【摘要】 目的探讨床旁超声在急性呼吸窘迫综合征(ARDS)患者液体管理中的价值。方法采取回顾性研究方法,选取我院2012年6月—2013年12月44例ARDS患者,根据治疗方法的不同分为A组和B组,A组采用床旁超声指导液体管理,B组采用中心静脉压指导液体管理。比较两组入院后当天以及第7天心率、平均动脉压、呼吸频率、气道平台压(Pplat)、呼气末气道正压(PEEP)、急性生理与慢性健康评分Ⅱ(APACHE II)和Murray肺损伤评分,并计算氧合指数(Pa O2/Fi O2)以及肺静态肺顺应性(Clst);记录心力衰竭发生率、急性肾衰竭发生率、机械通气时间、ICU停留时间以及28 d病死率。结果两组患者临床资料的比较差异无统计学意义。A组患者在第7天氧合指数、Clst、心率、呼吸频率、PEEP、Pplat、APACHE II评分、Murray肺损伤评分、机械通气时间和ICU停留时间与B组比较差异有统计学意义(P<0.05),平均动脉压、心力衰竭发生率、急性肾衰竭发生率以及28 d病死率两组比较差异无统计学意义(P>0.05)。结论床旁超声测量下腔静脉塌陷指数作为一项无创检查手段,安全,有效,对指导ARDS患者液体管理具有重要的临床意义。更多还原

【Abstract】 Objective To investigate the value of bedside ultrasonographic examination in fluid management of patients with acute respiratory distress syndrome( ARDS). Methods Clinical data of 44 ARDS patients during June2012 and December 2013 were retrospectively analyzed,and the 44 patients were divided into group A( n = 22) and group B( n = 22) according to therapy methods. During fluid management,group A undertook bedside ultrasonographic examination,while group B was given central venous pressure. The values of heart rate,mean arterial pressure,respiratory rate,airway plateau pressure( Pplat),positive end expiratory pressure( PEEP),acute physiology and chronic health evaluation II scores( APACHE II) and Murray score of pulmonary injury between the 1std and the 7thd upon admission in the two groups,and the values of oxygenation index( Pa O2/ Fi O2) and the static lung compliance( Clst) were also calculated; the incidence rates of heart failure and acute renal failure,duration of mechanical ventilation,the length of ICU stay and mortality rate on the 28 thd were recorded. Results No significant difference of the clinical data was found in the two groups. The differences in values of Pa O2/ Fi O2,Clst,heat rate,respiratory rate,PEEP,Pplat,APACHE II scores,Murray scores,duration of mechanical ventilation and length of ICU stay on the 7thd upon admission in group A were statistically significant,compared with those in group B( P < 0. 05),while the differences in values of mean arterial pressure,the incidence rates of heart failure and acute renal failure,and mortality rate on the 28 thd were no statistically significant in the two groups( P > 0. 05). Conclusion Examination of collapsible index of inferior vena cava by bedside ultrasonographic examination is safe,effective and non-invasive,and it may guide the fluid management in patients with acute respiratory distress syndrome.更多还原