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心搏骤停相关肺水肿:探讨跨肺温度稀释分析中暂停时间的作用。

Cardiac arrest related lung edema: examining the role of downtimes in transpulmonary thermodilution analysis.

机构信息

Department of Acute and Emergency Medicine, Elisabeth-Hospital Essen, Klara-Kopp-Weg 1, 45138, Essen, Germany.

Department of Cardiology and Angiology, Contilia Heart and Vascular Center Elisabeth-Hospital Essen, Essen, Germany.

出版信息

Intern Emerg Med. 2024 Mar;19(2):501-509. doi: 10.1007/s11739-023-03420-7. Epub 2023 Sep 12.

Abstract

Pulmonary edema and its association with low flow times has been observed in postcardiac arrest patients. However, diagnosis of distinct types of lung pathology is difficult.The aim of this study was to investigate pulmonary edema by transpulmonary thermodilution (TPTD) after out-of-hospital cardiac arrest (OHCA), and the correlation to downtimes. In this retrospective single-center study consecutive patients with return of spontaneous circulation (ROSC) following OHCA, age ≥ 18, and applied TPTD were enrolled. According to downtimes, patients were divided into a short and a long no-flow-time group, and data of TPTD were analysed. We identified 45 patients (n = 25 short no-flow time; n = 20 long no-flow time) who met the inclusion criteria. 24 h after ROSC, the extra vascular lung water index (EVLWI) was found to be lower in the group with short no-flow time compared to the group with long no-flow time (10.7 ± 3.5 ml/kg vs. 12.8 ± 3.9 ml/kg; p = 0.08) and remained at a similar level 48 h (10.9 ± 4.3 ml/kg vs. 12.9 ± 4.9 ml/kg; p = 0.25) and 72 h (11.1 ± 5.0 ml/kg vs. 13.9 ± 7.7 ml/kg; p = 0.27) post-ROSC. We found a statistically significant and moderate correlation between no-flow duration and EVLWI 48 h (r = 0.51; p = 0.002) and 72 h (r = 0.54; p = 0.004) post-ROSC. Pulmonary vascular permeability index (PVPI) was not correlated with downtimes. Our observation underlines the presence of cardiac arrest-related lung edema by determination of EVLWI. The duration of no-flow times is a relevant factor for increased extravascular lung water index.

摘要

在心脏骤停后患者中已经观察到肺水肿及其与低血流时间有关。然而,对不同类型的肺部病理进行诊断是困难的。本研究的目的是通过经肺温度稀释(TPTD)来研究心脏骤停后患者的肺水肿,并与停搏时间相关联。在这项回顾性的单中心研究中,纳入了符合以下条件的连续患者:年龄≥18 岁,且接受了 TPTD 的院外心脏骤停(OHCA)后自主循环恢复(ROSC)。根据停搏时间,患者分为短停搏时间组和长停搏时间组,并对 TPTD 数据进行分析。我们共纳入 45 名符合条件的患者(n=25 名短停搏时间组;n=20 名长停搏时间组)。ROSC 后 24 小时,短停搏时间组的血管外肺水指数(EVLWI)低于长停搏时间组(10.7±3.5ml/kg 比 12.8±3.9ml/kg;p=0.08),并且在 48 小时(10.9±4.3ml/kg 比 12.9±4.9ml/kg;p=0.25)和 72 小时(11.1±5.0ml/kg 比 13.9±7.7ml/kg;p=0.27)时仍保持相似水平。我们发现,停搏时间与 48 小时(r=0.51;p=0.002)和 72 小时(r=0.54;p=0.004)后 EVLWI 之间存在显著的中度相关性。PVPI 与停搏时间无相关性。我们的观察结果强调了通过 EVLWI 测定确定心脏骤停相关肺水肿的存在。无血流时间的持续时间是血管外肺水指数增加的一个相关因素。

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