血管外肺水在百草枯ARDS中诊断及预后中的价值

The value of extravascular lung water in the diagnosis and prognosis of paraquat ARDS

【目的】探讨百草枯(paraquat,PQ)中毒后发生急性呼吸窘迫综合症(acute respiratory distress syndrome,ARDS)时血管外肺水(extravacular lung water,EVLW)是否增加,及EVLW预测PQ中毒后发生ARDS及死亡的可能。【方法】该研究为单中心随机对照性研究,对31例急性PQ中毒患者常规给予PiCCO监测,检测组间EVLW的差异,评估EVLW是否可替代氧合指数作为ARDS的诊断标准。【结果】ARDS组同非ARDS组EVLW比较,发现12 h后ARDS组EVLW(9.45±3.61)ml/kg较非ARDS组EVLW(6.85±1.30)ml/kg有明显差异;EVLW和氧合指数吻合程度统计学意义显著;发现24 h后生存组EVLW[24 h EVLW(6.97±1.82)ml/kg,36 h EVLW 6.82±2.22)ml/kg,48 h EVLW(6.60±0.92)ml/kg,60 h EVLW(6.75±1.84)ml/kg,72 h EVLW(8.12±2.00)ml/kg,84 h EVLW(6.92±1.56)ml/kg,96 h EVLW(7.03±1.55)ml/kg,108 h EVLW(5.95±1.57)ml/kg,120 h EVLW(6.69±2.85)ml/kg,132 h EVLW(7.17±3.09)ml/kg]明显低于死亡组EVLW[24 h EVLW(12.65±3.80)ml/kg,36 h EVLW(15.37±3.79)ml/kg,48 h EVLW(16.94±5.18)ml/kg,60 h EVLW(12.90±2.95)ml/kg,72 h EVLW(13.10±0.96)ml/kg,84 h EVLW(10.26±2.65)ml/kg,96 h EVLW(12.29±1.78)ml/kg,108 h EVLW(14.27±2.63)ml/kg,120 h EVLW(15.87±4.32)ml/kg,132 h EVLW(18.72±2.27)ml/kg]。【结论】PQ中毒死亡组EVLW明显高于生存组;发生ARDS的EVLW明显高于非ARDS患者;本研究中发现ARDS组24 h EVLW即显著增高。EVLW可以代替氧合指数作为ARDS诊断标准之一。

[ Objective ] To explore whether extravascular lung water （EVLW） increased in acute respiratory distress syndrome （ARDS） caused by paraquat （PQ） and the possibility of EVLW in predicting the ARDS caused by PQ poisonifig and death. [ Methods] In the single center randomized controlled study, 31 patients with acute PQ poisoning in the Chinese people＇s armed police force logistics institute hospital poisoning first-aid center were enrolled. They were given monitoring conventional PiCCO and detecting. The EVLW difference between groups were analyzed, and EVLW was evaluated to take place of oxygenation index in the diagnostic standards of ARDS. [ Results]Compared with non-ARDS group, the EVLW in the ARDS group was significantly higher at 12 h [（9.45 ± 3.61） ml/kg, （6.85 ±1.30） ml/kg]. The coincidence degree between EVLW and oxygenation index was statistically significant. The volumes of EVLW in the survival group at 24 h, 36 h, 48 h, 60 h, 72 h, 84 h, 96 h, 108 h, 120 h and 132 h [（6.97 ± 1.82） ml/kg, （6.82 ± 2.22） ml/kg, （6.60 ± 0.92） ml/kg, （6.75 ± 1.84） ml/kg, （8.12 ± 2.00） ml/kg, （6.92 ± 1.56 ） ml/kg, （7.03 ± 1.55 ）ml/kg, （5.95 ＋ 1.57） ml/kg, （6.69 ± 2.85） ml/ kg, （7.17 ± 3.09） ml/kg] were obviously lower than those in the death group [（12.65± 3.80） ml/kg, （15.37 ± 3.79） ml/kg, （16.94 ± 5.18） ml/kg, （12.90 ± 2.95） ml/kg, （13.10 ±0.96） ml/kg, （10.26 ± 2.65） ml/kg, （12.29± 1.78） ml/kg, （14.27 ± 2.63） ml/kg, （15.87 ± 4.32） ml/kg and （18.72 ± 2.27） ml/kg]. [Gonclusion ]The EVLW in the death group is significantly higher than that in the survival group. Comparedwith the non-ARDS＇ s group, there is a significant increase of EVLW in the ARDS＇ s group. EVLW at 24 h increases significantly in the ARDS group. EVLW can replace the oxygenation index as one of the diagnostic standards for ARDS.