血管外肺水指数在急性脑梗死并发神经源性肺水肿(NEP)患者中的动态监测及临床应用

Dynamic monitoring and clinical applications of extravascular lung water index( EVLWI) in patients with severe acute cerebral infarction

目的血管外肺水指数（EVLWI）和肺毛细血管通透性指数（PVPI）在急性脑梗死并发神经源性肺水肿（NEP）患者中的动态监测及临床意义。方法收集2012年6月~2014年3月收入本院的45例急性脑梗死并发神经源性肺水肿（NEP）患者,在常规治疗的基础上运用脉搏指数持续心输出量监护仪（PICCO）进行血流动力学监测,监测在发病第1、3、5和7 d血流动力学指标EVLWI、PVPI、CI、SVRI、d Pmax、CFI、GEDI、和ITBV的动态变化,并分析发病第3 d EVLW与GCS、PVPI的相关性。结果第3 d EVLWI开始升高,然后逐渐升高,至第7 d达到9.8±0.6,与第1 d比较具有明显差异（P〈0.05）;患者发病第3 d EVLWI与GCS评分呈正相关（r=0.517,P〈0.05）,与肺毛细血管通透性呈负相关（r=-0.5,P≤0.05）。结论急性重症脑梗死患者EVLWI明显升高,病情越重EVLWI水平越高,神经源性肺水肿（NEP）是急性重症脑梗死患者严重的并发症;EVLWI与肺毛细血管通透性指数以及脑梗死严重程度密切相关。

Objective To observe dynamic changes and clinical significance of EVLWI（ extravascular lung water index） and PVPI（ pulmonary vascular permeability index） in patients with severe acute cerebral infarction complicated with neurogenic pulmonary edema（ NEP）. Methods 45 cases of severe acute ischemic stroke patients complicated with neurogenic pulmonary edema（ NEP） were selected. Continuous hemodynamic pulse index cardiac output monitor（ PICCO） were conducted on the basis of conventional treatment and monitored the dynamic changes of EVLWI、PVPI、CI、SVRI、d Pmax、CFI、GEDI and ITBV in 1,3,5,7 d. To calculate the difference of each index by statistical software,and to analyze the correlation between EVLW and GCS,PVPI in the third day. Results There were no significant changes in CI、SVRI、d Pmax、CFI、GEDI and ITBV at the first day（ P〉0. 05）; EVLWI began to gradually increase from the first day,it reached 9. 8 ± 0. 6 in 7 d,there was a significant difference compared with the first day,（ P〈0. 05）; there was a significant correlation between EVLWI with GCS score（ r = 0. 517,P〈0. 05）,and pulmonary capillary permeability index with EVLWI（ r = 0. 517,P〈0. 05）. Conclusions EVLWI significantly increased in patients with severe acute cerebral infarction,more severer and more higher level. Neurogenic pulmonary edema（ NEP） is a severe complication in patients with severe acute ischemic stroke. There was a significant correlation between EVLWI with GCS score,at the same time it is closely related between EVLWI and pulmonary vascular permeability index.