伤指数(LIS)评分显著高于对照组(P<0.05);重度组SIG水平(12.33±4.81)显著高于轻度组(6.12±2.11)和中度组(7.41±2.89)(均P<0.05);重度组LIS评分[(2.2±0.1)分]显著高于轻度组[(1.5±0.2)分](P<0.05)。在纠正呼吸衰竭后,各组SIG水平和LIS评分均明显下降(P<0.05或P<0.01)。经Pearson相关分析,SIG在轻度组和重度组中与LIS呈正相关(r=0.559,0.522,均P<0.05),同时在重度组中与平均住院时间呈正相关(r=0.399,P<0.05)。结论 ARDS患者血清SIG水平明显升高,且随着呼吸衰竭程度的加重而升高,与LIS存在一定的相关性,对ARDS的早期诊断、风险评估及治疗评价均具有指导意义。

Objective To investigate the changes of the strong ion gap （ SIG） in patients with acute respiratory distress syndrome（ ARDS） .Methods Sixty cases of ARDS admitted to Zaoyang First People′s Hospital from Jan.2013 to Jan.2014 were divided into three groups：mild group（n =14）,moderate group （n=25） and severe group（n =21）,and another 20 normal cases were enrolled as control group.On the basis of determination of blood gas and electrolyte,Stewart-Figge methodology equations were used to calcu-late SIG.Results Compared with the control group,the levels of SIG,Lung injury score （LIS） in the ARDS group before treatment were higher and the differences were statistically significant （ P〈0.05 ） .The level of SIG in severe group（12.33 ±4.81） was significantly higher than the mild group（6.12 ±2.11） and moder-ate group（7.41 ±2.89）（P〈0.05）; the LIS score in severe group[（2.2 ±0.1） scores] was significantly higher than the mild group [（1.5 ±0.2） scores]（P 〈0.05）.After correcting respiratory failure,the SIG level and LIS score were decreased significantly（P〈0.05 or P〈0.01）.Pearson correlation analysis indica-ted that SIG was positively related with the LIS in the mild and the severe group （ r =0.559,0.522,P 〈0.05）, and positively related with mean hospital day in the severe group（r=0.399,P〈0.05）.Conclusion The serum SIG levels of ARDS patients are significantly increased and increase as respiratory failure degree aggravates,and have certain relevance with LIS,which is of guiding significance for the early diagno-sis,risk assessment and efficacy evaluation of ARDS.