摘要
目的:比较肺内、外源性急性呼吸窘迫综合征(ARDS)的血管外肺水指数(EVLWI)和肺毛细血管渗透性指数(PVPI)的差异。方法:选取ARDS患者87例,根据病因分为肺内源性(47例)及肺外源性(40例),行脉搏轮廓曲线连续心排血量(Pi CCO)监测,记录2组患者置管即刻各指标并行相关性分析,记录置管后12、24、36、48、60、72 h及7 d的EVLWI及PVPI,比较其在2组间的差异。选取置管时EVLWI和PVPI值绘制ROC曲线。结果:1置管0 h肺内源性ARDS的EVLWI和PVPI较肺外源性的高(P<0.01)。2相关性分析显示:EVLWI与PVPI(r=0.833,P<0.01)、EVLWI与舒张末期容积指数(GEDVI)(r=0.251,P<0.05)、EVLWI与中心静脉压(CVP)(r=0.228,P<0.05)显著相关,EVLWI与急性生理学及慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、心脏指数(CI)、血管外阻力(SVRI)均无显著相关性(均P>0.05)。PVPI与EVLWI(r=0.833,P<0.01)、PVPI与GEDVI(r=-0.236,P<0.05)显著相关。3在ARDS的前48 h,肺内源性及肺外源性的EVLWI与PVPI有统计学差异,到72 h和7 d时,2组无统计学差异。4EVLWI:曲线下面积(AUC)0.703,截断点为9.18,其诊断敏感性53.2%,特异性82.5%;PVPI:AUC 0.722,截断点为1.2,其诊断敏感性85.1%,特异性50.0%。结论:ARDS初期,肺内源性的EVLWI、PVPI较肺外源性的高。EVLWI和PVPI在诊断不同病因所致ARDS中有一定价值。
Objective： To compare the extravascular lung water index（ EVLWI） and the pulmonary vascular permeability index（ PVPI） in cases of pulmonary and extrapulmonary forms of acute respiratory distress syndrome（ ARDS）. Methods：According to the etiology of diseases,87 patients with ARDS were divided into two groups： pulmonary ARDS group（ 47 cases） and extrapulmonary ARDS group（ 40 cases）. Pulse index continuous cardiac output（ Pi CCO） monitoring were performed,all indexes of both groups were recorded instantly after tracheal intubation,and correlation analysis was made. EVLWI and PVPI were recorded and compared between the two groups at 12,24,36,48,60 and 72 hours and 7 days after tracheal intubation. Results： ① EVLWI and PVPI in pulmonary ARDS group were significantly higher than those in extrapulmonary ARDS group at 0 hour after tracheal intubation（ P 〈0. 01）. ② EVLWI showed significant correlation with PVPI（ r =0. 833,P〈 0. 01）,as well as with GEDVI（ r = 0. 251,P 〈0. 05） and central venous pressure（ CVP）（ r = 0. 228,P 〈0. 05）,while it showed no correlation with acute physiology and chronic health evaluationⅡ（ APACHE Ⅱ） score,cardiac index（ CI）,and SVRI（ all P〉 0. 05）. PVPI was significantly correlated with EVLWI（ r = 0. 833,P 〈0. 01） and GEDVI（ r =- 0. 236,P 〈0. 05）. ③ In the first 48 hours of ARDS,the differences of EVLWI and PVPI between the two groups showed statistical significance,which was not seen till the 72 hour and the 7th day. 4 For EVLWI,the area under the curve（ AUC） was 0. 703,the cut-off points was 9. 18,with the sensitivity of 53. 2% and the specificity of 82. 5%. For PVPI,AUC was 0. 722,the cut-off points was 1. 2,with the sensitivity of 85. 1% and the specificity of 50. 0%. Conclusions： EVLWI and PVPI in pulmonary ARDS patients are higher than those in extrapulmonary ARDS patients in the early stage of ARDS. EVLWI and PVPI have some values in diagnosing ARDS with different causes.
出处
《内科急危重症杂志》
2015年第1期20-23,共4页
Journal of Critical Care In Internal Medicine
基金
2013年度江苏省南通市科技发展指令性项目(No:HS2013044)
关键词
急性呼吸窘迫综合征
血管外肺水指数
肺毛细血管渗透性指数
Acute respiratory distress syndrome
Extravascular lung water index
Pulmonary vascular permeability index
