CAJ | 학술논문

目的应用PiCCO技术监测并比较脓毒症合并急性肺损伤(ALI)或急性呼吸窘迫综合征(ARDS)患者的血流动力学改变,以探讨血管外肺水与各肺损伤指标及肺内炎症因子水平的相关性.方法选取40例2009年至2010年广州市第一人民医院ICU住院脓毒症患者进行观察,其中未合并ALI/ARDS的患者作为对照组.应用PiCCO技术连续7d监测血管外肺水等血流动力学指标,并记录血气分析结果、呼吸机参数、胸片,检测血清及肺泡灌洗液中炎症因子白介素-1( IL-1)及肿瘤坏死因子-α(TNF-α)的水平.结果在40例脓毒症患者中,15例(37.5％)合并ARDS,14例(35％)合并ALI.与对照组相比,ALI及ARDS患者表现为显著增高的血管外肺水指数(EVLWI)及肺泡灌洗液中IL-1、TNF-α水平.同时,血管外肺水指数与氧合指数、肺损伤指数及IL-1、TNF-α水平呈显著相关性(r=-0.524,r=0.147,r=0.572,r=0.655；P＜0.05),且高ELVW水平组患者ICU病死率及住院病死率均显著高于低ELVW水平组.结论在脓毒症介导的ALI及ARDS患者中,血管外肺水指标与肺内炎症因子水平及肺损伤严重程度具有相关性.因此,EVLW的检测可能对于判断脓毒症患者肺损伤程度及预后具有一定意义.
목적 응용PiCCO기술감측병비교농독증합병급성폐손상(ALI)혹급성호흡군박종합정(ARDS)환자적혈류동역학개변,이탐토혈관외폐수여각폐손상지표급폐내염증인자수평적상관성.방법 선취40례2009년지2010년엄주시제일인민의원ICU주원농독증환자진행관찰,기중미합병ALI/ARDS적환자작위대조조.응용PiCCO기술련속7d감측혈관외폐수등혈류동역학지표,병기록혈기분석결과、호흡궤삼수、흉편,검측혈청급폐포관세액중염증인자백개소-1( IL-1)급종류배사인자-α(TNF-α)적수평.결과 재40례농독증환자중,15례(37.5％)합병ARDS,14례(35％)합병ALI.여대조조상비,ALI급ARDS환자표현위현저증고적혈관외폐수지수(EVLWI)급폐포관세액중IL-1、TNF-α수평.동시,혈관외폐수지수여양합지수、폐손상지수급IL-1、TNF-α수평정현저상관성(r=-0.524,r=0.147,r=0.572,r=0.655；P＜0.05),차고ELVW수평조환자ICU병사솔급주원병사솔균현저고우저ELVW수평조.결론 재농독증개도적ALI급ARDS환자중,혈관외폐수지표여폐내염증인자수평급폐손상엄중정도구유상관성.인차,EVLW적검측가능대우판단농독증환자폐손상정도급예후구유일정의의.
Objective To investigate and compare the change of extravascular lung water (EVLW) and levels of cytokines in septic patients without clinical acute lung injury (ALI) /acute respiratory distress syndrome (ARDS) with those in spetic patients with sepsis-induced ALI/ARDS in order to determine the role of EVLW involved in the pathogenesis of lung injury in the patients by quantifying the relationship between EVLW and biomarkers of lung injury in patients with sepsis.Methods A total of 40 septic patients complicated either with or without clinical ALI/ARDS after sepsis. In each patient,transpulmonary thermodilution (PiCCO) was used to measure cardiovascular hemodynamics and EVLWI for 7 days via an arterial cannula indwelled within 72 hours after diagnosis of severe sepsis was made, and serial bronchoalveolar lavages (BAL) were carried out.Other examinations including blood gas analysis,ventilator parameters,chest X-ray and the levels of pro-inflammatory cytokines such as tumor necrosis factor (TNF-oα),interleukin-1 in the BAL were recorded.In-hospital and ICU mortalities were also observed.Results Of total 40 patients,29 were complicated with clinically defined septic ALI/ARDS ( ARDS n =15,and ALI n =14).The septic patients complicated with ALL/ARDS had significantly higher amount of EVLWI and higher levels of TNF-α and interleukin-1 in the BAL than patients without ALI/ARDS ( P ＜ 0.05).The arterial oxygen tension/fractional inspired oxygen ratio,lung injury score,and the levels of TNF-α,IL-1 in the BAL correlated with EVLWI.Moreover,in-hospital mortality,ICU mortality and the length of ICU stay of the patients with high amount of EVLWI were markedly increased than those of patients with low amount of EVLWI. Conclusions In septic patients complicated with ALI/ARDS, the extravascular lung water index correlates with oxygenation,lung injury severity and inflammatory cytokines in lung.Determination of EVLWI may be useful for evaluation of severity of lung injury and prognosis of septic patients.