中华内科杂志
中華內科雜誌
중화내과잡지
CHINESE JOURNAL OF INTERNAL MEDICINE
2011年
7期
593-596
,共4页
杨从山%谢剑锋%莫敏%刘松桥%黄英姿%邱海波%杨毅
楊從山%謝劍鋒%莫敏%劉鬆橋%黃英姿%邱海波%楊毅
양종산%사검봉%막민%류송교%황영자%구해파%양의
毛细血管通透性%肺水肿%急性肺损伤%诊断
毛細血管通透性%肺水腫%急性肺損傷%診斷
모세혈관통투성%폐수종%급성폐손상%진단
Capillary permeability%Pulmonary edema%Acute lung injury%Diagnosis
目的 探讨肺血管通透性指数(PVPI)在急性肺水肿鉴别诊断中的价值.方法 选2004年5月至2008年9月收住东南大学附属中大医院重症医学科,留置脉搏指示连续心排血量(PiCCO)导管,氧合指数[PaO2/吸入氧浓度(FiO2)]＜300 mm Hg(1 mm Hg=0.133 kPa)且血管外肺水指数(EVLWI)≥7 ml/kg的急性肺水肿患者,分为急性肺损伤(ALI)组和心源性肺水肿组,观察PVPI、胸腔内血容量指数(ITBVI)、肺血容量(PBV)、血管外肺水(EVLW)/胸腔内血容量(ITBV)在2组中的变化与差异.结果 (1)34例患者纳入研究,其中ALI 22例,心源性肺水肿12例;(2)ALI组PVPI为2.7±1.4,心源性肺水肿组为1.9±0.6,2组比较,P＜0.05.EVLWI、ITBVI在2组间差异无统计学意义(P＞0.05);(3)PVPI与EVLWI呈正相关(r=0.762,P=0.000),与PaO2/FiO2呈负相关(r=-0.478,P=0.012);(4)纳入患者中肺内原因ARDS 8例,肺外原因ARDS 5例,肺外原因ARDS患者PVPI、EVLW/ITBV和EVLWI显著高于肺内原因ARDS患者.结论 PVPI有助于对重症患者肺水肿类型的鉴别.
目的 探討肺血管通透性指數(PVPI)在急性肺水腫鑒彆診斷中的價值.方法 選2004年5月至2008年9月收住東南大學附屬中大醫院重癥醫學科,留置脈搏指示連續心排血量(PiCCO)導管,氧閤指數[PaO2/吸入氧濃度(FiO2)]＜300 mm Hg(1 mm Hg=0.133 kPa)且血管外肺水指數(EVLWI)≥7 ml/kg的急性肺水腫患者,分為急性肺損傷(ALI)組和心源性肺水腫組,觀察PVPI、胸腔內血容量指數(ITBVI)、肺血容量(PBV)、血管外肺水(EVLW)/胸腔內血容量(ITBV)在2組中的變化與差異.結果 (1)34例患者納入研究,其中ALI 22例,心源性肺水腫12例;(2)ALI組PVPI為2.7±1.4,心源性肺水腫組為1.9±0.6,2組比較,P＜0.05.EVLWI、ITBVI在2組間差異無統計學意義(P＞0.05);(3)PVPI與EVLWI呈正相關(r=0.762,P=0.000),與PaO2/FiO2呈負相關(r=-0.478,P=0.012);(4)納入患者中肺內原因ARDS 8例,肺外原因ARDS 5例,肺外原因ARDS患者PVPI、EVLW/ITBV和EVLWI顯著高于肺內原因ARDS患者.結論 PVPI有助于對重癥患者肺水腫類型的鑒彆.
목적 탐토폐혈관통투성지수(PVPI)재급성폐수종감별진단중적개치.방법 선2004년5월지2008년9월수주동남대학부속중대의원중증의학과,류치맥박지시련속심배혈량(PiCCO)도관,양합지수[PaO2/흡입양농도(FiO2)]＜300 mm Hg(1 mm Hg=0.133 kPa)차혈관외폐수지수(EVLWI)≥7 ml/kg적급성폐수종환자,분위급성폐손상(ALI)조화심원성폐수종조,관찰PVPI、흉강내혈용량지수(ITBVI)、폐혈용량(PBV)、혈관외폐수(EVLW)/흉강내혈용량(ITBV)재2조중적변화여차이.결과 (1)34례환자납입연구,기중ALI 22례,심원성폐수종12례;(2)ALI조PVPI위2.7±1.4,심원성폐수종조위1.9±0.6,2조비교,P＜0.05.EVLWI、ITBVI재2조간차이무통계학의의(P＞0.05);(3)PVPI여EVLWI정정상관(r=0.762,P=0.000),여PaO2/FiO2정부상관(r=-0.478,P=0.012);(4)납입환자중폐내원인ARDS 8례,폐외원인ARDS 5례,폐외원인ARDS환자PVPI、EVLW/ITBV화EVLWI현저고우폐내원인ARDS환자.결론 PVPI유조우대중증환자폐수종류형적감별.
Objective To assess the value of pulmonary vascular permeability index in differentiating acute lung injury (ALI) from cardiac pulmonary edema. Methods Critically ill patients with acute pulmonary edema were included from May, 2004 to September, 2008. Patients were divided into two groups, the ALI group and the cardiac pulmonary edema group (C group). Pulmonary vascular permeability index (PVPI) , intrathoracic blood volume (ITBVI) were determined by pulse indicator continuous cardiac output(PiCCO) system. Results ( 1 ) Thirty-four patients were enrolled, 22 cases in ALI group and 12 cases in C group. (2) The PVPI in patients of ALI group (2.7 ± 1.4) was higher than that of C group (1.9 ±0.6 ;P＜0.05). EVLWI and ITBVI did not have the significant difference between the two groups (P ＞0. 05). (3) PVPI was positively correlated with EVLWI(r = 0. 762) , negatively correlated with PaO2/ FiO2(r= -0.478). (4)ARDS was diagnosed in 13 cases, including 8 pulmonary cause(ARDSp) and 5 extra-pulmonary cause ( ARDSexp). PVPI, EVLW/ITBV and EVLWI of patients with ARDSexp were obviously higher than those with ARDSp. Conclusions PVPI may be useful for differentiating the types of pulmonary edema in the critically ill.
