[目的]探讨不同血糖控制对神经源性肺水肿（neurogenic pulmonary edema,NPE）伴应激性高血糖(stress hyperglycemia,SHG)患者的脉搏指示连续心排血量（pulse indicator continuous cardiac output，PiCCO）监测主要指标的影响，评价血糖控制对NPE伴SHG患者肺水变化及预后的意义。[方法]采用前瞻性临床研究方法，对51例NPE伴SHG的危重患者，随机分为两组：研究组(26例)，以持续胰岛素静脉微泵输注治疗方案控制血糖于4.4～8.3 mmol·L-1；对照组(25例)，控制血糖于10.0～11.1mmol·L-1，两组其他常规治疗相同。观察两组患者治疗开始3d的CI、ITBVI、GEDVI、EVLWI、PVPI、CVP等PiCCO监测指标，血糖与ITBVI、GEDVI、EVLWI、CVP之间进行相关性分析；根据患者结局分为死亡组与存活组，比较两组的血糖、EVLWI及APACHE Ⅱ评分变化。[结果]研究组CI与氧合指数（PaO2/FiO2）高于对照组，差异具有统计学意义(均P<0．05)，ITBVI、EVLWI、PVPI均低于对照组，差异具有统计学意义(P<0．05，P<0．01，P<0．01)；血糖与EVLWI呈显著正相关（r=0．68，P<0．001），与PVPI、ITBVI呈显著正相关（r=0．64，P<0．001，r=0．52、P<0．05），而与GEDVI、CVP无显著相关性（r=0．17，P＞0．05，r=0．20，P＞0．05）；血糖与PaO2/FiO2呈显著负相关（r=-0．57、P<0．05）。死亡组血糖、EVLWI水平、APACHE Ⅱ评分均高于存活组，差异有统计学意义（均P<0．01）。[结论]良好的血糖控制能改善NPE伴SHG患者的PiCCO监测主要指标，减轻肺水，血糖控制水平与PaO2/FiO2负相关，可结合PiCCO监测主要指标更好地评估病情及预后。%[Objective] To evaluate the effects of glucose-control level on monitoring indicators of PiCCO in NPE patients with SHG, and to assess the change of lung water and prognostic significance of glucose-control on these patients. [Methods] In this prospective study, 51 NPE patients with SHG were randomly divided into two groups: research group(n=26) and control group(n=25) .The blood glucose was control ed by insulin within 4.4-8.3 mmol/L in research group, and 10.0-11.1 mmol/L in control group. Other therapies were identical in two groups. Parameters of PiCCO such as CI, ITBVI,GEDVI, EVLWI,PVPI and CVP were observed in the first three treating days, The correlation between ITBVI,GEDVI,EVLWI,CVP and blood glucose was assessed; According to the outcome, these patients were divided into nonsurvivor group and survivor group. The change in blood glucose, EVLWI and APACHE Ⅱscore was compared between two groups.[Results] In research group, the CI,PaO2/FiO2 were significantly elevated, and ITBV, EVLWI, PVPI were significantly reduced compared with control group. Blood glucose was significantly and positively correlated with EVLWI(r=0 .68,P<0.001),PVPI(r=0.64,P展开▼
