血管外肺水指数变化和液体平衡对重度子痫前期患者预后的影响研究

Effect of Extravascular Lung Water Index Change and Liquid Balance on the Prognosis of Patients with Severe Preeclampsia

目的:探讨血管外肺水指数(EVLWI)变化和液体平衡对重度子痫前期患者预后的影响。方法:选取2014年8月-2016年8月本院收治的重度子痫前期产后患者57例,根据患者意愿分为EVLWI组(n=20)和中心静脉压(CVP)组(n=37),CVP组常规在早、中、晚连续测量3次CVP取均值,CVP低于8 cm H2O时进行补液直至CVP达到正常值,高于12 cm H2O时给予限制补液甚至利尿脱水直至CVP达到正常值,EVLWI组早、中、晚连续测量3次EVLWI取均值,EVLWI低于3 m L/kg进行补液直至EVLWI达到正常值,EVLWI高于7 m L/kg时给予限制补液甚至利尿脱水直至EVLWI达到正常值。监测比较两组液体平衡量、补液24 h和72 h的急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、ICU住院天数、机械通气时间及追踪患者临床转归情况。结果:与CVP组比较,EVLWI组补液0~6、6~24、24~48、48~72 h的液体平衡量降低,补液24、72 h的APACHEⅡ评分亦升高,ICU住院天数和机械通气时间缩短,孕产妇产时、产后心衰、肺水肿、产后出血和弥散性血管内凝血、胎儿生长受限、早产儿、新生儿出生缺陷、新生儿疾病及新生儿围生期死亡等不良妊娠结局的总发生率降低(P<0.05)。结论:依据EVLWI进行重度子痫前期补液指导有助于控制其液体平衡并改善患者预后,值得临床推广应用。

Objective： To investigate the effect of extravascular lung water index change （ EVLWI ） and liquid balance on the prognosis of patients with severe preeclampsia.Method： A total of 57 cases of severe preeclampsia patients after baby birth in our hospital from August 2014 to August 2016 were selected and divided into EVLWI group （ n=20 ） and central venous pressure （ CVP ） group （ n=37 ） according to the patients wiI1.CVP group had conventional CVP continuous measurement in the morning, noon and night for 3 times and take the average value, when CVP was lower than 8 cm H2O fluid infusion was applied to adjust CVP to normal, and when CVP was more than 12 em H2O limits fluid infusion, diuresis and dehydration therapy was applied to adjust CVP to normal.And the EVLWI group had EVLWI continuous measurement in the morning, noon and night for 3 times and take the average value, when EVLWI was lower than 3 mL/kg fluid infusion was applied to adjust CVP to normal, and when EVLWI was above 7 mL/kg limits fluid infusion, diuresis and dehydration therapy was applied to adjust EVLWI to normal.Monitoring of liquid equilibrium quantity of the two groups were monitored and compared, and 24 and 72 h after fluid infusion acute physiology and chronic health evaluation systemlI （ APACHEII ） score, ICU hospitalization days, mechanical ventilation time and hospital outcomes in follow up of the two groups were compared.Result： Compared with CVP group, liquid equilibrium quantity of EVLWI group after fluid infusion in 0-6, 6-24, 24-48, 48-72 h was reduced, 24 and 72 h after fluid infusion APACHE]] score was increased, ICU mechanical ventilation time and hospitalization days were shorter, and total incidence of maternal intrapartum and postpartum heart failure, pulmonary edema, postpartum hemorrhage and diffuse intravascular coagulation,fetal growth restriction, birth defects, newborn diseases babies and neonatal death in the perinatal period and other adverse pregnancy outcomes were lower （P〈0.05） .Conclusion： Fluid infusion on the basis of EVLWI in severe preeclampsia can help to control the liquid balance and improve patients prognosis, therefore, it is worthy of clinical popularization and application.