胸腔积液对经肺热稀释法血管外肺水监测准确性的影响

摘要

目的 探讨胸腔积液对经肺热稀释技术监测血管外肺水(EVLW)准确性的影响.方法 6只北京长条猪通过静脉注射油酸制备急性肺损伤(ALI)模型,然后先后分别向肺泡内及胸膜腔内灌注一定量的生理盐水,在两种不同灌注方式的前后均采用经肺热稀释法测定EVLW,观察肺泡灌注前后EVLW变化与所灌注生理盐水量之间的相关性,同时观察胸腔内灌注生理盐水前后EVLW含量的变化.结果 基础状态下正常肺组织EVLW含量(276.6±10.8)mL,ALI模型成功后EVLW含量(378.9±12.2) mL,与基础状态比较差异有统计学意义(P＜0.001)；肺泡灌注前后EVLW的变化与实际肺泡灌注生理盐水量之间具有良好的相关性(r=0.973,P＜0.001)；胸腔内灌注前后测定的EVLW含量无变化(P＞0.05).结论 经肺热稀释技术对血管外肺水的监测具有良好的准确性,胸腔积液对血管外肺水监测准确性无影响.%Objective To evaluate the effect of pleural effusion on the accuracy of extravascular lung water (EVLW)quantificated by transpulmonary thermodilution technique. Methods 6 acute lung injury(ALI) models were prepared by intravenous injection with oleic acid. EVLW was measured by PiCCO monitor ( PULSION, Germany) before and immediately after the intratracheal introduction of normal saline solution in the alveolar cavity; Similarly EVLW was also measured before and immediately after the introduction of normal saline solution to pleural cavity. Results ①The EVLW of the baseline was (276.6 ± 10. 8) mL, while the EVLW of the ALI models was (378. 9 ± 12. 2) mL, there was significant difference (P <0. 001) ;②The change of EVLW between before and immediately after the intratracheal injection ( AEVLW) was similar to the volume of normal saline introduced with a good correlation( r = 0. 973, P < 0. 001 ) ; ③There was no difference in AEVLW between before and immediately after the introduction to pleural cavity ( P > 0. 05 ). Conclusion Transpulmonary thermodilution technique is an accurate method for the quantification of EVLW, and pleural effusion has no effect on the accuracy of the quantification of EVLW.