血管外肺水指數(shù)對(duì)感染性休克患者預(yù)后的評(píng)價(jià).pdf
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作者單位: 210009南京,東南大學(xué)附屬中大醫(yī)院危重病醫(yī)學(xué)科
通信作者:楊從山, Email : ycs7415@s ohu . com
·論著·
血管外肺水指數(shù)對(duì)感染性休克患者預(yù)后的
評(píng)價(jià)
楊從山 邱海波 劉松橋 楊毅 黃英姿 劉玲
【摘要 】 目的 評(píng)價(jià)血管外肺水指數(shù) ( EVLW I )對(duì)感染性休克患者預(yù)后判斷的意義。方法 選
收住在 I CU的感染性休克患者 ,右頸內(nèi)靜脈置管接 PiCCO溫度探頭 ,用 PiCCO監(jiān)測(cè)其 EVLW I ,記錄每
日液體用量 ,用受試者操作特征曲線 (ROC)評(píng)價(jià)各指標(biāo)對(duì)預(yù)后評(píng)價(jià)的準(zhǔn)確性。結(jié)果 (1)共 50例感
染性休克患者入選本研究 , 26例患者住院期間病情好轉(zhuǎn)存活 (存活組 ) , 24例病情惡化死亡 (死亡
組 )。 (2)置管時(shí)的 EVLW I存活組與死亡組差異無統(tǒng)計(jì)學(xué)意義 ( P = 01551) ;置管第 3天的 EVLW I存
活組顯著低于死亡組 ( P = 01001)。將 50例患者置管第 3天的 EVLW I按 0～7 ml /kg、 8～14 ml /kg、> 14 ml /kg進(jìn)行分層 ,病死率分別為 25%、 4117%、 10 /10。 (3)置管第 1天、 前 3 d的液體平衡 ,存活
組與死亡組差異有統(tǒng)計(jì)學(xué)意義 ( P = 01000, 01000)。液體負(fù)平衡者病死率低。 (4) ROC曲線置管第 3
天的 EVLW I的 AUC為 01740 ± 01072。置管第 3天的 EVLW I > 715 ml /kg時(shí) ,預(yù)后評(píng)價(jià)的敏感性為
8313% ,特異性為 5318%。結(jié)論 動(dòng)態(tài)觀察感染性休克患者 EVLW I ,可作為預(yù)后評(píng)價(jià)的指標(biāo)之一。
如治療早期 EVLW I明顯下降 ,液體呈負(fù)平衡 ,預(yù)后可能較好。
【關(guān)鍵詞 】 血管外肺水指數(shù); 休克 ,膿毒性; 死亡率; ROC曲線
The prognosti c va lue of extrava scul ar lung wa ter i ndex i n cr iti ca lly ill septi c shock pa ti en ts YANG
Cong2 shan, Q I U Hai2 bo, L I U Song2 qiao, YANG Yi , HUANG Ying2 zi , L I U L ing . Depart m ent of Critical Care
M edicine, Zhong2 Da Hospital and School of ClinicalM edicine, Southeast Univer sity, N anjing 210009, China
Corresponding author : YANG Cong2 shan, Em ail : ycs7415@sohu . com
【Abstract】 Objecti ve To investigate the p r ognostic value of extravascular lung water index
( EVLW I ) in critically ill patientswith sep tic shock in intensive care unit ( I CU) . Methods EVLW Iwas
deter mined by using a PiCCO Monit or, and the daily fluid balance was recorded . Results Fifty patients
with sep tic shock were admitted and t wenty2six patients survived . The average EVLW I at baseline was 1117
ml /kg, and the difference was not different bet ween survivors and nonsurvivors, P = 01551 . The EVLW I of
day 3 ( EVLW I d3) in nonsurvivors was significantly higher than the survivors [ ( 1413 ±818 ) ml /kg vs
(811 ± 217) ml /kg, P = 01001 ]. I f the patientswere divided int o three gr oup s by the EVLW I d3
, gr oup one
0 - 7 ml /kg (4 /16) , gr oup t wo 8 - 14 ml /kg (10 /24) , and gr oup three > 14 ml /kg ( 10 /10) , the hosp ital
mortality of the third group was significantly higher than the other t wo gr oup s ( P = 01000, 01002) . There
was a significant difference bet ween the survivors and the nonsurvivors in the fluid balance at the first day
and the foll owing three days ( P = 01000, 01000 ) . Negative fluid balance was ass ociated with a l ower
mortality . By using receiver operating characteristic analysis, the area under the curve was 01740 ± 01072 t o
EVLW I d3
. I f EVLW I > 715 ml /kg, the sensitivity and the specificity of accurate judgmentwere 8313% and
5318%. Conclusi on Dynamic observati on of EVLW I can be one of the fact ors for p redicting the p rognosis
of patientswith sep tic shock . A reducti on of EVLW I at early treat ment and a negative fluid balance were
ass ociated with a better p rognosis .
