CAJ | 학술논문

目的探讨脉搏指示连续心排血量(PiCCO)监测在神经源性肺水肿(NPE)患者中的应用,评估容量参数胸腔内血容量指数(ITBVI)、全心舒张期末容量指数(GEDVI)及压力参数中心静脉压(CVP)对NPE严重程度评估的准确性,评价血管外肺水指数(EVLWI)对NPE患者预后判断的意义.方法采用前瞻性临床观察研究方法,对36例并发NPE的神经科危重患者,采用PiCCO监测平均动脉压(MAP)、心排血指数(CI)、CVP、ITBVI、GEDVI、EVLWI、肺血管通透性指数(PVPI)等指标,ITBVI、GEDVI、CVP与EVLWI之间进行相关性分析；根据患者结局分为死亡组与存活组,比较两组在治疗前及治疗3d的EVLWI变化.结果 EVLWI与ITBVI呈显著正相关(r=0.54,P＜0.001),与GEDVI呈显著正相关(r=0.62,P＜0.0001),而与CVP无显著相关性(r=0.12,P＞0.05)；PVPI、EVLWI与氧合指数(PaO2/FiO2)均呈显著负相关(r=-0.55、P＜0.001,r=-0.48、P＜ 0.05).存活组与死亡组治疗前EVLWI(ml/kg)水平差异无统计学意义(8.6±2.6比9.4±1.8,P＞0.05)；存活组治疗3d后EVLWI水平明显低于治疗前(6.92±1.64比8.64±2.62,P＜0.05),且明显低于死亡组治疗3d后(6.92±1.64比9.88±2.44,P＜0.05).结论容量参数GEDVI、ITBVI比压力参数CVP评估NPE患者的EVLWI更为准确、可靠；NPE患者PVPI、EVLWI越高,PaO2/FiO2越低；动态观察NPE患者的EVLWI可评估预后.
목적 탐토맥박지시련속심배혈량(PiCCO)감측재신경원성폐수종(NPE)환자중적응용,평고용량삼수흉강내혈용량지수(ITBVI)、전심서장기말용량지수(GEDVI)급압력삼수중심정맥압(CVP)대NPE엄중정도평고적준학성,평개혈관외폐수지수(EVLWI)대NPE환자예후판단적의의.방법 채용전첨성림상관찰연구방법,대36례병발NPE적신경과위중환자,채용PiCCO감측평균동맥압(MAP)、심배혈지수(CI)、CVP、ITBVI、GEDVI、EVLWI、폐혈관통투성지수(PVPI)등지표,ITBVI、GEDVI、CVP여EVLWI지간진행상관성분석；근거환자결국분위사망조여존활조,비교량조재치료전급치료3d적EVLWI변화.결과 EVLWI여ITBVI정현저정상관(r=0.54,P＜0.001),여GEDVI정현저정상관(r=0.62,P＜0.0001),이여CVP무현저상관성(r=0.12,P＞0.05)；PVPI、EVLWI여양합지수(PaO2/FiO2)균정현저부상관(r=-0.55、P＜0.001,r=-0.48、P＜ 0.05).존활조여사망조치료전EVLWI(ml/kg)수평차이무통계학의의(8.6±2.6비9.4±1.8,P＞0.05)；존활조치료3d후EVLWI수평명현저우치료전(6.92±1.64비8.64±2.62,P＜0.05),차명현저우사망조치료3d후(6.92±1.64비9.88±2.44,P＜0.05).결론 용량삼수GEDVI、ITBVI비압력삼수CVP평고NPE환자적EVLWI경위준학、가고；NPE환자PVPI、EVLWI월고,PaO2/FiO2월저；동태관찰NPE환자적EVLWI가평고예후.
Objective To evaluate the application of pulse induced contour cardiac output (PiCCO)monitoring in patients with neurogenic pulmonary edema (NPE),and to assess the accuracy of capacity parameters such as intra thoracic blood volume index (ITBVI) and global end diastolic volune index (GEDVI) and pressure parameters such as central venous pressure (CVP) in estimating severity of NPE,and to assess the prognostic significance of extravascular lung water index (EVLWI) on patients with NPE.Methods In this prospective study,36 patients with NPE in the department of neurological intensive care unit (NICU) underwent PiCCO monitoring,including mean arterial pressure (MAP),cardiac index (CI),CVP,ITBVI,GEDVI,EVLWI,pulmonary vascular permeability index (PVPI).The correlation between ITBVI,GEDVI,CVP and EVLWI was assessed.According to the outcome,these patients were divided into nonsurvivor group and survivor group.The change in EVLWI before and after treatment was compared between two groups.Results ITBVI,GEDVI were significantly and positively correlated with EVLWI,for the former r =0.54,P＜0.001,and for the latter r=0.62,P＜0.0001,but there was no significant correlation between CVP and EVLWI,r=0.12,P＞0.05.PVPI,EVLWI were significantly and negatively correlated with oxygenation index (PaO2 / FiO2),for the former r=-0.55,P＜ 0.001,and for the latter r=-0.48,P＜0.05.The difference in EVLWI (ml/kg) level before treatment between survivor group and nonsurvivor group was not statistically significant (8.6 ± 2.6 vs.9.4 ± 1.8,P＞0.05).In survivor group,EVLW1 level obviously declined after treatment (6.92 ± 1.64 vs.8.64 ± 2.62,P＜0.05),EVLWI level of survivor group was significantly lower than that of nonsurvivor group (6.92 ± 1.64 vs.9.88 ± 2.44,P＜0.05).Conclusions Capacity parameters such as GEDVI,ITBVI can assess EVLWI of NPE patients accurately and reliably.In NPE patients,the higher the PVPI and EVLWI,the lower the PaO2 / FiO2.By dynamic observation of the trends of EVLWI in NPE patients,we are able to assess the prognosis of these patients.