急性呼吸窘迫综合征患者氧合指数与血管外肺水相关性研究

发布时间：2018-06-18 15:58

本文选题：ARDS + 氧合指数　；参考：《广西医科大学》2012年硕士论文

【摘要】：目的探讨急性呼吸窘迫综合征(ARDS)患者氧合指数与血管外肺水的相关性,研究ARDS患者用血管外肺水来反映其氧合情况,应用血管外肺水新指标代替氧合指数,更科学地指导ICU护士对ARDS患者的监护,减轻病人的痛苦,减少病人成本费用、降低护士的工作量。方法本实验纳入2010年1月至2011年12月收住于广西医科大学第一附属医院重症医学科二区行脉搏轮廓温度稀释连续心输出量测量技术(PiCCO)监测的急性呼吸窘迫综合征(ARDS)患者43例作为研究对象。入住后收集患者一般情况资料包括性别、年龄、职业、婚姻状况、文化程度、经济状况、原发病、病情危重程度、治疗方法等。收治我科后利用多功能监护仪常规监测患者的心率、血压、呼吸频率、血氧饱和度(SPO2)。入住我科24h内,征得患者及家属同意,排除禁忌症后行脉搏轮廓温度稀释连续心输出量测量(PiCCO)监测。利用经肺热稀释技术监测患者的非连续性参数：全心舒张末期容积(GEDV)、胸腔内血容量(ITBV)、血管外肺水(EVLW)、肺血管通透性指数(PVPI)。每8小时用经肺热稀释测定作一次校正。在患者出现连续心排血量变化与病情变化较大时加测校正一次。ARDS患者在每次经肺热稀释监测全心舒张末期容积(GEDV)、胸腔内血容量(ITBV)、血管外肺水(EVLW)、肺血管通透性指数(PVPI)时,护士穿刺桡动脉行血气分析,通过PaO2/FiO2来计算其氧合指数(OI)。同时记录多功能监护仪监测到的患者的心率、平均动脉压、呼吸频率、血氧饱和度(SPO2)。另外记录ARDS患者行血气分析、PiCCO监测的次数,计算ARDS患者行血气分析、PiCCO监测的成本费用。收集病人相关资料,建立数据库,运用描述性分析、t检验、方差分析、卡方检验、回归与相关、多元线性回归分析等统计方法,对ARDS病人的氧合指数(OI)、全心舒张末期容积(GEDV)、胸腔内血容量(ITBV)、血管外肺水(EVLW)、肺血管通透性指数(PVPI),呼吸频率、血氧饱和度(SPO：)、平均动脉压进行分析。另外统计分析ARDS患者行血气分析、PiCCO监测的次数,比较ARDS患者行血气分析、PiCCO监测的成本费用。结果 1、ARDS氧合指数相关因素的Pearson单因素分析ARDS患者氧合指数与血氧饱和度呈正相关(p0.05)；ARDS患者氧合指数与呼吸频率、血管外肺水、肺血管通透性指数负相关(p0.05)；与心率、平均动脉压、胸腔内血容量、全心舒张末期容积无关(p0.05)。 2、ARDS患者氧合指数与相关因素的简单线性回归分析ARDS患者氧合指数与呼吸频率、血氧饱和度、血管外肺水、肺血管通透性指数存在直线关系(P0.05),氧合指数与心率、平均动脉压、胸腔内血容量、全心舒张末期容积无关(P0.05)。 3、ARDS患者氧合指数相关因素的多元线性回归分析ARDS患者氧合指数与平均动脉压、血管外肺水、肺微血管通透性指数线性回归关系有统计学意义(p0.05),ARDS患者氧合指数与平均动脉压、血管外肺水、肺微血管通透性指数具有显著相关性。 4、ARDS患者血管外肺水相关因素的多元线性回归分析ARDS患者血管外肺水与肺血管通透性指数线性回归关系有统计学意义(p0.05),胸腔内血容量、全心舒张末期容积对ARDS患者血管外肺水无影响(p0.05)。 5、血气分析监测与PiCCO监测的效价比较血气分析成本单价约为169元,PiCCO监测成本单价约为220元。43例ARDS患者人均行血气分析次数为35.74±9.299次,人均行PiCCO监测次数为24.42±6.423次,两者比较差异有统计学意义(t=6.571,p=0.000)。43例ARDS患者人均行血气分析总费用为6040.77±1571.615元,43例ARDS患者人均行行PiCCO监测费用5372.09±1412.961元,两费用比较差异有统计学意义(t=2.075,p=0.041)。结论 1、ARDS的氧合指数与平均动脉压、血管外肺水、肺血管通透性指数显著相关。血管外肺水对氧合指数的影响最大,是ARDS患者氧合指数的决定因素。ARDS患者氧合指数与全心舒张末期容积(GEDV).胸腔内血容量无关。 2、ARDS患者监测能够利用血管外肺水新指标代替氧合指数。血管外肺水较氧合指数更具优越性。
[Abstract]:Objective to investigate the correlation between oxygenation index and extravascular pulmonary water in patients with acute respiratory distress syndrome (ARDS), to study the oxygenation of ARDS patients with extravascular lung water, and to replace oxygenation index by the new index of extravascular lung water, and to guide the monitoring of ARDS patients by ICU nurses so as to reduce the patient's pain and reduce the cost of the patients. Reduce the workload of the nurses.
Methods from January 2010 to December 2011, 43 patients with acute respiratory distress syndrome (PiCCO) monitored by pulse contours temperature dilution continuous cardiac output (PiCCO) were enrolled in the two district of the First Affiliated Hospital of Guangxi Medical University. 43 cases of acute respiratory distress syndrome (acute respiratory distress syndrome) were investigated. No, age, occupation, marital status, educational level, economic condition, primary disease, critical degree, treatment method, etc. after our department, we used a multifunction monitor to routinely monitor the heart rate, blood pressure, respiratory rate, and blood oxygen saturation (SPO2). Check in our family 24h, obtain the consent of the patients and their families, and remove the pulse contour temperature after the contraindication. Dilute continuous cardiac output measurement (PiCCO) monitoring. Non continuous parameters of patients were monitored by pulmonary thermo dilution technique: full cardiac end diastolic volume (GEDV), intrapleural volume of blood volume (ITBV), extravascular lung water (EVLW), pulmonary vascular permeability index (PVPI). A correction was performed every 8 hours by pulmonary thermo dilution measurement. Continuous cardiac output was observed in patients. When the change and the condition of the disease were large,.ARDS patients were monitored at the end diastolic volume (GEDV), intrapleural blood volume (ITBV), extravascular pulmonary water (EVLW), and pulmonary vascular permeability index (PVPI). The nurse punctured the radial artery for blood gas analysis, and the oxygen index (OI) was calculated by PaO2/FiO2. At the same time, the number of oxygen index (OI) was recorded. At the same time, the nurses were recorded more. The heart rate, average arterial pressure, respiratory frequency and blood oxygen saturation (SPO2) were monitored by the function monitor. In addition, the blood gas analysis of the patients with ARDS, the number of PiCCO monitoring, the blood gas analysis of the ARDS patients and the cost of PiCCO monitoring were calculated.
