血管外肺水指数和肺血管通透性指数评估重症患者急性呼吸窘迫综合征程度的可靠性

Reliability of extravascular lung water index and pulmonary vascular permeability index in assessing severity of acute respiratory distress syndrome in critically ill patients

目的 探讨血管外肺水指数（EVLWI）和肺血管通透性指数（PVPI）评估重症患者急性呼吸窘迫综合征（ARDS）程度的可靠性.方法 选择本院EICU住院治疗的ARDS患者46例,年龄18～72岁,体重46～ 72 kg,性别不限,急性生理与慢性健康评分11 ～25分.将患者分成3组：重度组（n=16）：氧合指数（PaO2/FiO2）≤100 mmHg;中度组（n=14）：100 mmHg ＜PaO2/FiO2≤200 mmHg;轻度组（n=16）：200 mmHg ＜PaO2/FiO2≤300 mmHg.于治疗前、诊断ARDS后24和72 h时测量PVPI和EVLWI、心指数（CI）、胸腔内血容量指数（ITBVI）,并行血气分析,计算PaO2/FiO2.记录患者入院28 d的病死情况.PVPI、EVLWI与PaO2/FiO2、ITBVI和CI进行Pearson相关分析.结果 与轻度组比较,中度组及重度组患者各时点PVPI、EVLWI和28 d病死率升高（P＜0.05）;与中度组比较,重度组患者各时点PVPI、EVLWI和28 d病死率升高（P＜0.05）.PVPI与EVLWI和PaO2/FiO2的相关系数分别为0.778和-0.437（P＜0.05）,与CI和ITBVI无相关性（P＞0.05）;EVLWI与PaO2/FiO2和ITBVI的相关系数分别为-0.448,0.347（P＜ 0.05）.PVPI和PaO2/FiO2的相关系数与EVLWI和PaO2/FiO2的相关系数比较差异无统计学意义（P＜0.05）.结论 PVPI和EVLWI均可评估重症患者ARDS程度,可靠性一致.

Objective To investigate the reliability of extravascular lung water index （EVLWI） and pulmonary vascular permeability index （PVPI） in assessing the severity of acute respiratory distress syndrome （ARDS） in critically ill patients.Methods Forty-six patients with ARDS,who were admitted in our emergency intensive care unit,aged 18-72 yr,weighing 46-72 kg,of Acute Physiology and Chronic Health Evaluation Ⅱ score 11-25,were divided into 3 groups：PaO2/FiO2 ≤ 100 mmHg severe group （n =16）;100 mmHg 〈PaO2/FiO2 ≤ 200 mmHg moderate group （n =14）;200 mmHg 〈PaO2/FiO2 ≤ 300 mmHg mild group （n=16）.Before treatment,and at 24 and 72 h after diagnosis of ARDS,PVPI,EVLWI,cardiac index （CI）,and intrathoracic blood volume index （ITBVI） were measured,and blood gas analysis was performed.PaO2/FiO2 was calculated.The 28 day fatality after admission to hospital was recorded.Person correlation of PVPI and EVLWI with PaO2/FiO2,ITBVI and CI was analyzed.Results The PVPI,EVLWI and fatality rate were significantly higher at each time point in moderate group and severe group than in mild group,and in severe group than in moderate group （P〈0.05）.The correlation coefficient between PVPI and PaO2/FiO2 was 0.778,and between EVLWI and PaO2/FiO2 was-0.437 （P〈0.05）.There was no correlation between CI and ITBVI （P〉0.05）.The correlation coefficient between EVLWI and PaO2/FiO2 was-0.448,and between EVLWI and ITBVI was 0.347 （P〈0.05）.There was no significant difference between the correlation coefficient between PVPI and PaO2/FiO2 and the correlation coefficient between EVLWI and PaO2/FiO2 （P〈0.05）.Conclusion PVPI and EVLWI both can assess the severity of ARDS in critically ill patients,showing a consistent reliability.