【Key words】 Extravascular lung water index; Shock, sep tic; Mortality; ROC curve
感染性休克患者由于感染、 炎癥反應(yīng)導(dǎo)致容量
血管擴(kuò)張 ,毛細(xì)血管滲漏 ,有效循環(huán)血量不足。而相
應(yīng)的液體復(fù)蘇及感染、 炎癥反應(yīng)導(dǎo)致的毛細(xì)血管通
透性增高 ,使發(fā)生肺水腫及繼發(fā)感染的幾率明顯增
加。傳統(tǒng)的容量評(píng)價(jià)指標(biāo) — — — 中心靜脈壓 (CVP)和
肺動(dòng)脈嵌頓壓 ( PAWP)的測(cè)定 ,易受心血管順應(yīng)性、胸腔內(nèi)壓、 瓣膜反流等影響,不能準(zhǔn)確代表心臟前負(fù)
荷 ,尤其不能反映血管外肺水 ( EVLW)含量[ 1 ]。近
年來脈搏指示的持續(xù)心排監(jiān)測(cè)儀 ( PiCCO p lus)逐漸
應(yīng)用于臨床 ,可直接為臨床醫(yī)師提供兩個(gè)最重要的
血流動(dòng)力學(xué)信息 — — —EVLW 和心臟容量負(fù)荷 ......
通信作者:楊從山, Email : ycs7415@s ohu . com
·論著·
血管外肺水指數(shù)對(duì)感染性休克患者預(yù)后的
評(píng)價(jià)
楊從山 邱海波 劉松橋 楊毅 黃英姿 劉玲
【摘要 】 目的 評(píng)價(jià)血管外肺水指數(shù) ( EVLW I )對(duì)感染性休克患者預(yù)后判斷的意義。方法 選
收住在 I CU的感染性休克患者 ,右頸內(nèi)靜脈置管接 PiCCO溫度探頭 ,用 PiCCO監(jiān)測(cè)其 EVLW I ,記錄每
日液體用量 ,用受試者操作特征曲線 (ROC)評(píng)價(jià)各指標(biāo)對(duì)預(yù)后評(píng)價(jià)的準(zhǔn)確性。結(jié)果 (1)共 50例感
染性休克患者入選本研究 , 26例患者住院期間病情好轉(zhuǎn)存活 (存活組 ) , 24例病情惡化死亡 (死亡
組 )。 (2)置管時(shí)的 EVLW I存活組與死亡組差異無統(tǒng)計(jì)學(xué)意義 ( P = 01551) ;置管第 3天的 EVLW I存
活組顯著低于死亡組 ( P = 01001)。將 50例患者置管第 3天的 EVLW I按 0～7 ml /kg、 8～14 ml /kg、> 14 ml /kg進(jìn)行分層 ,病死率分別為 25%、 4117%、 10 /10。 (3)置管第 1天、 前 3 d的液體平衡 ,存活
組與死亡組差異有統(tǒng)計(jì)學(xué)意義 ( P = 01000, 01000)。液體負(fù)平衡者病死率低。 (4) ROC曲線置管第 3
天的 EVLW I的 AUC為 01740 ± 01072。置管第 3天的 EVLW I > 715 ml /kg時(shí) ,預(yù)后評(píng)價(jià)的敏感性為
8313% ,特異性為 5318%。結(jié)論 動(dòng)態(tài)觀察感染性休克患者 EVLW I ,可作為預(yù)后評(píng)價(jià)的指標(biāo)之一。
如治療早期 EVLW I明顯下降 ,液體呈負(fù)平衡 ,預(yù)后可能較好。
【關(guān)鍵詞 】 血管外肺水指數(shù); 休克 ,膿毒性; 死亡率; ROC曲線
The prognosti c va lue of extrava scul ar lung wa ter i ndex i n cr iti ca lly ill septi c shock pa ti en ts YANG
Cong2 shan, Q I U Hai2 bo, L I U Song2 qiao, YANG Yi , HUANG Ying2 zi , L I U L ing . Depart m ent of Critical Care
M edicine, Zhong2 Da Hospital and School of ClinicalM edicine, Southeast Univer sity, N anjing 210009, China
Corresponding author : YANG Cong2 shan, Em ail : ycs7415@sohu . com
【Abstract】 Objecti ve To investigate the p r ognostic value of extravascular lung water index
( EVLW I ) in critically ill patientswith sep tic shock in intensive care unit ( I CU) . Methods EVLW Iwas
