CAJ | 학술논문

目的探讨急性呼吸窘迫综合征(ARDS)患者撤机后血管外肺水、容量指标、心排指标的变化及其对撤机结局的影响.方法 ARDS患者达到撤机条件后,序贯进行撤机、拔管,根据48 h内撤机结局分为撤机成功组和失败组.在脉搏指数连续心输出量监测(PiCCO)下,观察比较撤机前(T0)、撤机后1/2 h(T1)、拔管后1/2 h(T2)和观察终点(撤机成功组为撤机后48h,失败组为重新上机前；T3)两组的血管外肺水指数(EVLWI)、胸腔内血容量指数(ITBI)、全心舒张末容积指数(GEDI)和心排量(CO)、心指数(CI)的前后变化,比较组间不同时间点的上述各参数的变化.结果纳入2010年8月至2012年9月共69例ARDS病例.不同时间点自身前后比较:GEDI和ITBI在T1、T2上升,EVLWI在T1、T2、T3均上升,PVPI在T3出现升高(均P＜0.05).组间比较:在T1、T2、T3,失败组GEDI和ITBI均高于成功组(均P＜0.05),EVLWI在T2、T3显著高于成功组(均P＜0.05),PVPI在T3高于成功组(均P＜0.05).结论 ARDS患者呼吸机撤离、拔管等干预会带来额外容量负荷,并可能以渗透性血管外肺水增加的形式发生肺水肿,导致撤机失败；对EVLWI及容量指标的监测可能有助于对撤机结局的预测.
목적 탐토급성호흡군박종합정(ARDS)환자철궤후혈관외폐수、용량지표、심배지표적변화급기대철궤결국적영향.방법 ARDS환자체도철궤조건후,서관진행철궤、발관,근거48 h내철궤결국분위철궤성공조화실패조.재맥박지수련속심수출량감측(PiCCO)하,관찰비교철궤전(T0)、철궤후1/2 h(T1)、발관후1/2 h(T2)화관찰종점(철궤성공조위철궤후48h,실패조위중신상궤전；T3)량조적혈관외폐수지수(EVLWI)、흉강내혈용량지수(ITBI)、전심서장말용적지수(GEDI)화심배량(CO)、심지수(CI)적전후변화,비교조간불동시간점적상술각삼수적변화.결과 납입2010년8월지2012년9월공69례ARDS병례.불동시간점자신전후비교:GEDI화ITBI재T1、T2상승,EVLWI재T1、T2、T3균상승,PVPI재T3출현승고(균P＜0.05).조간비교:재T1、T2、T3,실패조GEDI화ITBI균고우성공조(균P＜0.05),EVLWI재T2、T3현저고우성공조(균P＜0.05),PVPI재T3고우성공조(균P＜0.05).결론 ARDS환자호흡궤철리、발관등간예회대래액외용량부하,병가능이삼투성혈관외폐수증가적형식발생폐수종,도치철궤실패；대EVLWI급용량지표적감측가능유조우대철궤결국적예측.
Objective To analyze and evaluate the variability and effects of extra-vascular lung water index (EVLWI),preload and cardiac function on weaning from mechanical ventilation in patients with ARDS.Methods All patients suffered from ARDS were treated with mechanical ventilation and monitored by pulse indicator continuous cardiac output (PiCCO) till they reached weaning criteria,then spontaneous breathing trial,weauing and extubation were performed in succession.The enrolled patients were divided into two groups,namely success group and failure group according to clinic outcome after weaning in 48 hours.EVLWI,preload markers such as global end-diastolic volume index (GEDI),intrathoracic blood volume index (ITBI),and cardiac function such as cardiac output and cardiac index were compared between two groups before weaning (T0),0.5 h after weaning (T1),0.5 h after extubation (T2),and observational endpoints (T3) (Observational eudpoint is defined as “ before re-intubation” in failure group or 48 h after extubation in succcss group).Results A total of 69 ARDS patients were enrolled from August 2010 to September 2012.Compared with variables before weaning,GEDI and ITBI were markedly higher observed at T1 and T2 (P ＜ 0.05).EVLWI was significantly increased at T1,T2 and T3 (P ＜ 0.01).Increased pulmonary vascular permeability index (PVPI) were also found at T3 (P ＜ 0.05).Compared with the success group,GEDI and ITBI in the failure group were higher at T1,T2 and T3 (P ＜0.05),and EVLWI were significant higher at T2 and T3 (P ＜ 0.05),and increased PVPI at 33 (P ＜0.05).Conclusions Additional volume load may result from weaning off mechanical ventilation and extubation in ARDS patients,and can induce high pulmonary vascular permeability causing pulmonary edema and weaning failure.Therefore,monitoring of EVLWI and preload markers could be valuable to predicting the prognosis of weaning from mechanical ventilation.