CAJ | 학술논문

目的研究容量负荷试验对急性呼吸窘迫综合征(ARDS)患者氧合和氧输送的影响,明确其在指导 ARDS 治疗液体管理中的作用.方法将11例 ARDS 患者纳入研究,脉搏指示持续心输出量(PiCCO)进行动态血流动力学监测,记录基础心输出量指数(CI)、血管外肺水指数(ELWI)、氧合指数(PaO2/FiO2)、氧输送指数(DO2I)等数据后进行容量负荷试验:6%羟乙基淀粉250ml 在30min 内匀速静脉输注,若心输出量增加(△CI)<15%(无反应),则结束试验;若△CI≥15%(有反应),则再进行一次容量负荷试验,每次容量负荷试验后均收集上述数据.共进行19例次试验,按△CI 分为有反应例次和无反应例次,分析各变量的变化.结果有反应例次给予容量负荷后 CI 明显增加(P<0.05),而 PaO2/FiO2,ELWI 无明显改变;无反应例次给予容量负荷后血流动力学状态有所恶化,表现为 CI 减少(P<0.05)、中心静脉压(CVP)升高(P<0.05)、DO2I 明显减少(P<0.05).结论容量负荷试验在 ARDS 患者的液体管理中有重要意义,有反应者可增加心输出量而不恶化肺氧合功能,无反应者则应限制补液,以免对心脏输出和肺氧合功能产生不利影响.
목적연구용량부하시험대급성호흡군박종합정(ARDS)환자양합화양수송적영향,명학기재지도 ARDS 치료액체관리중적작용.방법장11례 ARDS 환자납입연구,맥박지시지속심수출량(PiCCO)진행동태혈류동역학감측,기록기출심수출량지수(CI)、혈관외폐수지수(ELWI)、양합지수(PaO2/FiO2)、양수송지수(DO2I)등수거후진행용량부하시험:6%간을기정분250ml 재30min 내균속정맥수주,약심수출량증가(△CI)<15%(무반응),칙결속시험;약△CI≥15%(유반응),칙재진행일차용량부하시험,매차용량부하시험후균수집상술수거.공진행19례차시험,안△CI 분위유반응례차화무반응례차,분석각변량적변화.결과유반응례차급여용량부하후 CI 명현증가(P<0.05),이 PaO2/FiO2,ELWI 무명현개변;무반응례차급여용량부하후혈류동역학상태유소악화,표현위 CI 감소(P<0.05)、중심정맥압(CVP)승고(P<0.05)、DO2I 명현감소(P<0.05).결론용량부하시험재 ARDS 환자적액체관리중유중요의의,유반응자가증가심수출량이불악화폐양합공능,무반응자칙응한제보액,이면대심장수출화폐양합공능산생불리영향.
[ ] Objective To evaluate the clinical applicability of fluid chal enge in guiding fluid management for patients with acute respiratory distress syndrome (ARDS). Methods Eleven ARDS patients were enrol ed. Cardiac output index(CI), extravascular lung water index (ELWI) were obtained from a PiCCO plus monitor. The whole set of hemodynamic measure-ments was performed before and after fluid chal enge with 250 mL hydroxyethyl starch. Fluid chal enge was given again if the increased cardiac output ≥15% (responder). Results The CI increased significantly after fluid chal enge (4.5±0.3、5.3± 0.2, P<0.05) without deteriorating oxygenation and oxygen delivery index (DO2I) in responders, While hemodynamics were deteriorated with decreased CI (4.6±0.4、4.3±0.4, P<0.05) and DO2I (463±31、416±35, P<0.05) after fluid chal enge in nonresponders. Conclusion Fluid chal enge may be of value in guiding fluid management for acute respiratory distress syn-drome patients. Fluid should be restricted in nonresponders to avoid decreasing in cardiac output and oxygenation.