血管外肺水在ARDS患者液体管理中的应用价值探讨

发布时间：2018-03-19 03:07

本文选题：急性呼吸窘迫综合征　切入点：机械通气　出处：《浙江大学》2012年硕士论文　论文类型：学位论文

【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)患者生存率,ICU住院、机械通气时间,急性肺损伤评分和氧合指数变化的影响,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月至2011年9月在我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24小时进行一次急性肺损伤评分和氧合指数计算,记录24小时出入量,以28天和60天生存率为主要终点,以ICU住院时间、机械通气时间、急性肺损伤和氧和指数变化为次要终点进行评价。结果两组患者在28天和60天生存率上无明显差异,在ICU住院时间和机械通气时间上限制性液体管理组时间小于开放性液体管理组(P0.05)；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(均P0.05)。结论在ARDS,患者,限制性液体管理与开放性液体管理,虽然在总体生存率上无明显差异,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。
[Abstract]:objective
Through the observation of two different fluid management strategies in acute respiratory distress syndrome (ARDS) patients survival rate, length of stay in ICU, duration of mechanical ventilation, acute lung injury score and oxygenation index changes, explore the extravascular lung water (EVLW) application value in liquid management in patients with ARDS, so as to explore the best fluid management strategy in patients with ARDS.
Method
From May 2008 to September 2011 in line with the critical care medicine in our hospital included 27 ARDS patients as the research object, randomly divided into restrictive fluid management group and the open fluid management group, once every 24 hours of acute lung injury score and oxygenation index calculation, recorded 24 hours and amount to 28 day and the 60 day survival rate as the main end point in ICU, hospitalization time, mechanical ventilation time, changes of acute lung injury and oxygenation index were evaluated as a secondary end point.
Result
Two groups of patients on the 28 day and the 60 day survival rate had no significant difference, restrictive fluid management group less than open fluid management group in the ICU hospitalization time and mechanical ventilation time (P0.05); two group patients, compared between groups, in the treatment of acute lung injury after different time scores, statistics the significance of differences in oxygenation index significantly (P0.05).
conclusion
In ARDS, patients with restrictive fluid management and open fluid management, although no significant difference in the overall survival rate, but there is an obvious improvement on the acute lung injury score and oxygenation index, and shortened the duration of mechanical ventilation and ICU stay. Limit liquid management in patients with ARDS. Especially with EVLW as the target, can bring the benefits for them.

【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R563.8

【共引文献】