肺水相关指数对重症烧伤并发急性呼吸窘迫综合征患者病情预后的评估价值

目的评价肺水相关指数对重症烧伤并发急性呼吸窘迫综合征(ARDS)患者严重程度、预后判断的价值。方法对31例重症烧伤并发ARDS患者,除记录一般临床资料及主要合并症外,均利用脉搏指示剂连续心输出量(PiCCO)监测仪监测,并记录置入PiCCO导管时的急性生理和慢性健康状况(APACHE)Ⅱ评分,置管后0、24、48、72h氧合指数,肺血管通透性指数(PVPI)和血管外肺水指数(EVLWI)值。根据28天预后分为存活组和死亡组,分析两组各指数之间的差异及其对预后的评估能力。结果纳入研究的31例患者中,28天内死亡21例(67.7%),吸入性损伤、脓毒血症是主要合并症及影响预后的主要因素。存活组患者置管后72h氧合指数高于死亡组,差异有统计学意义(P0.05);存活组患者置管后48、72hPVPI低于死亡组,差异有统计学意义(P0.05);存活组患者置管后24、48、72hEVLWI低于死亡组,差异有统计学意义(P0.05);且随着置管时间延长,氧合指数、PVPI、EVLWI均对预后评价准确性增加,置管后72h的氧合指数、PVPI、EVLWI值对预后的评价最佳,3个指数对预后评估价值差异无统计学意义(P0.05)。结论运用PiCCO监测仪对肺水相关指数连续监测对重症烧伤并发ARDS患者严重程度、预后评价具有重要临床意义。

Value of lung waterrelevantindex assessing the severity and prognosis of patients with sever burns concurrent acute respiratory distress syndrome

Objective To assess the severity categories definition and prognostic value of lung water relevant in-dex in patients with severe burns concurrent acute respiratory distress syndrome （ARDS） . Methods The study included 31 adult severely burned patients with ARDS ,and record the general clinical data and primary complica-tions .All patients are monitored by pulse indicator continuous cardiac output （PiCCO ） plus system ,and acute physiology and chronic health evaluation （APACHE） Ⅱ score was recorded in the initial .The oxygenation index , extravascular lung water index （EVLWI） ,and pulmonary vascular permeability index （PVPI） at 0 ,24 ,72 hours were analyzed .All patients were divided into death and survival groups by the 28-day mortality to analyze the difference of these indexes between tow groups to investigate the prognostic value of these indexes . Results The 28-day mortality was 67.7% （21/31） ,the inhalation injure and sepsis were the major complications which make effect to the prognosis .The oxygenation index at 72 hour in the survival group was significantly higher than that in death group （P＆lt;0.05）;the PVPI at 48 ,72 hours in the survival group was significantly lower than that in death group （P＆lt;0.05）;the EVLWI at 24 ,48 ,72 hours in the survival group was significantly lower than that in death group （P＆lt;0.05） .The accurate judgment of oxygenation index ,PVPI and EVLWI were increase gradually as time went on after placing catheter ,and these indexes at 72 hour were valuable indicators to prognosis .The receiver op-erating characteristic curve （ROC curve） used to evaluate the prognosis accuracy of these indicators were no differ-ence （P＆gt;0.05） . Conclusion The PiCCO system continuously monitored to detect the lung water relevant index was significant to the severity assessment and prognostic value in severely burned patients with ARDS in clinic .