浙江中医药大学学报
浙江中醫藥大學學報
절강중의약대학학보
JOURNAL OF ZHEJIANG UNIVERSITY OF TRADITIONAL CHINESE MEDICINE
2014年
4期
436-438,439
,共4页
NPE%SHG%PiCCO%血管外肺水指数
NPE%SHG%PiCCO%血管外肺水指數
NPE%SHG%PiCCO%혈관외폐수지수
NPE%SHG%PiCCO%extra-vascular lung water index(EVLWI)
[目的]探讨不同血糖控制对神经源性肺水肿（neurogenic pulmonary edema,NPE）伴应激性高血糖(stress hyperglycemia,SHG)患者的脉搏指示连续心排血量（pulse indicator continuous cardiac output，PiCCO）监测主要指标的影响，评价血糖控制对NPE伴SHG患者肺水变化及预后的意义。[方法]采用前瞻性临床研究方法，对51例NPE伴SHG的危重患者，随机分为两组：研究组(26例)，以持续胰岛素静脉微泵输注治疗方案控制血糖于4.4～8.3 mmol·L-1；对照组(25例)，控制血糖于10.0～11.1mmol·L-1，两组其他常规治疗相同。观察两组患者治疗开始3d的CI、ITBVI、GEDVI、EVLWI、PVPI、CVP等PiCCO监测指标，血糖与ITBVI、GEDVI、EVLWI、CVP之间进行相关性分析；根据患者结局分为死亡组与存活组，比较两组的血糖、EVLWI及APACHE Ⅱ评分变化。[结果]研究组CI与氧合指数（PaO2/FiO2）高于对照组，差异具有统计学意义(均P<0．05)，ITBVI、EVLWI、PVPI均低于对照组，差异具有统计学意义(P<0．05，P<0．01，P<0．01)；血糖与EVLWI呈显著正相关（r=0．68，P<0．001），与PVPI、ITBVI呈显著正相关（r=0．64，P<0．001，r=0．52、P<0．05），而与GEDVI、CVP无显著相关性（r=0．17，P＞0．05，r=0．20，P＞0．05）；血糖与PaO2/FiO2呈显著负相关（r=-0．57、P<0．05）。死亡组血糖、EVLWI水平、APACHE Ⅱ评分均高于存活组，差异有统计学意义（均P<0．01）。[结论]良好的血糖控制能改善NPE伴SHG患者的PiCCO监测主要指标，减轻肺水，血糖控制水平与PaO2/FiO2负相关，可结合PiCCO监测主要指标更好地评估病情及预后。
[目的]探討不同血糖控製對神經源性肺水腫（neurogenic pulmonary edema,NPE）伴應激性高血糖(stress hyperglycemia,SHG)患者的脈搏指示連續心排血量（pulse indicator continuous cardiac output，PiCCO）鑑測主要指標的影響，評價血糖控製對NPE伴SHG患者肺水變化及預後的意義。[方法]採用前瞻性臨床研究方法，對51例NPE伴SHG的危重患者，隨機分為兩組：研究組(26例)，以持續胰島素靜脈微泵輸註治療方案控製血糖于4.4～8.3 mmol·L-1；對照組(25例)，控製血糖于10.0～11.1mmol·L-1，兩組其他常規治療相同。觀察兩組患者治療開始3d的CI、ITBVI、GEDVI、EVLWI、PVPI、CVP等PiCCO鑑測指標，血糖與ITBVI、GEDVI、EVLWI、CVP之間進行相關性分析；根據患者結跼分為死亡組與存活組，比較兩組的血糖、EVLWI及APACHE Ⅱ評分變化。[結果]研究組CI與氧閤指數（PaO2/FiO2）高于對照組，差異具有統計學意義(均P<0．05)，ITBVI、EVLWI、PVPI均低于對照組，差異具有統計學意義(P<0．05，P<0．01，P<0．01)；血糖與EVLWI呈顯著正相關（r=0．68，P<0．001），與PVPI、ITBVI呈顯著正相關（r=0．64，P<0．001，r=0．52、P<0．05），而與GEDVI、CVP無顯著相關性（r=0．17，P＞0．05，r=0．20，P＞0．05）；血糖與PaO2/FiO2呈顯著負相關（r=-0．57、P<0．05）。死亡組血糖、EVLWI水平、APACHE Ⅱ評分均高于存活組，差異有統計學意義（均P<0．01）。[結論]良好的血糖控製能改善NPE伴SHG患者的PiCCO鑑測主要指標，減輕肺水，血糖控製水平與PaO2/FiO2負相關，可結閤PiCCO鑑測主要指標更好地評估病情及預後。
