【作者】 胡炜；

【导师】 崔巍；

【作者基本信息】 浙江大学 ， 内科学， 2012， 硕士

【摘要】 目的通过观察两种不同液体管理策略对急性呼吸窘迫综合征(ARDS)患者生存率,ICU住院、机械通气时间,急性肺损伤评分和氧合指数变化的影响,探讨血管外肺水(EVLW)在ARDS患者液体管理中的应用价值,从而探寻ARDS患者的最佳液体管理策略。方法选取2008年5月至2011年9月在我院重症医学科住院的符合纳入标准的ARDS患者27例为研究对象,随机分为限制性液体管理组和开放性液体管理组,每24小时进行一次急性肺损伤评分和氧合指数计算,记录24小时出入量,以28天和60天生存率为主要终点,以ICU住院时间、机械通气时间、急性肺损伤和氧和指数变化为次要终点进行评价。结果两组患者在28天和60天生存率上无明显差异,在ICU住院时间和机械通气时间上限制性液体管理组时间小于开放性液体管理组(P<0.05)；两组患者组内、组间比较,在治疗后不同时间的急性肺损伤评分、氧合指数的差异均有显著的统计学意义(均P<0.05)。结论在ARDS,患者,限制性液体管理与开放性液体管理,虽然在总体生存率上无明显差异,但对急性肺损伤评分和氧合指数上有明显的改善,且在机械通气时间和ICU住院时间上有所缩短。对ARDS患者进行限制性的液体管理,尤其是以EVLW为目标,能为其带来相应的益处。更多还原

【Abstract】 ObjectiveTo discuss the clinical value of extravascular lung water (EVLW) for acute respiratory distress syndrome (ARDS) patients in fluid-management by investigating the effect of two different fluid-management strategies on28days and60days survival rate, ICU days、mechanical ventilation days、acute lung injury score and oxygenation index to find the optimal fluid-management in ARDS patients.MethodsA total of27patients with acute respiratory distress syndrome (ARDS) in our ICU department from May2008to September2011met the inclusion criteria were selected as research objects. They were randomly assigned to restricted fluid management strategy group and liberal fluid management strategy group, acute lung injury score. Oxygenation index were measured per24h,the volume of24h fluid balance was recorded,28-day and60-day survival rates were as the primary end points, mechanical ventilation days and ICU days were as secondary end points.ResultsThere is no significant difference in28-day and60-day survival rate between two groups, however ICU days and mechanical ventilation days were much shorter in restricted fluid management strategy group than in liberal fluid management strategy group (P<0.05);acute lung injury score and oxygenation index both showed a significantly statistical difference during the treatment in and between groups (P<0.05)ConclusionAlthough there is no marked difference in survival rate between restricted fluid management strategy and liberal fluid management strategy for ARDS patients, the restricted fluid management strategy can greatly improve the acute lung injury score and oxygenation index, shorten the days of mechanical ventilation and ICU days. Restricted fluid management strategy for ARDS patients, especially with target of EVLW, is an effective approach to many corresponding benefits.更多还原