CAJ | 학술논문

目的比较血管外肺水指数(EVLWI)与氧合指数(PaO2/FiO2)评估急性肺损伤(ALI)程度的准确性.方法创伤后(创伤时间＜48 h)ALI行机械通气患者16例,性别不限,年龄18～80岁,采用PiCCO监测仪监测EVLWI,建立PiCCO监测后每隔24 h采集动脉血样,测定PaO2,计算PaO2/FiO2;同时记录EVLWI,并进行肺损伤评分(LIS).分别在建立HCCO监测后24、48、72 h时按PaO2/FiO2将患者分为PaO2/FiO2≤300组(200 mm Hg＜PaO2/FiO2≤300 mm Hg)和PaO2/FiO2≤200组(PaO2/FiO2≤200 mm Hg),按EVLWI将患者分为EVLWI＜10组(EVLWI＜10 ml/kg)和EVLWI≥10组(EVLWI≥10 ml/kg).结果与PaO2/FiO2≤300组比较,PaO2/FiO2≤200组建立PiCCO监测后24、48 h时LIS评分差异无统计学意义(P＞0.05),建立PiCCO监测后72 h时LIS评分升高(P＜0.01).与EVLWI＜10组比较,EVLWI≥10组各时点LIS评分均升高(P＜0.05或0.01).结论临床中PaO2/FiO2作为评估ALI程度的指标存在局限性,而EVLWI在评估ALI程度方面可能比PaO2/FiO2更准确.
목적 비교혈관외폐수지수(EVLWI)여양합지수(PaO2/FiO2)평고급성폐손상(ALI)정도적준학성.방법 창상후(창상시간＜48 h)ALI행궤계통기환자16례,성별불한,년령18～80세,채용PiCCO감측의감측EVLWI,건립PiCCO감측후매격24 h채집동맥혈양,측정PaO2,계산PaO2/FiO2;동시기록EVLWI,병진행폐손상평분(LIS).분별재건립HCCO감측후24、48、72 h시안PaO2/FiO2장환자분위PaO2/FiO2≤300조(200 mm Hg＜PaO2/FiO2≤300 mm Hg)화PaO2/FiO2≤200조(PaO2/FiO2≤200 mm Hg),안EVLWI장환자분위EVLWI＜10조(EVLWI＜10 ml/kg)화EVLWI≥10조(EVLWI≥10 ml/kg).결과 여PaO2/FiO2≤300조비교,PaO2/FiO2≤200조건립PiCCO감측후24、48 h시LIS평분차이무통계학의의(P＞0.05),건립PiCCO감측후72 h시LIS평분승고(P＜0.01).여EVLWI＜10조비교,EVLWI≥10조각시점LIS평분균승고(P＜0.05혹0.01).결론 림상중PaO2/FiO2작위평고ALI정도적지표존재국한성,이EVLWI재평고ALI정도방면가능비PaO2/FiO2경준학.
Objective To compare extravascular lung water index (EVLWI) and oxygenation index (PaO2/FiO2) in estimation of acute lung injury(ALI) .Methods Sixteen patients with post traumatic ALI (within 48 h) of both sexes, aged 18-80 yr, were studied. The patients were mechanically ventilated. Right internal jugular vein and femoral artery were catheterized and connected to PiCCO monitor (IntelliVue MP50, Philips, Netherlands).EVLWI was monitored with the PiCCO system. PaO2 was determined every 24 h. ALI was diagnosed based on the following criteria:(1)PaO2/FiO2≤300 mm Hg; (2)X-ray chest film-patchy shadows in the bilateral lungs and (3) CVP≤12 mm Hg.Lung injury score(LIS) was recorded. The patients were divided into PaO2/FiO2≤ 300 group and ≤200 group and EVLWI ≥ 10 group and ＜ 10 group. Results There was no significant difference in LIS between PaO2/FiO2 ≤300 group and PaO2/FiO2 ≤200 group at 24 and 48 h of PiCCO monitoring. At 72 h of PiCCO monitoring LIS was significantly increased in PaO2/FiO2 ≤200 group as compared with PaO2/FiO2 ≤300 group, LIS was significantly higher in EVLWI≥ 10 group than in EVLWI ＜ 10 group at 24, 48 and 72 h of PiCCO monitoring. Conclusion EVLWI is more accurate than PaO2 /FiO2 in estimation of severity of ALI.