CAJ | 학술논문

目的通过观察慢性阻塞性肺疾病(COPD)急性加重期合并呼吸衰竭患者血管外肺水指数(ELWI)与氧合指数和胸腔内血容量指数(ITBI)的相关性,探讨脉搏指示下连续心输出量(PiCCO)在COPD急性加重期合并呼吸衰竭患者液体管理中的指导意义. 方法选择2010年10月至2013年9月符合COPD急性发作合并呼吸衰竭的患者71例,应用PiCCO技术监测患者ELWI和ITBI,比较ELWI与氧合指数和ITBI与ELWI之间的相关性. 结果 ELWI与氧合指数呈明显负相关(r=-0.743,P＜0.01).进一步以ELWI=14 ml/kg进行分层分析,当ELWI＜14 ml/kg时,两者仍呈负相关(r=-0.533,P=0.080),但差异无统计学意义;当ELWI≥14 ml/kg时,两者呈明显负相关(r=-0.961,P＜0.01).ELWI与ITBI无明显相关性(r=0.477,P=0.072).进一步以ITBI=1 000 ml/m2进行分层分析,当ITBI＜1 000 ml/m2时,两者无明显相关性(r=0.338,P=0.116);当ITBI≥1 000 ml/m2时,两者呈明显正相关(r=0.677,P＜0.01). 结论对于COPD急性发作合并呼吸衰竭的患者,当ELWI≥14 ml/kg时,ELWI也成为影响氧合的重要因素,因此可以通过降低ELWI来改善氧合,当ITBI≥1000 ml/m2时,可以通过降低ITBI来降低ELWI.
목적 통과관찰만성조새성폐질병(COPD)급성가중기합병호흡쇠갈환자혈관외폐수지수(ELWI)여양합지수화흉강내혈용량지수(ITBI)적상관성,탐토맥박지시하련속심수출량(PiCCO)재COPD급성가중기합병호흡쇠갈환자액체관리중적지도의의. 방법 선택2010년10월지2013년9월부합COPD급성발작합병호흡쇠갈적환자71례,응용PiCCO기술감측환자ELWI화ITBI,비교ELWI여양합지수화ITBI여ELWI지간적상관성. 결과 ELWI여양합지수정명현부상관(r=-0.743,P＜0.01).진일보이ELWI=14 ml/kg진행분층분석,당ELWI＜14 ml/kg시,량자잉정부상관(r=-0.533,P=0.080),단차이무통계학의의;당ELWI≥14 ml/kg시,량자정명현부상관(r=-0.961,P＜0.01).ELWI여ITBI무명현상관성(r=0.477,P=0.072).진일보이ITBI=1 000 ml/m2진행분층분석,당ITBI＜1 000 ml/m2시,량자무명현상관성(r=0.338,P=0.116);당ITBI≥1 000 ml/m2시,량자정명현정상관(r=0.677,P＜0.01). 결론 대우COPD급성발작합병호흡쇠갈적환자,당ELWI≥14 ml/kg시,ELWI야성위영향양합적중요인소,인차가이통과강저ELWI래개선양합,당ITBI≥1000 ml/m2시,가이통과강저ITBI래강저ELWI.
Objective To investigate the clinical effects of the pulse indicator continuous cardiac output (PiCCO) in goal-optimized fluid management on patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) with respiratory failure.Methods A total of 71 AECOPD patients with respiratory failure who were hospitalized in department of Critical Care Medicine in our hospital were selected from October 2010 to September 2013.The PiCCOtechnology was applied to monitor intrathoracic blood volume index (ITBI) and extravascular lung water index (ELWI).We compared the relationship of ELWI with ITBI and oxygenation index,and a simple correlation analysis was used for statistical analysis.Results A significantly negative correlation was found between ELWl and oxygenation index (r=-0.743,P＜0.01).ELWI =14 ml/kg was defined as the cutoff value for the subgroup analysis.A negative correlation still was found between ELWI and oxygenation index in the subgroup with ELWI ＜ 14 ml/kg,but it had no significant difference (r=-0.533,P=0.080),while a significantly negative correlation was found in the subgroup with ELWI≥14 ml/kg (r=-0.961,P＜0.01).There was no significant correlation between ELWI and ITBI (r=0.477,P=0.072).ITBI=1 000 ml/m2 was defined as the cutoff value for the subgroup analysis.There is no significant correlation between ELWI and ITBI in the subgroup with ITBI＜1 000 ml/m2(r=0.338,P=0.116),but in the subgroup with ITBI≥1 000 ml/m2,a significantly positive correlation between ELWI and ITBI was found (r=0.677,P＜ 0.01).Conclusions The results suggest that when ELWI is higher than 14 ml/kg,ELWI becomes an important influencing factor for oxygenation,which can be decreased to improve oxygenation in patients with AECOPD,and when ITBI≥ 1 000 ml/m2,ITBI can be reduced by decreasing ELWI.PiCCO has an important clinical significance on a goal-optimized fluid management in AECOPD patients with respiratory failure.