血管外肺水在ARDS患者液体管理中的应用价值探讨

摘要

目的 通过观察两种不同液体管理策略对急性呼吸窘迫综合征(ARDS)患者急性肺损伤评分、氧合指数变化、机械通气时间、住ICU时间及死亡病例数的影响,探讨血管外肺水(EVLW)在ARDS患者液体管理中的应用价值,从而探寻ARDS患者的最佳液体管理策略.方法 选取2008年5月～2011年9月在笔者医院重症医学科住院的符合纳入标准的ARDS患者27例为研究对象,随机分为限制性液体管理组和开放性液体管理组,每24h进行一次急性肺损伤评分和氧合指数计算,记录24h出入量,以28天和60天生存率为主要终点,以机械通气时间、ICU住院时间为次要终点进行评价.结果 两组患者在28天和60天死亡病例数上无明显差异,在机械通气时间和住ICU时间上限制性液体管理组时间小于开放性液体管理组(P＜0.05)；两组患者组内、组间比较,在治疗后不同时间的急性肺损伤评分、氧合指数的差异均有显著的统计学意义(P均＜0.05).结论 在ARDS患者,限制性液体管理与开放性液体管理,虽然在总体病死率上无明显差异,但对急性肺损伤评分和氧合指数上有明显的改善,且在机械通气时间和ICU住院时间上有所缩短.对ARDS患者进行限制性的液体管理,尤其是以EVLW为目标,能为其带来相应的益处.%Objective To discuss the clinical value of extravascular lung water ( EVLW) for acute respiratory distress syndrome ( ARDS) patients in fluid - management by investigating the effect of two different fluid - management strategies on acute lung injury score, Oxygenation index .mechanical ventilation days, ICU days, death cases and to find the optimal fluid - management in ARDS patients. Methods A total of 27 patients with acute respiratory distress syndrome ( ARDS) in our ICU department from May 2008 to September 2011 met the inclusion criteria were selected as research objects. They were randomly assigned to restricted fluid management strategy group and liberal fluid management strategy group. Acute lung injury score, Oxygenation index were measured per 24h. The volume of 24h fluid balance was recorded. 28 - day and 60 - day survival rates were as the primary end points, and mechanical ventilation days and ICU days were as secondary end points. Results There was no significant difference in 28 - day and 60 - day death cases between two groups. However mechanical ventilation days and ICU days were much shorter in restricted fluid management strategy group than in liberal fluid management strategy group( P <0. 05). Acute lung injury score and Oxygenation index both showed a significantly statistical difference during the treatment in and between groups ( P <0. 05). Conclusion Although there was no marked difference in death rates between restricted fluid management strategy and liberal fluid management strategy for ARDS patients, the restricted fluid management strategy can greatly improve the acute lung injury score and Oxygenation index, shorten the days of mechanical ventilation and ICU. Restricted fluid management strategy for ARDS patients, especially with target of EVLW, is an effective approach to many corresponding benefits.