不同病因肺水肿患者血管外肺水指数的差异研究

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摘要目的研究不同病因肺水肿患者血管外肺水指数（EVLWI）的差异。方法选取2014年1月～2015年6月我院重症医学科收治的典型肺水肿患者75例，按不同病因将其分为两组，急性心源性肺水肿组（ACPE组）44例，急性呼吸窘迫综合征组（ARDS组）31例。分析两组患者EVLWI差异及EVLWI与预后的关系。结果ACPE组MAP、HR、CI、EVLWI、PVPI显著低于ARDS组，且ACPE组CVP、OI显著高于ARDS组（P＜0.05）；两组MAP、CVP、OI、CI及PVPI的OR值均＞1；且在ACPE组中，PVPI的OR值最高为4.33，在ARDS组中，PVPI的OR值最高为4.21，PVPI对两组EVLWI的危险性更高；ACPE组死亡率为6.82%，显著低于ARDS组的25.81%（P＜0.05）；两组死亡与存活在0、24、72 h时的EVLWI值均高于正常值，且ACPE组死亡与存活在0、24 h时的EVLWI值均显著低于ARDS组，在72 h时的EVLWI值显著高于ARDS组（P＜0.05）；动态监测ACPE组存活EVLWI有降低趋势，死亡EVLWI有升高趋势，动态监测ARDS组存活与死亡EVLWI均有降低趋势。结论EVLWI的影响因素包括MAP、CVP、OI、CI及PVPI等，ACPE及ARDS患者EVLWI存在显著差异，不同病因肺水肿患者死亡率也存在差异，因此临床上通过检测患者EVLWI水平确定不同肺水肿病因，并对预测预后及对患者实施针对性治疗有重要意义。

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	吴寿坤
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关键词 ：急性心源性肺水肿, 急性呼吸窘迫综合征, 肺水肿, 血管外肺水指数, 差异

Abstract：Objective To study the differences of EVLWI in the patients with pulmonary edema induced by different causes of disease.Methods 75 patients with typical pulmonary edema who were admitted to the department of critical medicine in our hospital from January 2014 to June 2015 were selected.They were assigned to two groups according to different causes of disease，namely acute cardiogenic pulmonary edema group（ACPE group）of 44 patients and acute respiratory distress syndrome group（ARDS group）of 31 patients.The difference of EVLWI in both groups and the relationship between EVLWI and prognosis were analyzed.Results MAP，HR，CI，EVLWI，PVPI in ACPE group was significantly lower than that in ARDS group respectively，CVP and OI in ACPE group was significantly higher than that in ARDS group respectively（P＜0.05）；OR values of MAP，CVP，OI，CI and PVPI was respectively＞1；In ACPE group，OR value of PVPI was up to 4.33 maximally，and in ARDS group，OR value of PVPI was up to 4.21 maximally.The risk of PVPI for EVLWI in both groups was higher；The mortality rate in ACPE group was 6.82%，significantly lower than 25.81%in ARDS group（P＜0.05）；The death and survival EVLWI values at 0，24 and 72 h in both groups was respectively higher than the normal value.The death and survival EVLWI values at 0 and 24 h in ACPE group was respectively significantly lower than that in ARDS group，and EVLWI value at 72 h was significantly higher than that of ARDS group（P＜0.05）；Survival and death EVLWI in ACPE group was dynamically monitored respectively，and survival EVLWI was in a decreasing trend and death EVLWI was in an increasing trend.Survival and death EVLWI in ARDS group was dynamically monitored respectively and they were both in a decreasing trend.Conclusion The influencing factors for EVLWI include MAP，CVP，OI，CI and PVPI.ACPE and ARDS patients show significant differences in EVLWI.The mortality rate of patients with pulmonary edema induced by different causes of disease also have differences.Therefore，different causes of pulmonary edema is determined via clinical testing of patients′EVLWI levels，which is of great significance in predicting prognosis and performing individualized treatment for the patients.

Key words： ACPE ARDS Pulmonary edema EVLWI Differences

基金资助:广东省江门市第八批科技计划项目（2014020）

作者简介: 吴寿坤（1981-），男，本科，主治医师

引用本文:

吴寿坤;伍义;罗文晓;郑志忠;谭先念. 不同病因肺水肿患者血管外肺水指数的差异研究[J]. 中国当代医药, 2016, 23(15): 32-34转37.
WU Shou-kun;WU Yi;LUO Wen-xiao;ZHENG Zhi-zhong;TAN Xian-nian. Study of the differences of extravascular lung water index in the Patients with Pulmonary edema induced by different causes of disease. 中国当代医药, 2016, 23(15): 32-34转37.

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