CAJ | 학술논문

目的探讨影响毛细血管渗漏综合征(CLS)患者预后的相关因素.方法对安徽省立医院重症医学科收治的191例出现CLS患者的临床资料进行回顾性分析,按疾病转归将患者分为3组:死亡组37例,治愈组132例,未愈组22例.将治愈组和死亡组患者在入院时、出现CLS时和出院前的各项临床资料进行比较,探寻影响患者预后的相关因素.结果与治愈组比较,死亡组患者的中心静脉压、血清白蛋白明显降低(P＜0.01),阴离子间隙、甘油三酯、压力调整心率、氧合指数也较低(P＜0.01或P＜0.05),血糖、全身性炎症反应综合征评分明显增高(P＜0.01)；入院时出现肾损伤的患者较多(P＜0.01).在治疗方面,治愈组应用羟乙基淀粉氯化钠注射液、乌司他丁、连续性血液净化治疗者较多(P＜0.05).结论发生CLS患者有效循环血量不足、严重低蛋白血症、内环境紊乱、营养状态较差、氧合指数低、肾损伤和全身炎症反应较重者,预后不良；应用羟乙基淀粉氯化钠注射液、乌司他丁、血液净化治疗,可能有助于改善CLS患者的预后.
목적 탐토영향모세혈관삼루종합정(CLS)환자예후적상관인소.방법 대안휘성립의원중증의학과수치적191례출현CLS환자적림상자료진행회고성분석,안질병전귀장환자분위3조:사망조37례,치유조132례,미유조22례.장치유조화사망조환자재입원시、출현CLS시화출원전적각항림상자료진행비교,탐심영향환자예후적상관인소.결과 여치유조비교,사망조환자적중심정맥압、혈청백단백명현강저(P＜0.01),음리자간극、감유삼지、압력조정심솔、양합지수야교저(P＜0.01혹P＜0.05),혈당、전신성염증반응종합정평분명현증고(P＜0.01)；입원시출현신손상적환자교다(P＜0.01).재치료방면,치유조응용간을기정분록화납주사액、오사타정、련속성혈액정화치료자교다(P＜0.05).결론 발생CLS환자유효순배혈량불족、엄중저단백혈증、내배경문란、영양상태교차、양합지수저、신손상화전신염증반응교중자,예후불량；응용간을기정분록화납주사액、오사타정、혈액정화치료,가능유조우개선CLS환자적예후.
Objective To discuss influence factors on prognosis of the patients with capillary leak syndrome (CLS) in ICU.Methods The clinical data of 191 patients with CLS in ICU were reviewed,and the patients were divided into three groups according to prognosis:death group ( n =37),cured group ( n =132) and non-healed group (n =22).The clinical data of death group were compared with those of cured group at admission,during the course of CLS and before discharging from hospital.Results Compared with the cured group,the central venous pressure and serum albumin decreased ( P ＜ 0.01 ) ; anion gap,triglycerides,pressure adjusted heart rate (PAHR) and oxygenation index were lower ( P ＜ 0.01 or P ＜ 0.05) ; serum glucose and SIRS score increased ( P ＜ 0.01 ) in death group.There was higher rate of poor renal function at admission in death group than that in other groups ( P ＜ 0.01 ).There were more many patients treated with intravenous administration of hydroxyethyl starch,ulinastatin and continuous blood filtration therapy in cured group than those in other groups ( P ＜ 0.05).Conclusions The factors influencing the outcomes of the patients with CLS were hypovolemia,severe hypoproteinemia,interior milieu disorder,malnutrition,hypoxemia,renal injury and severe systemic inflammatory response.The outcomes of patients with CLS in ICU could be improved by using hydroxyethyl starch,ulinastatin and continuous blood filtration therapy.