肺血管通透性指数在急性肺水肿鉴别诊断中的临床应用

[The clinical application of pulmonary vascular permeability index on differential diagnosis of acute pulmonary edema].

作者信息

Yang Cong-shan, Xie Jian-feng, Mo Min, Liu Song-qiao, Huang Ying-zi, Qiu Hai-bo, Yang Yi

机构信息

Department of Critical Care Medicine, Nanjing Zhongda Hospital, Southeast University, Nanjing 210009, China.

出版信息

Zhonghua Nei Ke Za Zhi. 2011 Jul;50(7):593-6.

PMID:22041272

Abstract

OBJECTIVE

To assess the value of pulmonary vascular permeability index in differentiating acute lung injury (ALI) from cardiac pulmonary edema.

METHODS

Critically ill patients with acute pulmonary edema were included from May, 2004 to September, 2008. Patients were divided into two groups, the ALI group and the cardiac pulmonary edema group (C group). Pulmonary vascular permeability index (PVPI), intrathoracic blood volume (ITBVI) were determined by pulse indicator continuous cardiac output (PiCCO) system.

RESULTS

(1) Thirty-four patients were enrolled, 22 cases in ALI group and 12 cases in C group. (2) The PVPI in patients of ALI group (2.7 ± 1.4) was higher than that of C group (1.9 ± 0.6; P < 0.05). EVLWI and ITBVI did not have the significant difference between the two groups (P > 0.05). (3) PVPI was positively correlated with EVLWI (r = 0.762), negatively correlated with PaO2/FiO2 (r = -0.478). (4) ARDS was diagnosed in 13 cases, including 8 pulmonary cause (ARDSp) and 5 extra-pulmonary cause (ARDSexp). PVPI, EVLW/ITBV and EVLWI of patients with ARDSexp were obviously higher than those with ARDSp.

CONCLUSIONS

PVPI may be useful for differentiating the types of pulmonary edema in the critically ill.

摘要

目的

评估肺血管通透性指数在鉴别急性肺损伤（ALI）与心源性肺水肿中的价值。

方法

纳入2004年5月至2008年9月期间患有急性肺水肿的危重症患者。将患者分为两组，即ALI组和心源性肺水肿组（C组）。采用脉搏指示连续心输出量（PiCCO）系统测定肺血管通透性指数（PVPI）、胸腔内血容量（ITBVI）。

结果

（1）共纳入34例患者，其中ALI组22例，C组12例。（2）ALI组患者的PVPI（2.7±1.4）高于C组（1.9±0.6；P<0.05）。两组间血管外肺水指数（EVLWI）和ITBVI无显著差异（P>0.05）。（3）PVPI与EVLWI呈正相关（r=0.762），与氧合指数（PaO2/FiO2）呈负相关（r=-0.478）。（4）13例患者被诊断为急性呼吸窘迫综合征（ARDS），其中8例为肺源性（ARDSp），5例为肺外源性（ARDSexp）。ARDSexp患者的PVPI、EVLW/ITBV和EVLWI明显高于ARDSp患者。