中国医师进修杂志
中國醫師進脩雜誌
중국의사진수잡지
CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
2012年
14期
5-8
,共4页
彭民%宋世辉%周文%张鹏
彭民%宋世輝%週文%張鵬
팽민%송세휘%주문%장붕
血管外肺水%心排血量%肺挫伤%液体管理
血管外肺水%心排血量%肺挫傷%液體管理
혈관외폐수%심배혈량%폐좌상%액체관리
Extravascular lung water%Cardiac output%Pulmonary contusion%Fluid management
目的 通过对肺挫伤患者血管外肺水指数(EVLWI)的监测,对患者监护中的临床指标进行评价,指导液体管理.方法 选取31例严重胸部损伤致肺挫伤患者,分别行中心静脉置管及股动脉置管,连接血流动力学监测仪,运用热稀释法测量肺挫伤后EVLWI,详细记录液体出入量,控制液体量,并应用利尿剂,评价氧合指数、EVLWI和液体平衡差值在不同时间的变化及其相关性.结果 肺挫伤后EVLWI在入院后第1～7天分别为(9.25±0.71)、( 8.98±0.61)、(8.61±0.59)、(7.75±0.53)、(6.64±0.49)、(6.22±0.36)、( 5.59±0.39) ml/kg,入院后第3天开始EVLWI与入院后第1天比较差异有统计学意义(P＜0.05)；氧合指数在入院后第1～7天分别为(145.76±23.61)、(144.19±20.24)、( 146.67±19.25)、( 159.33±15.42)、(177.38±14.25)、( 199.33±19.04)、(213.71±18.51) mm Hg(1 mm Hg=0.133 kPa),入院后第4天开始氧合指数与入院后第1天比较差异有统计学意义(P＜0.05)；入院后第1～7天液体均为负平衡,入院后第3～6天液体平衡差值与入院后第1天比较差异有统计学意义[( -431.43±121.17)、(-601.43±127.09)、(-629.52±140.69)、(-320.01±93.71) ml比(-213.81±63.91) ml](P＜ 0.05).氧合指数与EVLWI呈负相关(r=-0.824,P＜0.01).液体平衡差值与EVLWI和氧合指数无相关性.结论 肺挫伤后EVLWI的有效监测,不仅可用于评价肺挫伤后不同时期肺部血管通透性变化,而且在指导肺挫伤后液体管理方面有重要意义.
目的 通過對肺挫傷患者血管外肺水指數(EVLWI)的鑑測,對患者鑑護中的臨床指標進行評價,指導液體管理.方法 選取31例嚴重胸部損傷緻肺挫傷患者,分彆行中心靜脈置管及股動脈置管,連接血流動力學鑑測儀,運用熱稀釋法測量肺挫傷後EVLWI,詳細記錄液體齣入量,控製液體量,併應用利尿劑,評價氧閤指數、EVLWI和液體平衡差值在不同時間的變化及其相關性.結果 肺挫傷後EVLWI在入院後第1～7天分彆為(9.25±0.71)、( 8.98±0.61)、(8.61±0.59)、(7.75±0.53)、(6.64±0.49)、(6.22±0.36)、( 5.59±0.39) ml/kg,入院後第3天開始EVLWI與入院後第1天比較差異有統計學意義(P＜0.05)；氧閤指數在入院後第1～7天分彆為(145.76±23.61)、(144.19±20.24)、( 146.67±19.25)、( 159.33±15.42)、(177.38±14.25)、( 199.33±19.04)、(213.71±18.51) mm Hg(1 mm Hg=0.133 kPa),入院後第4天開始氧閤指數與入院後第1天比較差異有統計學意義(P＜0.05)；入院後第1～7天液體均為負平衡,入院後第3～6天液體平衡差值與入院後第1天比較差異有統計學意義[( -431.43±121.17)、(-601.43±127.09)、(-629.52±140.69)、(-320.01±93.71) ml比(-213.81±63.91) ml](P＜ 0.05).氧閤指數與EVLWI呈負相關(r=-0.824,P＜0.01).液體平衡差值與EVLWI和氧閤指數無相關性.結論 肺挫傷後EVLWI的有效鑑測,不僅可用于評價肺挫傷後不同時期肺部血管通透性變化,而且在指導肺挫傷後液體管理方麵有重要意義.