[목적]탐토불동혈당공제대신경원성폐수종（neurogenic pulmonary edema,NPE）반응격성고혈당(stress hyperglycemia,SHG)환자적맥박지시련속심배혈량（pulse indicator continuous cardiac output，PiCCO）감측주요지표적영향，평개혈당공제대NPE반SHG환자폐수변화급예후적의의。[방법]채용전첨성림상연구방법，대51례NPE반SHG적위중환자，수궤분위량조：연구조(26례)，이지속이도소정맥미빙수주치료방안공제혈당우4.4～8.3 mmol·L-1；대조조(25례)，공제혈당우10.0～11.1mmol·L-1，량조기타상규치료상동。관찰량조환자치료개시3d적CI、ITBVI、GEDVI、EVLWI、PVPI、CVP등PiCCO감측지표，혈당여ITBVI、GEDVI、EVLWI、CVP지간진행상관성분석；근거환자결국분위사망조여존활조，비교량조적혈당、EVLWI급APACHE Ⅱ평분변화。[결과]연구조CI여양합지수（PaO2/FiO2）고우대조조，차이구유통계학의의(균P<0．05)，ITBVI、EVLWI、PVPI균저우대조조，차이구유통계학의의(P<0．05，P<0．01，P<0．01)；혈당여EVLWI정현저정상관（r=0．68，P<0．001），여PVPI、ITBVI정현저정상관（r=0．64，P<0．001，r=0．52、P<0．05），이여GEDVI、CVP무현저상관성（r=0．17，P＞0．05，r=0．20，P＞0．05）；혈당여PaO2/FiO2정현저부상관（r=-0．57、P<0．05）。사망조혈당、EVLWI수평、APACHE Ⅱ평분균고우존활조，차이유통계학의의（균P<0．01）。[결론]량호적혈당공제능개선NPE반SHG환자적PiCCO감측주요지표，감경폐수，혈당공제수평여PaO2/FiO2부상관，가결합PiCCO감측주요지표경호지평고병정급예후。
[Objective] To evaluate the effects of glucose-control level on monitoring indicators of PiCCO in NPE patients with SHG, and to assess the change of lung water and prognostic significance of glucose-control on these patients. [Methods] In this prospective study, 51 NPE patients with SHG were randomly divided into two groups: research group(n=26) and control group(n=25) .The blood glucose was control ed by insulin within 4.4-8.3 mmol/L in research group, and 10.0-11.1 mmol/L in control group. Other therapies were identical in two groups. Parameters of PiCCO such as CI, ITBVI,GEDVI, EVLWI,PVPI and CVP were observed in the first three treating days, The correlation between ITBVI,GEDVI,EVLWI,CVP and blood glucose was assessed; According to the outcome, these patients were divided into nonsurvivor group and survivor group. The change in blood glucose, EVLWI and APACHE Ⅱscore was compared between two groups.[Results] In research group, the CI,PaO2/FiO2 were significantly elevated, and ITBV, EVLWI, PVPI were significantly reduced compared with control group. Blood glucose was significantly and positively correlated with EVLWI(r=0 .68,P<0.001),PVPI(r=0.64,P<O.001) and ITBVI(r=0.52,but no significant correlation with GEDVI,CVP(r=0.17,r=0.20,).Blood glucose was significantly and negatively correlated with oxygenation index(PaO2/FiO2) (r=-0.57). Blood glucose level, EVLWI and APACHE Ⅱscore of nonsurvivor group were significantly higher than that of survivor. [Conclusions] Better glucose-control can improve monitoring indicators of PiCCO and reduce lung water in NPE patients with SHG. Blood glucose which negatively correlated with oxygenation index, combined with parameters of PiCCO, can be used to assess the prognosis of these patients.
