脉搏指示下连续心输出量指导的慢性阻塞性肺疾病加重期并呼吸衰竭患者液体管理的意义

The clinical effects of pulse indicator continuous cardiac output in goal-optimized fluid management on patients with acute exacerbation of chronic obstructive pulmonary disease with respiratory failure

目的通过观察慢性阻塞性肺疾病（COPD）急性加重期合并呼吸衰竭患者血管外肺水指数（ELWI）与氧合指数和胸腔内血容量指数（ITBI）的相关性，探讨脉搏指示下连续心输出量（PiCCO）在COPD急性加重期合并呼吸衰竭患者液体管理中的指导意义。方法选择2010年10月至2013年9月符合COPD急性发作合并呼吸衰竭的患者71例，应用PiCCO技术监测患者ELWI和ITBI，比较ELWI与氧合指数和ITBI与ELWI之间的相关性。结果ELWI与氧合指数呈明显负相关（r=-0．743，P〈0．01）。进一步以ELWI=14ml／kg进行分层分析，当ELWI〈14ml／kg时，两者仍呈负相关（r=0．533，P=0．080），但差异无统计学意义；当ELWI≥14ml／kg时，两者呈明显负相关（r=-0．961，P〈0．01）。ELWI与ITBI无明显相关性（r=0．477，P=0．072）。进一步以ITBI=1000ml／m^2进行分层分析，当ITBI〈1000ml／m^2时，两者无明显相关性（R=0．338，P=0．116）；当ITBI≥1000ml／m。时，两者呈明显正相关（r=0．677，P〈0．01）。结论对于COPD急性发作合并呼吸衰竭的患者，当ELWI≥14ml／kg时，ELWI也成为影响氧合的重要因素，因此可以通过降低ELWI来改善氧合，当ITBI≥1000ml／m^2时，可以通过降低ITBI来降低ELWI。

Objective To investigate the clinical effects of the pulse indicator continuous cardiac output （PiCCO） in： goal-optimized fluid management on patients with acute exacerbation of chronic obstructive pulmonary disease （AECOPD） with respiratory failure. Methods A total of 71 AECOPD patients with respiratory failure who were hospitalized in department of Critical Care Medicine in our hospital were selected from October 2010 to September 2013. The PiCCOteehnology was applied to monitor intrathoracic blood volume index （ITBI） and extravascular lung water index （ELWI）. We compared the relationship of ELWI with ITBI and oxygenation index, and a simple correlation analysis was used for statistical analysis. Results A significantly negative correlation was found between ELWl and oxygenation index （ r= - 0. 743, P〈 0.01 ）. ELWI = 14 ml/kg was defined as the cutoff value for the subgroup analysis. A negative correlation still was found between ELWI and oxygenation index in the subgroup with ELWI〈 14 ml/kg, but it had no significant difference （r=- 0. 533, P=0. 080）, while a significantly negative correlation was found in the subgroup with ELWI≥14 ml/kg （r=- 0. 961, P〈0.01）. There was no significant correlation between ELWI and ITBI （ r=0. 477, P=0. 072）. ITBI= 1 000 ml/m^2 was defined as the cutoff value for the subgroup analysis. There is no significant correlation between ELWI and ITBI in the subgroup withITBI〈1 000 ml/m^2（r=0.338, P=0.116）, but in the subgroup with ITBI〈1000 ml/m^2, a significantly positive correlation between ELWI and ITBI was found （r= 0. 677, P〈0.01）.Conclusions The results suggest that when ELWI is higher than 14 ml/kg, ELWI becomes an important influencing factor for oxygenation, which can be decreased to improve oxygenation in patients with AECOPD, and when ITBI≥1 000 ml/m^2, ITBI can be reduced by decreasing ELWI. PiCCO has an important clinical significance on a goal-optimized fluid management in AECOPD patients with respiratory failure.