摘要
目的 探讨胸腔内血容量指数（ITBVI）及血管外肺水（EVLW）在指导创伤性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2011年5月～2012年5月符合纳入标准的创伤性ARDS患者57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.记录SOFA评分、氧合指数以及7d和28 d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 限制性液体管理组患者在治疗后36 h较开放性液体管理组SOFA评分明显降低,P=0.037,ICU住院时间及机械通气时间明显缩短,P＜0.05,两组患者病死率差异无统计学意义,P＞0.05;治疗前后不同时间氧合指数之间差异有统计学意义,F =60.232,P=0.000;两组患者氧合指数组内、组间比较差异有统计学意义,P ＜0.05.结论 对于创伤性ARDS患者,联合应用ITBVI和EVLW为液体管理目标,精准地进行限制性液体管理能明显改善氧合指数,缩短机械通气时间、ICU住院时间,具有积极的临床意义.
Objective To explore the application value of intrathoracic blood volume index （ITBVI） and extravascular lung water （EVLW） in fluid management for traumatic acute respiratory distress syndrome （ARDS） patients.Methods 57 traumatic ARDS patients were randomly divided into 2 groups：restricted fluid management group （n=28） keeping 800 ml/m2＜ITBVI＜1000 ml/m2 and 3 ml/kg＜EVLW＜7 ml/m2,and liberal fluid management group （n=29） keeping 1000 ml/m2＜ITBVI＜1200 ml/m2 and 7 ml/kg＜EVLW＜14 ml/kg.The TBVI and EVLW were measured every 8 h,and the oxugenation index （OI）,mechanical ventilation time,ICU stay time,mortality,and sequential organ failure assessment （SOFA） score were recorded and compared.Results The SOFA score 36 h after treatment of the restricted fluid managfement group was significantly lower than that of the liberal fluid management group （P =0.037）.The The ICU stay time and mechanical ventilation time of the restricted fluid management group were both shorter than those of the liberal fluid management group （both P ＜0.05）.The OI values at different time points after treatment of both groups were all significantly higher than those before treatment （F-60.232,P =0.000）,and the OI values at different time points after treatment of the restricted fluid management group were all significantly than those of the liberal fluid management group （all P ＜0.05）.There was no significant difference in mortality between these 2 groups.Conclusion For the traumatic ARDS patients,prfecise fluid management strategy with monitoring TBVI and EVLW greatly improve the OI,decreases the ICU stay time and mechanical ventilation time.
出处
《中国急救复苏与灾害医学杂志》
2014年第10期926-929,共4页
China Journal of Emergency Resuscitation and Disaster Medicine
基金
辽宁省科学技术计划项目（2013225089）
关键词
急性呼吸窘迫综合征
创伤
血管外肺水
Acute respiratory distress syndrome （ARDS）
Trauma
Extravascular lung water （EVLW）
Intrathoracic blood volume index （ITBVI）
