Yang Cong-shan, Qiu Hai-bo, Liu Song-qiao, Yang Yi, Huang Ying-zi, Liu Ling
Department of Critical Care Medicine, Zhong-Da Hospital and School of Clinical Medicine, Southeast University, Nanjing 210009, China.
Zhonghua Nei Ke Za Zhi. 2006 Mar;45(3):192-5.
To investigate the prognostic value of extravascular lung water index (EVLWI) in critically ill patients with septic shock in intensive care unit (ICU).
EVLWI was determined by using a PiCCO Monitor, and the daily fluid balance was recorded.
Fifty patients with septic shock were admitted and twenty-six patients survived. The average EVLWI at baseline was 11.7 ml/kg, and the difference was not different between survivors and nonsurvivors, P = 0.551. The EVLWI of day 3 (EVLWI(d3)) in nonsurvivors was significantly higher than the survivors [(14.3 +/- 8.8) ml/kg vs (8.1 +/- 2.7) ml/kg, P = 0.001]. If the patients were divided into three groups by the EVLWI(d3), group one 0-7 ml/kg (4/16), group two 8-14 ml/kg (10/24), and group three > 14 ml/kg (10/10), the hospital mortality of the third group was significantly higher than the other two groups (P = 0.000, 0.002). There was a significant difference between the survivors and the nonsurvivors in the fluid balance at the first day and the following three days (P = 0.000, 0.000). Negative fluid balance was associated with a lower mortality. By using receiver operating characteristic analysis, the area under the curve was 0.740 +/- 0.072 to EVLWI(d3). If EVLWI > 7.5 ml/kg, the sensitivity and the specificity of accurate judgment were 83.3% and 53.8%.
Dynamic observation of EVLWI can be one of the factors for predicting the prognosis of patients with septic shock. A reduction of EVLWI at early treatment and a negative fluid balance were associated with a better prognosis.
探讨血管外肺水指数（EVLWI）对重症监护病房（ICU）中感染性休克重症患者的预后价值。
使用PiCCO监测仪测定EVLWI，并记录每日液体平衡情况。
50例感染性休克患者入院，26例存活。基线时平均EVLWI为11.7 ml/kg，存活者与非存活者之间差异无统计学意义，P = 0.551。非存活者第3天的EVLWI（EVLWI(d3)）显著高于存活者[（14.3±8.8）ml/kg对（8.1±2.7）ml/kg，P = 0.001]。若根据EVLWI(d3)将患者分为三组，第一组0 - 7 ml/kg（4/16），第二组8 - 14 ml/kg（10/24），第三组> 14 ml/kg（10/10），第三组的医院死亡率显著高于其他两组（P = 0.000，0.002）。存活者与非存活者在第1天及随后3天的液体平衡存在显著差异（P = 0.000，0.000）。负液体平衡与较低死亡率相关。通过受试者工作特征分析，EVLWI(d3)的曲线下面积为0.740±0.072。若EVLWI> 7.5 ml/kg，准确判断的敏感性和特异性分别为83.3%和53.8%。
动态观察EVLWI可作为预测感染性休克患者预后的因素之一。早期治疗时EVLWI降低及负液体平衡与较好的预后相关。
