CAJ | 학술논문

目的分析人感染H7N9禽流感并发急性呼吸窘迫综合征(ARDS)患者血管外肺水指数(EVLWI)的变化特点,探讨EVLWI与患者肺损伤严重程度、肺氧合功能的关系.方法南昌大学第一附属医院2013年4月至6月收治4例人感染H7N9禽流感患者,其中并发重度ARDS患者实施小潮气量联合呼气末正压(PEEP)的保护性通气策略,并采用脉搏指示连续心排血量(PiCCO)技术监测血流动力学参数和EVLWI.机械通气期间采集患者PEEP、吸入氧浓度(FiO2)、动脉血氧分压(PaO2)、氧合指数(PaO2/FiO2)、心排血指数(CI)、外周血管阻力指数(SVRI)、肺血管阻力指数(PVRI)、EVLWI、中心静脉压(CVP).结果 4例H7N9禽流感患者入院时均并发ARDS,其中2例并发重度ARDS患者实施保护性机械通气为主的综合治疗,这2例患者机械通气时间分别为9d与30 d,分别实施PiCCO监测9d和21 d；机械通气开始后1、2、3 d EVLWI(ml/kg)分别为10.0±3.2、12.0±2.9、14.0±4.2和24.0±6.7、24.0±6.1、23.0±5.8,随着病情好转,EVLWI逐渐下降,撤离机械通气时分别降至5.5±2.7和7.0±3.0;PEEP、FiO2逐渐下凋,PaO2/FiO2逐渐上升,撤离机械通气时PaO2/FiO2(mm Hg,l mm Hg=0.133 kPa)分别升高至334±64和142±53；CI、SVRI、PVRI、CVP则无显著变化.结论人感染H7N9禽流感患者并发重度ARDS时EVLWI明显增加；随着患者病情逐渐好转,EVLWI逐渐恢复正常.EVLWI动态变化与ARDS严重程度、肺氧合功能存在相关性.
목적 분석인감염H7N9금류감병발급성호흡군박종합정(ARDS)환자혈관외폐수지수(EVLWI)적변화특점,탐토EVLWI여환자폐손상엄중정도、폐양합공능적관계.방법 남창대학제일부속의원2013년4월지6월수치4례인감염H7N9금류감환자,기중병발중도ARDS환자실시소조기량연합호기말정압(PEEP)적보호성통기책략,병채용맥박지시련속심배혈량(PiCCO)기술감측혈류동역학삼수화EVLWI.궤계통기기간채집환자PEEP、흡입양농도(FiO2)、동맥혈양분압(PaO2)、양합지수(PaO2/FiO2)、심배혈지수(CI)、외주혈관조력지수(SVRI)、폐혈관조력지수(PVRI)、EVLWI、중심정맥압(CVP).결과 4례H7N9금류감환자입원시균병발ARDS,기중2례병발중도ARDS환자실시보호성궤계통기위주적종합치료,저2례환자궤계통기시간분별위9d여30 d,분별실시PiCCO감측9d화21 d；궤계통기개시후1、2、3 d EVLWI(ml/kg)분별위10.0±3.2、12.0±2.9、14.0±4.2화24.0±6.7、24.0±6.1、23.0±5.8,수착병정호전,EVLWI축점하강,철리궤계통기시분별강지5.5±2.7화7.0±3.0;PEEP、FiO2축점하조,PaO2/FiO2축점상승,철리궤계통기시PaO2/FiO2(mm Hg,l mm Hg=0.133 kPa)분별승고지334±64화142±53；CI、SVRI、PVRI、CVP칙무현저변화.결론 인감염H7N9금류감환자병발중도ARDS시EVLWI명현증가；수착환자병정축점호전,EVLWI축점회복정상.EVLWI동태변화여ARDS엄중정도、폐양합공능존재상관성.
Objective To analyze the characteristic of changes in extravascular lung water index (EVLWI) of H7N9 avian influenza patients who complicated with acute respiratory distress syndrome (ARDS),and to approach the relevance between EVLWI and severity,pulmonary oxygenation in patients with lung injury.Methods Four H7N9 avian influenza patients administered from April to June in 2013 in First Affiliated Hospital of Nanchang University were studied.The patients who suffered from severe ARDS were administered with low tide volume ventilation plus positive end-expiratory pressure (PEEP),namely protected ventilation strategy,with monitoring hemodynamic parameters and EVLWI through pulse-indicated continuous cardiac output (PiCCO) catheter.During ventilation,patients' parameters,such as PEEP,fraction of inspired oxygen (FiO2),arterial partial pressure of oxygen (PaO2),oxygenation index (PaO2/FiO2),cardiac index (CI),systemic vascular resistance index (SVRI),pulmonary vascular resistance index (PVRI),EVLWI,and central venous pressure (CVP) were collected.Results All 4 H7N9 avian influenza patients were complicated with ARDS,2 patients were classified to severe ARDS and administered with comprehensive therapies,specially protected ventilation strategy; ventilation duration was 9 days and 30 days respectively,and PiCCO monitoring was 9 days and 21 days respectively.EVLWI (ml/kg) of 2 patients on the 1 st,2nd,3rd day was 10.0 ± 3.2,12.0 ± 2.9,14.0 ±4.2,and 24.0 ± 6.7,24.0 ± 6.1,23.0 ± 5.8,respectively.As their conditions became better,patients' EVLWI decreased to 5.5 ± 2.7 and 7.0 ± 3.0,respectively at weaning.PEEP and FiO2 of 2 patients were down-regulated,PaO2/FiO2 (mm Hg,1 mm Hg=0.133 kPa) increased to 334 ±64 and 142 ±53 at weaning.However,no significant changes in CI,SVRI,PVRI and CVP in the 2 patients were observed.Conclusions EVLWI increases when H7N9 avian influenza patients are complicated with severe ARDS.As the conditions get better,EVLWI returns to normal value gradually.There is relevance between the motive changes in EVLWI and severity of ARDS and pulmonary oxygenation.