不同病因肺水肿患者血管外肺水指数差异研究.docVIP

不同病因肺水肿患者血管外肺水指数的差异研究 　　[摘要] 目的 研究不同病因肺水肿患者血管外肺水指数（EVLWI）的差异。 方法 选取2014年1月～2015年6月我院重症医学科收治的典型肺水肿患者75例，按不同病因将其分为两组，急性心源性肺水肿组（ACPE组）44例，急性呼吸窘迫综合征组（ARDS组）31例。分析两组患者EVLWI差异及EVLWI与预后的关系。 结果 ACPE组MAP、HR、CI、EVLWI、PVPI显著低于ARDS组，且ACPE组CVP、OI显著高于ARDS组（P1；且在ACPE组中，PVPI的OR值最高为4.33，在ARDS组中，PVPI的OR值最高为4.21，PVPI对两组EVLWI的危险性更高；ACPE组死亡率为6.82%，显著低于ARDS组的25.81%（P0.05）；两组死亡与存活在0、24、72 h时的EVLWI值均高于正常值，且ACPE组死亡与存活在0、24 h时的EVLWI值均显著低于ARDS组，在72 h时的EVLWI值显著高于ARDS组（P0.05）；动态监测ACPE组存活EVLWI有降低趋势，死亡EVLWI有升高趋势，动态监测ARDS组存活与死亡EVLWI均有降低趋势。 结论 EVLWI的影响因素包括MAP、CVP、OI、CI及PVPI等，ACPE及ARDS患者EVLWI存在显著差异，不同病因肺水肿患者死亡率也存在差异，因此临床上通过检测患者EVLWI水平确定不同肺水肿病因，并对预测预后及对患者实施针对性治疗有重要意义。 　　[关键词] 急性心源性肺水肿；急性呼吸窘迫综合征；肺水肿；血管外肺水指数；差异 　　[中图分类号] R541.6+3 [文献标识码] A [文章编号] 1674-4721（2016）05（c）-0032-04 　　Study of the differences of extravascular lung water index in the patients with pulmonary edema induced by different causes of disease 　　WU Shou-kun WU Yi LUO Wen-xiao ZHENG Zhi-zhong TAN Xian-nian 　　Department of Critical Medicine，Peopele′s Hospital of Taishan City in Guangdong Province，Taishan 529200，China 　　[Abstract] Objective To study the differences of EVLWI in the patients with pulmonary edema induced by different causes of disease. Methods 75 patients with typical pulmonary edema who were admitted to the department of critical medicine in our hospital from January 2014 to June 2015 were selected.They were assigned to two groups according to different causes of disease，namely acute cardiogenic pulmonary edema group（ACPE group ） of 44 patients and acute respiratory distress syndrome group（ARDS group ） of 31 patients.The difference of EVLWI in both groups and the relationship between EVLWI and prognosis were analyzed. Results MAP，HR，CI，EVLWI，PVPI in ACPE group was significantly lower than that in ARDS group respectively，CVP and OI in ACPE group was significantly higher than that in ARDS group respectively（P1；In ACPE group，OR value of PVPI was up to 4.33 maximally，and in ARDS group，OR value of PVPI was up to 4.21 maxi