血管外肺水指数和肺血管通透性指数在急性呼吸窘迫综合征评估中的临床应用

Application value analysis of the reliability of extravascular lung water index and pulmonary vascular permeability index in evaluating the severity of acute respiratory distress syndrome

目的分析血管外肺水指数(EVLWI)和肺血管通透性指数(PVPI)在评价急性呼吸窘迫综合征(ARDS)严重程度中的应用价值,并其对ARDS患者预后评价的价值。方法选择我院2015年6月至2016年12月ICU收治的22例ARDS患者为研究对象,收集并整理患者临床资料,根据ARDS 2012柏林标准将所有患者分为3组:轻度组8例、中度组6例、重度组8例。采用脉波指示剂连续心排血量监测技术(PICCO)测量并比较各组患者治疗前、治疗后24 h、治疗后72 h的EVLWI、PVPI、心脏指数(CI)、胸腔内血容量指数(ITBVI)。以EVLWI=13 ml/Kg和PVPI=3为界限,分析并比较不同EVLWI水平和PVPI水平患者ICU住院时间、ICU病死率、28 d病死率。结果治疗前、治疗后24 h、治疗后72 h,中度组、重度组EVLWI、PVPI水平均高于轻度组,重度组EVLWI、PVPI水平均高于中度组,各组间比较均具有统计学差异,P<0.05。高EVLWI组患者ICU住院时间(23.6±6.6)d、ICU病死率69.2%、28 d病死率76.9%均高于低PVPI组(15.3±5.2)d,33.3%,44.4%,各组间比较差异具有统计学意义,P<0.05。高PVPI组患者ICU住院时间(24.3±6.5)d、ICU病死率57.1%、28 d病死率78.6%均高于低PVPI组(16.4±4.2)d,25.0%,37.5%,且组间比较差异具有统计学意义,P<0.05。结论 EVLWI和PVPI水平是评估ARDS患者病情严重程度的重要指标,且高水平EVLWI和PVPI患者预后较差。

Objective To analysis the application of the reliability of extravascular lung water index（ EVLWI） and pulmonary vascular permeability index（ PVPI） in evaluating the severity of acute respiratory distress syndrome（ ARDS）,and to discuss the value of EVLWI and PVPI on the prognosis of ARDS. Method A summary of 22 patients with ARDS in ICU of our hospital from June 2015 to December 2016,were chosed as our experimental objects. All the clinical data were collected and classified. All the patients were devided into three groups according to 2012 Berlin standard of ARDS： the mild group（ n = 8）,the moderate group（ n = 6）,the severe group（ n = 8）. The levels of EVLWI,PVPI,cardiac index（ CI） and intrathoracic blood volume index（ ITBVI） of three groups in pre-therapy,24 h after therapy and 72 h after therapy were measured by pulse indicator continuous cardiac output technology（ PICCO） and compared. With EVLWI = 13 ml/Kg and PVPI = 3as limits,the duration of hospital in ICU,mortality rate of ICU and mortality rate of 28 d after therapy of the three groups were assessed and compared in patients with different levels of EVLWI and PVPI. Results In24 h after therapy and 72 h after therapy,the levels of EVLWI,PVPI of the moderate group and severe groupwere significantly higher than these of the mild group,respectively,and the levels of EVLWI,PVPI of the severe group were evidently higher than these of the moderate group,P0.05.The duration of hospital in ICU（23.6±6.6）d,mortality rate of ICU（69.2%）and mortality rate of 28 d（76.9%）after therapy of the high EVLWI group were remarkably higher than these of the low EVLWI group（（15.3±5.2）d,33.3%,44.4%）,P0.05.The duration of hospital in ICU（24.3±6.5）d,mortality rate of ICU（57.1%）and mortality rate of28 d（78.6%）after therapy of the high PVPI group were remarkably higher than these of the low PVPI group（16.4±4.2）d,25.0%,37.5%）,P0.05.ConclusionEVLWI and PVPI levels are important indicators of the severity of the disease in patients with ARDS,and high levels of EVLWI and PVPI are associated with a poor prognosis.