重症慢性肺心病患者液体平衡状态与预后的关系研究

Association of fluid balance with ICU outcome in critically ill patients with chronic cor pulmonale

目的:探讨重症慢性肺源性心脏病(肺心病)患者液体平衡状态与ICU结局的关系。方法:对入住呼吸ICU的87例慢性肺心病合并Ⅱ型呼吸衰竭患者的临床资料进行回顾性分析,根据1周内液体平衡情况分为液体正平衡组与液体负平衡组,根据患者二氧化碳潴留情况改善和(或)是否成功脱机情况将患者分为好转组与不好转组。统计方法采用单因素分析和多因素Logistic回归分析。结果:好转组的1周内液体平衡量和日均液体平衡量均显著低于不好转组(P=0.001)。液体正平衡组的ICU住院天数和总住院天数均明显多于液体负平衡组(P=0.038)。液体负平衡与良好的ICU结局正相关,且是影响预后的独立保护因子(OR=0.26,P=0.025)。结论:液体负平衡预示重症肺心病患者预后良好。

Objective： To examine the association between fluid balance and ICU outcomes in critically ill patients with chronic cor pulmonale. Methods： 87 patients who were diagnosed as chronic cor pulmonale complicated with hypercapnic respiratory failure in RICU were retrospectively evaluated. Fluid balance data up to one week were collected. Patients were divided into two groups according to ICU outcomes based on whether CO2 retention improved and（ or） patients could be successfully weaned from mechanical ventilation. Univariate and multiple logistic regression analyses were performed to identify the factors associated with ICU outcomes. Results：Cumulative fluid balance in one week and daily average fluid balance were significantly lower in patients with good outcomes than patients with bad outcomes（ P = 0. 001）. Negative fluid balance was positively associated with good ICU outcomes（ OR = 0. 26,P = 0. 025）. In addition,ICU length of stay and hospital length of stay were longer in positive fluid balance group than those in negative fluid balance group（ P = 0. 038）. Conclusion： Negative fluid balance in one week predicts better ICU outcome in patients with chronic cor pulmonale.