deter mined by using a PiCCO Monit or, and the daily fluid balance was recorded . Results Fifty patients
with sep tic shock were admitted and t wenty2six patients survived . The average EVLW I at baseline was 1117
ml /kg, and the difference was not different bet ween survivors and nonsurvivors, P = 01551 . The EVLW I of
day 3 ( EVLW I d3) in nonsurvivors was significantly higher than the survivors [ ( 1413 ±818 ) ml /kg vs
(811 ± 217) ml /kg, P = 01001 ]. I f the patientswere divided int o three gr oup s by the EVLW I d3
, gr oup one
0 - 7 ml /kg (4 /16) , gr oup t wo 8 - 14 ml /kg (10 /24) , and gr oup three > 14 ml /kg ( 10 /10) , the hosp ital
mortality of the third group was significantly higher than the other t wo gr oup s ( P = 01000, 01002) . There
was a significant difference bet ween the survivors and the nonsurvivors in the fluid balance at the first day
and the foll owing three days ( P = 01000, 01000 ) . Negative fluid balance was ass ociated with a l ower
mortality . By using receiver operating characteristic analysis, the area under the curve was 01740 ± 01072 t o
EVLW I d3
. I f EVLW I > 715 ml /kg, the sensitivity and the specificity of accurate judgmentwere 8313% and
5318%. Conclusi on Dynamic observati on of EVLW I can be one of the fact ors for p redicting the p rognosis
of patientswith sep tic shock . A reducti on of EVLW I at early treat ment and a negative fluid balance were
ass ociated with a better p rognosis .
【Key words】 Extravascular lung water index; Shock, sep tic; Mortality; ROC curve
感染性休克患者由于感染、 炎癥反應(yīng)導(dǎo)致容量
血管擴(kuò)張 ,毛細(xì)血管滲漏 ,有效循環(huán)血量不足。而相
應(yīng)的液體復(fù)蘇及感染、 炎癥反應(yīng)導(dǎo)致的毛細(xì)血管通
透性增高 ,使發(fā)生肺水腫及繼發(fā)感染的幾率明顯增
加。傳統(tǒng)的容量評(píng)價(jià)指標(biāo) — — — 中心靜脈壓 (CVP)和
肺動(dòng)脈嵌頓壓 ( PAWP)的測(cè)定 ,易受心血管順應(yīng)性、胸腔內(nèi)壓、 瓣膜反流等影響,不能準(zhǔn)確代表心臟前負(fù)
荷 ,尤其不能反映血管外肺水 ( EVLW)含量[ 1 ]。近
年來脈搏指示的持續(xù)心排監(jiān)測(cè)儀 ( PiCCO p lus)逐漸
應(yīng)用于臨床 ,可直接為臨床醫(yī)師提供兩個(gè)最重要的
血流動(dòng)力學(xué)信息 — — —EVLW 和心臟容量負(fù)荷 ......
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