胸腔液体水平和氧合指数在脓毒症性ARDS患者液体管理中的意义

The significance of thoracic fluid content and PaO2/FiO2 in the management of fluid infusion for septic ARDS patients

目的通过观察严重脓毒症性急性呼吸窘迫综合征（acuterespiratorydistresssyndrome，ARDS）患者胸腔液体水平（thoracicfluidcontent，TFC）与氧合指数（Pa02／Fi02）的变化，探讨TFC在脓毒症性ARDS患者液体管理中的指导意义，为脓毒症性ARDS患者液体管理提供新的临床治疗策略。方法选择2012-01-2014-06上海长征医院急救科重症监护病房（intensivecareunit，ICU）和上海普陀区人民医院急诊ICU符合严重脓毒症性ARDS诊断标准的58例患者作为研究对象，通过胸阻抗法（TEB）测定TFC，同时监测动脉血氧分压（PaO2）和吸入氧浓度（Fi02），计算Pa02／FiO2。比较TFC与PaO2／FiO2之间的相关性，采用简单相关分析法进行统计学分析。结果TFC与Pa02／Fi02呈明显负相关（r=-0．67，P〈0．01）。进一步以ARDS的轻重程度进行分层分析，轻度ARDS时，患者PaO2／FiO2与TFC无明显相关性（r=0．13，P=0．241）；中度ARDS时，两者呈明显负相关（r=-0．49，P=0．013）；重度ARDS时，两者呈明显负相关（r=-0．88，P=0．004）。这可以提示对中、重ARDS患者可以通过降低TFC来改善氧合，但对于轻度ARDS患者，由于肺毛细血管通透性增高症引起的PaO2／FiO2下降，不能通过降低TFC来改善缺氧状态。结论TFC在脓毒症性ARDS患者的液体管理中具有重要指导意义。

Objective To observe the changes of thoracic fluid content （TFC） and PaO2/FiO2 in septic acute respiratory distress syndrome （ARDS） patients, and to explore the effects of TFC on the management of fluid infusion, a perspective control study is performed. Methods A total of 58 severe septic acute lung injury patients were chosen in the Emergency and ICU department in Shanghai Changzhen Hospital and in Shanghai PeopleJs Hospital of Putuo District from Jan. 2012 to Jun. 2014. TEB was utilized for measuring the TFC, and oxygenation index was detected. Correlation of TFC and PaO2/FiO2 were analyzed respectively. Simple correlation and simple linear regression were used for statistical analysis. Results Significant negative correlation was found of TFC and PaO2/FiO2 （ r = -0. 67, P 〈0.01 ）. No correlation was found between TFC and PaO2/FiO2 in the subgroup with mild ARDS （r = 0. 13, P = 0. 241）, but in the subgroup with moderate ARDS, significant negative correlation was found （r = -0.49, P = 0.013 ）. In the subgroup with severe ARDS, significant negative correlation was found （ r = - 0.88, P = 0. 004）. These results suggest that for mild or severe ARDS patients, reducing TFC helps to improve oxygenation, but for mild ARDS caused by the increase of blood capilary permeability of the lung disease, the dorp of PaO2/FiO2, cannot be improved by reducing TFC.Conclusion TFC has a important role in the fluid management for patients of severe septic ARDS.