血管外肺水评估在百草枯中毒致急性呼吸窘迫综合征患者中的应用

Application of extravascular lung water assessment in patients with acute respiratory distress syndrome caused by paraquat poisoning

目的:评价血管外肺水指数(EVLWI)和肺血管通透性指数(PVPI)在百草枯(PQ)中毒致急性呼吸窘迫综合征(ARDS)患者预后评估中的作用。方法:分析23例PQ中毒致ARDS患者的临床资料,依据氧合指数(OI)分为轻、中、重度3组,比较各组患者APACHE II评分、EVLWI、PVPI指标差异。依据不同的临床预后,将患者分为死亡组和生存组,观察2组患者入组后0、12、24、36、48、60、72h的OI、EVLWI和PVPI指标的动态变化,分析各指标间的相关性并评估其对预后的指导价值。结果:所有患者28d总病死率为39.1%(9/23),轻度、中度、重度患者的病死率分别为10.0%(1/10)、54.5%(6/11)和100%(2/2);死亡组0、12、24、36、48、60、72h的OI值显著低于生存组(P<0.05,P<0.01),死亡组24、36、48、60、72h的EVLWI值及12、24、36、48、60、72h的PVPI值显著高于生存组(P<0.01);随着时间的延长,死亡组患者OI值显著降低,EVLWI、PVPI显著增高,生存组变化不明显;EVLWI与OI呈显著负相关(r=-0.660,P=0.000);PVPI与OI呈显著负相关(r=-0.592,P=0.000)。结论:血管外肺水(EVLW)评估可用于PQ致ARDS患者的预后评估。

Objective：To evaluate the effect of extravascular lung water index（EVLWI）and pulmonary vascular permeability index（PVPI）on the prognosis of acute respiratory distress syndrome（ARDS）patients induced by paraquat poisoning.Method：The clinical data of 23 patients with paraquat poisoning induced ARDS were analyzed.They were divided into three groups by oxygen index（OI）：mild,moderate and severe group.The difference of APACHEⅡscore,EVLWI and PVPI in the patients of three groups were compared.According to different clinical prognosis,the patients were divided into death group and survival group.the difference and relevance of OI,EVLWI and PVPI were compared between the two groups in 0,12,24,36,48,60,72 h.Result：The total mortality rate was 39.1%in 23 patients,10patients with mild ARDS（mortality rate 10.0%）,11 patients with moderate ARDS（mortality rate 54.5%）,and 2patients with severe ARDS（mortality rate 100%）.OI of death group in 0,12,24,36,48,60,72 hwere significantly lower than that of survival group（P〈0.05,P〈0.01）.EVLWI of death group in 24、36、48、60、72h,and PVPI in 12、24、36、48、60、72hwere significantly higher than that of survival group（P〈0.01）.With the extension of time,the OI value of the death group was significantly lower,EVLWI,PVPI were significantly higher,while the change in survival group was not obvious.Conclusion：Extravascular lung water index can be used for the assessment of the prognosis of patients with ARDS caused by paraquat poisoning.