血管外肺水的测量:为急性呼吸窘迫综合征患者实施精准诊治

Extravascular lung water measurements:accurate diagnosis and treatment for patients with acute respiratory distress syndrome

目前,对急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)的诊断采用的是柏林标准,根据影像学及氧合指数等指标对患者进行评估。然而该标准存在阅片主观性、病理改变与诊断标准不符等,使其诊断ARDS精准性受到质疑。肺血管通透性增加和血管外肺水聚集是ARDS的特征性表现,应用经肺热稀释技术可测量这两项指标,为ARDS精准诊治提供依据。血管外肺水(extravascular lung water,EVLW)超过10 mL/kg是诊断肺水肿的可靠指标,如果同时肺血管渗透指数(pulmonary vascular permeability index,PVPI)大于3,则提示为ARDS所致肺水渗出。EVLW和PVPI的测量将会对ARDS的临床研究与实践提供精准指标。

The current diagnostic criteria of ARDS is based on the Berlin definition,chest radiography,oxygenation index and other parameters are used to define patients.However,there are some defects in this standard,such as the subjectivity of chest radiography interpretation,the inconformity of pathological changes and clinical symptoms,so the accuracy of the standard is questioned.Increase in pulmonary vascular permeability accompanied with accumulation of excess extravsscular lung water(EVLW)is the hallmark of ARDS.EVLW and pulmonary vascular permeability index(PVPI)can be quantitatively measured using the transpulmonary thermodilution technique,which can provide basis for accurate diagnosis and treatment of ARDS.EVLW more than 10 mL/kg is a reasonable criterion for pulmonary edema,meanwhile PVPI more than three suggests increased vascular permeability of ARDS.EVLW and PVPI measurement will provide accurate indicators for clinical practice and research of ARDS.