Collect patient related data, establish a database, use descriptive analysis, t test, ANOVA, chi square test, regression and correlation, multiple linear regression analysis and other statistical methods for ARDS patients' oxygenation index (OI), full cardiac end diastolic volume (GEDV), thoracic blood volume (ITBV), extravascular lung water (EVLW), pulmonary vascular permeability index (PVPI), and respiratory index (PVPI). Frequency, blood oxygen saturation (SPO:) and mean arterial pressure were analyzed. In addition, the blood gas analysis of ARDS patients, the number of PiCCO monitoring, the blood gas analysis of ARDS patients and the cost of PiCCO monitoring were compared.
Result
1, Pearson single factor analysis of ARDS oxygenation index related factors, the oxygenation index of ARDS patients was positively correlated with oxygen saturation (P0.05); the oxygenation index of patients with ARDS was negatively correlated with respiratory frequency, extravascular lung water and pulmonary vascular permeability index (P0.05), and was not related to heart rate, mean arterial pressure, intrathoracic blood volume, and total ventricular end diastolic volume (P0.05).
2, simple linear regression analysis of oxygenation index and related factors in patients with ARDS, ARDS patients' oxygenation index and respiratory frequency, oxygen saturation, extravascular lung water, pulmonary vascular permeability index have a linear relationship (P0.05), oxygenation index and heart rate, mean arterial pressure, intrathoracic blood volume, and total ventricular end diastolic volume (P0.05).
3, multivariate linear regression analysis of oxygenation index related factors in ARDS patients, the linear regression relationship between ARDS patients' oxygenation index and mean arterial pressure, extravascular pulmonary water and pulmonary microvascular permeability index was statistically significant (P0.05). The oxygenation index of ARDS patients was significantly correlated with the mean arterial pressure, extravascular pulmonary water and pulmonary microvascular permeability index.
4, multivariate linear regression analysis of the water related factors of the extravascular lung in ARDS patients, the linear regression relationship between the extravascular pulmonary water and the pulmonary vascular permeability index in ARDS patients was statistically significant (P0.05). The blood volume in the thoracic cavity and the end diastolic volume of the heart had no effect on the extravascular pulmonary water of the patients with ARDS (P0.05).
5, the cost of blood gas analysis and PiCCO monitoring compared the cost of blood gas analysis cost about 169 yuan, PiCCO monitoring cost is about 220 yuan.43 cases of ARDS patients per capita blood gas analysis is 35.74 + 9.299 times, per capita PiCCO monitoring number of 24.42 + 6.423 times, the difference is statistically significant (t=6.571, p=0.000).43 case ARDS patients The total cost of per capita blood gas analysis was 6040.77 + 1571.615 yuan. The cost of PiCCO monitoring in 43 cases of ARDS patients was 5372.09 + 1412.961 yuan, and the two cost was statistically significant (t=2.075, p=0.041).
conclusion
1, the oxygenation index of ARDS was significantly related to the mean arterial pressure, the extravascular lung water and the pulmonary vascular permeability index. The effect of the extravascular lung water on the oxygenation index was the largest, which was the determinant of the oxygenation index in patients with ARDS and the oxygenation index of.ARDS patients and the total cardiac end diastolic volume (GEDV). The blood volume in the thoracic cavity was not related.
2, monitoring of ARDS patients can use extravascular lung water index instead of oxygenation index. Extravascular lung water is more advantageous than oxygenation index.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R563.8

【参考文献】