作者单位: 210009南京,东南大学附属中大医院危重病医学科

    通信作者:杨从山, Email : ycs7415@s ohu . com

    ·论著·

    血管外肺水指数对感染性休克患者预后的

    评价

    杨从山 邱海波 刘松桥 杨毅 黄英姿 刘玲

    【摘要 】 目的 评价血管外肺水指数 ( EVLW I )对感染性休克患者预后判断的意义。方法 选

    收住在 I CU的感染性休克患者 ,右颈内静脉置管接 PiCCO温度探头 ,用 PiCCO监测其 EVLW I ,记录每

    日液体用量 ,用受试者操作特征曲线 (ROC)评价各指标对预后评价的准确性。结果 (1)共 50例感

    染性休克患者入选本研究 , 26例患者住院期间病情好转存活 (存活组 ) , 24例病情恶化死亡 (死亡

    组 )。 (2)置管时的 EVLW I存活组与死亡组差异无统计学意义 ( P = 01551) ;置管第 3天的 EVLW I存

    活组显著低于死亡组 ( P = 01001)。将 50例患者置管第 3天的 EVLW I按 0～7 ml /kg、 8～14 ml /kg、> 14 ml /kg进行分层 ,病死率分别为 25%、 4117%、 10 /10。 (3)置管第 1天、 前 3 d的液体平衡 ,存活

    组与死亡组差异有统计学意义 ( P = 01000, 01000)。液体负平衡者病死率低。 (4) ROC曲线置管第 3

    天的 EVLW I的 AUC为 01740 ± 01072。置管第 3天的 EVLW I > 715 ml /kg时 ,预后评价的敏感性为

    8313% ,特异性为 5318%。结论 动态观察感染性休克患者 EVLW I ,可作为预后评价的指标之一。

    如治疗早期 EVLW I明显下降 ,液体呈负平衡 ,预后可能较好。

    【关键词 】 血管外肺水指数; 休克 ,脓毒性; 死亡率; ROC曲线

    The prognosti c va lue of extrava scul ar lung wa ter i ndex i n cr iti ca lly ill septi c shock pa ti en ts YANG

    Cong2 shan, Q I U Hai2 bo, L I U Song2 qiao, YANG Yi , HUANG Ying2 zi , L I U L ing . Depart m ent of Critical Care

    M edicine, Zhong2 Da Hospital and School of ClinicalM edicine, Southeast Univer sity, N anjing 210009, China

    Corresponding author : YANG Cong2 shan, Em ail : ycs7415@sohu . com

    【Abstract】 Objecti ve To investigate the p r ognostic value of extravascular lung water index

    ( EVLW I ) in critically ill patientswith sep tic shock in intensive care unit ( I CU) . Methods EVLW Iwas

    deter mined by using a PiCCO Monit or, and the daily fluid balance was recorded . Results Fifty patients

    with sep tic shock were admitted and t wenty2six patients survived . The average EVLW I at baseline was 1117

    ml /kg, and the difference was not different bet ween survivors and nonsurvivors, P = 01551 . The EVLW I of

    day 3 ( EVLW I d3) in nonsurvivors was significantly higher than the survivors [ ( 1413 ±818 ) ml /kg vs

    (811 ± 217) ml /kg, P = 01001 ]. I f the patientswere divided int o three gr oup s by the EVLW I d3

    , gr oup one

    0 - 7 ml /kg (4 /16) , gr oup t wo 8 - 14 ml /kg (10 /24) , and gr oup three > 14 ml /kg ( 10 /10) , the hosp ital

    mortality of the third group was significantly higher than the other t wo gr oup s ( P = 01000, 01002) . There

    was a significant difference bet ween the survivors and the nonsurvivors in the fluid balance at the first day

    and the foll owing three days ( P = 01000, 01000 ) . Negative fluid balance was ass ociated with a l ower

    mortality . By using receiver operating characteristic analysis, the area under the curve was 01740 ± 01072 t o

    EVLW I d3

    . I f EVLW I > 715 ml /kg, the sensitivity and the specificity of accurate judgmentwere 8313% and

    5318%. Conclusi on Dynamic observati on of EVLW I can be one of the fact ors for p redicting the p rognosis

    of patientswith sep tic shock . A reducti on of EVLW I at early treat ment and a negative fluid balance were

    ass ociated with a better p rognosis .

    【Key words】 Extravascular lung water index; Shock, sep tic; Mortality; ROC curve

    感染性休克患者由于感染、 炎症反应导致容量

    血管扩张 ,毛细血管渗漏 ,有效循环血量不足。而相

    应的液体复苏及感染、 炎症反应导致的毛细血管通

    透性增高 ,使发生肺水肿及继发感染的几率明显增

    加。传统的容量评价指标 — — — 中心静脉压 (CVP)和

    肺动脉嵌顿压 ( PAWP)的测定 ,易受心血管顺应性、胸腔内压、 瓣膜反流等影响,不能准确代表心脏前负

    荷 ,尤其不能反映血管外肺水 ( EVLW)含量[ 1 ]。近

    年来脉搏指示的持续心排监测仪 ( PiCCO p lus)逐渐

    应用于临床 ,可直接为临床医师提供两个最重要的

    血流动力学信息 — — —EVLW 和心脏容量负荷 ......