限制性液体管理对急性呼吸窘迫综合征患者的肺保护作用

发布时间：2018-04-27 02:28

本文选题：限制性液体管理 + 急性呼吸窘迫综合征　；参考：《广东医学》2014年18期

【摘要】：目的探讨限制性液体管理对急性呼吸窘迫综合征(ARDS)患者的肺保护作用。方法将符合标准的56例ARDS患者随机分为观察组29例和对照组27例,观察组采用出入量负平衡方式进行液体管理,对照组采用出入量平衡方式进行液体管理。动态监测入科后1、3、7 d氧合指数(PO2/FiO2)、血乳酸(Lac)、中心静脉压(CVP)、平均动脉压(MAP)、心脏指数(CI)、血管外肺水指数(EVLWI)、血浆脑利钠肽(BNP)水平,并进行肺损伤评分,记录ICU住院期间7 d内24 h液体日平均液体平衡量和急性肾损伤(AKI)发生率、肺复张次数、ICU机械通气时间、ICU住院时间、28 d病死率。结果入科后3、7 d,两组PO2/FiO2较入科后1 d明显升高(P0.05),Lac、EVLWI、BNP、肺损伤评分均较入科后1 d明显下降(P0.05),两组CVP、MAP、CI均呈下降趋势,入科后7 d与入科后1 d比较差异有统计学意义(P0.05)。入科后3、7 d,观察组PO2/FiO2较对照组明显升高(P0.05),Lac、EVLWI、BNP、肺损伤评分均较对照组明显下降(P0.05),而两组CVP、MAP、CI差异无统计学意义(P0.05)。观察组7 d内日平均液体平衡量(绝对值)大于对照组(P0.05),肺复张次数、ICU机械通气时间、ICU住院时间均少于对照组(P0.05);两组7 d内AKI发生率及28 d病死率差异无统计学意义(P0.05)。结论限制性液体管理可改善ARDS患者的肺功能,减少肺复张,缩短机械通气时间和住ICU时间。ARDS患者实施24 h出入量负平衡进行限制性液体管理方法简单易行,安全有效。
[Abstract]:Objective to investigate the lung protective effect of restrictive fluid management on ARDS patients with acute respiratory distress syndrome (ARDS). Methods Fifty-six patients with ARDS were randomly divided into observation group (n = 29) and control group (n = 27). The oxygen index (PO _ 2 / FiO _ 2), lactate (lactate), central venous pressure (CVP), mean arterial pressure (map), cardiac index (CI), extravascular lung water index (EVLWI), plasma brain natriuretic peptide (BNPs), and lung injury score were dynamically monitored. The mean daily liquid balance and the incidence of acute renal injury during 7 days of ICU were recorded. The time of mechanical ventilation and the mortality rate of 28 days were measured. Results on the 7th day after entering the department, the PO2/FiO2 of the two groups was significantly higher than that of the first day after entering the department. The lung injury score of the two groups was significantly lower than that of the first day after entering the department. The MAPCI of the two groups showed a downward trend, and there was a significant difference between the two groups on the 7th day after entering the department and the first day after entering the department. On the 7th day after admission, PO2/FiO2 in the observation group was significantly higher than that in the control group, and the lung injury score was significantly lower than that in the control group (P 0.05), but there was no significant difference in CI between the two groups (P 0.05). The mean daily fluid balance (absolute value) in the observation group was larger than that in the control group (P 0.05), the time of mechanical ventilation and the hospitalization time of the two groups were less than that in the control group, but there was no significant difference between the two groups in the incidence of AKI within 7 days and the fatality rate at 28 days (P 0.05). Conclusion restrictive fluid management can improve pulmonary function, reduce pulmonary retension, shorten mechanical ventilation time and live in ICU patients for 24 hours. The restrictive liquid management method is simple, safe and effective.
【作者单位】：广东省东莞市凤岗医院重症医学科;广东省人民医院(广东省医学科学院)重症医学科;
【分类号】：R563.8

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