COPD急性加重期并呼吸衰竭病人ELWI与ITBI及呼吸功能指标的相关性

CORRELATION OF ELWI WITH ITBI AND RESPIRATORY FUNCTION PARAMETERS IN PATIENTS WITH ACUTE EXACERBATION OF COPD AND RESPIRATORY FAILURE

目的探讨慢性阻塞性肺疾病急性加重期(AECOPD)并发呼吸衰竭的病人脉搏指示连续心排血量(PiCCO)监测下血管外肺水指数(ELWI)与胸腔内血容积指数(ITBI)及呼吸功能指标的关系。方法选取2013年6月—2016年12月本院重症监护病房收治的77例AECOPD并呼吸衰竭病人进行回顾性分析,所有病人均行PiCCO监测及血气分析,比较治疗前后各指标的变化,分析ELWI与ITBI、氧合指数(PaO_2/FiO_2)、呼吸频率(RR)、肺静态顺应性(Cs)等指标的相关性。结果本组77例病人,治疗后72h死亡6例,72h内病死率为7.79%。与治疗前比较,治疗后24、48、72h时病人ELWI、ITBI、RR、动脉血二氧化碳分压(PaCO_2)逐渐降低,PaO_2/FiO_2、Cs、动脉血氧分压(PaO_2)、pH值逐渐升高,差异均有统计学意义(F=11.945~31.872,P<0.05)。多元回归分析显示,ELWI与PaO_2/FiO_2、Cs、PaO_2、pH值呈负相关(B=-0.517^-0.268,P<0.05),与PaCO_2呈正相关(B=0.338,P<0.05)。结论 AECOPD并呼吸衰竭病人ELWI与ITBI及呼吸功能指标具有显著的相关性,根据PiCCO监测ELWI结果对病人进行液体管理在病人救治中具有重要意义。

Objective To investigate the relationship of extravascular lung water index （ELWI） monitored by pulse-in- duced contour cardiac output （PiCCO） with intrathoracic blood volume index （ITBI） and respiratory function parameters in patients with acute exacerbation of chronic obstructive pulmonary disease （AECOPD） and respiratory failure. Methods A retro- spective analysis was performed in 77 patients with AECOPD and respiratory failure who were admitted to the intensive care unit in our hospital from June 2013 to December 2016. All patients were monitored by PiCCO and subjected to blood gas analysis to inves- tigate the changes in each index after treatment and the correlation of ELWI with ITBI, partial pressure of oxygen （PaO2）/fraction of inspired oxygen （FiO2） ratio （PaO2/FiO2）, respiratory rate （RR）, static lung compliance （Cs）, and so on. Results At 72 hours after treatment,6 patients died, with a mortality rate of 7.79%. At 24,48, and 72 hours after treatment, ELWI, ITBI, RR, and partial pressure of carbon dioxide （PaCO2） gradually decreased, and PaO2/FiO2, Cs, PaO2, and pH gradually increased （F = 11.945--31.872,P〈0.05）. Multiple regression analysis showed that ELWI was negatively correlated with PaO2/FiO2, Cs, PaO2, and pH （B=-0.517-0.268,P〈0.05） and positively correlated with PaCO2 （B=0.338,P〈0.05）. Conclusion In patients with AECOPD and respiratory failure, ELWI is significantly correlated with ITBI and respiratory function parameters. It is of great significance for the patients to perform fluid management according to ELWI measured by PiCCO.