목적 통과대폐좌상환자혈관외폐수지수(EVLWI)적감측,대환자감호중적림상지표진행평개,지도액체관리.방법 선취31례엄중흉부손상치폐좌상환자,분별행중심정맥치관급고동맥치관,련접혈류동역학감측의,운용열희석법측량폐좌상후EVLWI,상세기록액체출입량,공제액체량,병응용이뇨제,평개양합지수、EVLWI화액체평형차치재불동시간적변화급기상관성.결과 폐좌상후EVLWI재입원후제1～7천분별위(9.25±0.71)、( 8.98±0.61)、(8.61±0.59)、(7.75±0.53)、(6.64±0.49)、(6.22±0.36)、( 5.59±0.39) ml/kg,입원후제3천개시EVLWI여입원후제1천비교차이유통계학의의(P＜0.05)；양합지수재입원후제1～7천분별위(145.76±23.61)、(144.19±20.24)、( 146.67±19.25)、( 159.33±15.42)、(177.38±14.25)、( 199.33±19.04)、(213.71±18.51) mm Hg(1 mm Hg=0.133 kPa),입원후제4천개시양합지수여입원후제1천비교차이유통계학의의(P＜0.05)；입원후제1～7천액체균위부평형,입원후제3～6천액체평형차치여입원후제1천비교차이유통계학의의[( -431.43±121.17)、(-601.43±127.09)、(-629.52±140.69)、(-320.01±93.71) ml비(-213.81±63.91) ml](P＜ 0.05).양합지수여EVLWI정부상관(r=-0.824,P＜0.01).액체평형차치여EVLWI화양합지수무상관성.결론 폐좌상후EVLWI적유효감측,불부가용우평개폐좌상후불동시기폐부혈관통투성변화,이차재지도폐좌상후액체관리방면유중요의의.
Objective To guide fluid management and evaluate the clinical index through monitoring extravascular lung water index(EVLWI) of patients with pulmonary contusion.Methods Thirtyone severe chest trauma patients with pulmonary contusion were selected,performed with central venous catheterization or femoral artery catheterization,and connected to pulse index continuous cardiac output (PICCO).EVLWI after pulmonary contusion were measured by using thermal dilution.The intake and output of patients were recorded in detail,fluid intake was controlled,furosemide was prescribed,and the changes and correlations of oxygenation index,EVLWI and liquid balance difference at different time points were evaluated.Results EVLWI after pulmonary contusion at 1st to 7th d after hospitalization was respectively (9.25 ±0.71),(8.98 ±0.61),(8.61 ±0.59),(7.75±0.53),(6.64 ±0.49),(6.22±0.36),(5.59 ±0.39) ml/kg.Comparing with 1st d after hospitalization,EVLWI declined from 3rd d (P ＜ 0.05).Oxygenation index at Ist to 7th d after hospitallzation was respectively( 145.76±23.61 ),( 144.19±20.24),( 146.67±19.25 ),(159.33±15.42),(177.38±14.25),(199.33±19.04),(213.71±18.51) mm Hg(1 mm Hg =0.133 kPa).Comparing with 1st d,oxygenation index from 4th to 7th d had significant difference (P ＜ 0.05 ).The fluid volume at 1st d to 7th d were all negative balance,that of 3rd d to 6th d had significant difference comparing with 1st d [(-431.43±121.17),(-601.43±127.09),(-629.52±140.69),(-320.01 ±93.71) ml vs.(-213.81±63.91 ) ml](P ＜ 0.05 ).Oxygenation index and EVLWI had negative correlation(r =-0.824,P＜0.01).Liquid balance difference and the changes of oxygenation index and EVLWI had no correlation.Conclusion EVLWI effectively monitoring after pulmonary contusion can not only evaluate the changes of pulmonary vascular permeability of patients with pulmonary contusion,but also have important significance to guide fluid management.
