Application value analysis of the reliability of extravascular lung water index and pulmonary vascular permeability index in evaluating the severity of acute respiratory distress syndrome

doi:10.3877/cma.j.issn.1674-6902.2017.05.010

Abstract

Abstract:

Objective

To analysis the application of the reliability of extravascular lung water index(EVLWI) and pulmonary vascular permeability index(PVPI) in evaluating the severity of acute respiratory distress syndrome(ARDS), and to discuss the value of EVLWI and PVPI on the prognosis of ARDS.

Method

A summary of 22 patients with ARDS in ICU of our hospital from June 2015 to December 2016, were chosed as our experimental objects. All the clinical data were collected and classified. All the patients were devided into three groups according to 2012 Berlin standard of ARDS: the mild group(n=8), the moderate group(n=6), the severe group(n=8). The levels of EVLWI, PVPI, cardiac index(CI) and intrathoracic blood volume index(ITBVI) of three groups in pre-therapy, 24 h after therapy and 72 h after therapy were measured by pulse indicator continuous cardiac output technology (PICCO) and compared. With EVLWI=13 ml/Kg and PVPI=3 as limits, the duration of hospital in ICU, mortality rate of ICU and mortality rate of 28 d after therapy of the three groups were assessed and compared in patients with different levels of EVLWI and PVPI.

Results

In 24 h after therapy and 72 h after therapy, the levels of EVLWI, PVPI of the moderate group and severe group were significantly higher than these of the mild group, respectively, and the levels of EVLWI, PVPI of the severe group were evidently higher than these of the moderate group, P<0.05. The duration of hospital in ICU(23.6±6.6)d, mortality rate of ICU(69.2%) and mortality rate of 28 d (76.9%) after therapy of the high EVLWI group were remarkably higher than these of the low EVLWI group((15.3±5.2)d, 33.3%, 44.4%), P<0.05. The duration of hospital in ICU(24.3±6.5)d, mortality rate of ICU (57.1%) and mortality rate of 28 d (78.6%) after therapy of the high PVPI group were remarkably higher than these of the low PVPI group(16.4±4.2)d, 25.0%, 37.5%), P<0.05.

Conclusion

EVLWI and PVPI levels are important indicators of the severity of the disease in patients with ARDS, and high levels of EVLWI and PVPI are associated with a poor prognosis.

Key words: Acute respiratory distress syndrome, Extravascular lung water index, Pulmonary vascular permeability index

Yifeng Cai, Keshu Chen, Jiawei Chen, Wenyang Cai. Application value analysis of the reliability of extravascular lung water index and pulmonary vascular permeability index in evaluating the severity of acute respiratory distress syndrome[J]. Chinese Journal of Lung Diseases(Electronic Edition), 2017, 10(05): 554-558.

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Figures/Tables 4

References 22

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组　别	例数	性别(男/女)	年龄(岁)	收缩压(mmHg)	舒张压(mmHg)
轻度组	8	4/4	43.6±14.3	112.8±16.3	71.2±11.2
中度组	6	4/2	44.2±13.5^a	113.6±15.9^a	72.0±12.1^a
重度组	8	5/3	44.1±14.1^ab	113.9±16.4^ab	71.8±11.6^ab
组　别	例数	总胆固醇(mmol/L)	甘油三脂(mmol/L)	PaO₂/FiO₂(mmHg)	PEEP(cmH₂O)
轻度组	8	1.46±0.52	2.88±0.62	241.6±34.5	5.6±2.3
中度组	6	1.47±0.63^a	2.83±0.57^a	157.8±42.3^c	8.8±4.5^c
重度组	8	1.46±0.58^ab	2.86±0.59^ab	70.9±11.3^cd	13.7±4.5^cd

组　别	例数	性别(男/女)	年龄(岁)	收缩压(mmHg)	舒张压(mmHg)
轻度组	8	4/4	43.6±14.3	112.8±16.3	71.2±11.2
中度组	6	4/2	44.2±13.5^a	113.6±15.9^a	72.0±12.1^a
重度组	8	5/3	44.1±14.1^ab	113.9±16.4^ab	71.8±11.6^ab
组　别	例数	总胆固醇(mmol/L)	甘油三脂(mmol/L)	PaO₂/FiO₂(mmHg)	PEEP(cmH₂O)
轻度组	8	1.46±0.52	2.88±0.62	241.6±34.5	5.6±2.3
中度组	6	1.47±0.63^a	2.83±0.57^a	157.8±42.3^c	8.8±4.5^c
重度组	8	1.46±0.58^ab	2.86±0.59^ab	70.9±11.3^cd	13.7±4.5^cd

组　别	例数	时间	EVLWI(ml/Kg)	PVPI	CI(ml/min×m²)	ITBVI(ml/m²)
轻度组	8	治疗前	12.1±2.1	2.4±0.4	5.1±0.7	1 110±372
?	?	治疗后24 h	9.8±2.8	2.2±0.9	5.1±0.6	1 060±332
?	?	治疗后72 h	9.8±2.4	1.6±0.5	5.0±1.0	1 096±310
中度组	6	治疗前	15.6±1.3^a	3.1±1.5^a	4.9±1.6^c	1 088±364^c
?	?	治疗后24 h	13.8±2.0^a	3.1±1.4^a	5.0±1.0^c	1 042±346^c
?	?	治疗后72 h	13.4±3.1^a	3.1±1.8^a	5.1±1.3^c	1 073±263^c
重度组	8	治疗前	19.2±2.5^ab	4.0±2.1^ab	5.1±1.4^cd	1 065±357^cd
?	?	治疗后24 h	17.3±2.9^ab	3.9±1.6^ab	4.8±1.5^cd	1 076±302^cd
?	?	治疗后72 h	18.1±2.2^ab	4.1±2.1^ab	5.0±1.3^cd	1 048±284^cd

组　别	例数	时间	EVLWI(ml/Kg)	PVPI	CI(ml/min×m²)	ITBVI(ml/m²)
轻度组	8	治疗前	12.1±2.1	2.4±0.4	5.1±0.7	1 110±372
?	?	治疗后24 h	9.8±2.8	2.2±0.9	5.1±0.6	1 060±332
?	?	治疗后72 h	9.8±2.4	1.6±0.5	5.0±1.0	1 096±310
中度组	6	治疗前	15.6±1.3^a	3.1±1.5^a	4.9±1.6^c	1 088±364^c
?	?	治疗后24 h	13.8±2.0^a	3.1±1.4^a	5.0±1.0^c	1 042±346^c
?	?	治疗后72 h	13.4±3.1^a	3.1±1.8^a	5.1±1.3^c	1 073±263^c
重度组	8	治疗前	19.2±2.5^ab	4.0±2.1^ab	5.1±1.4^cd	1 065±357^cd
?	?	治疗后24 h	17.3±2.9^ab	3.9±1.6^ab	4.8±1.5^cd	1 076±302^cd
?	?	治疗后72 h	18.1±2.2^ab	4.1±2.1^ab	5.0±1.3^cd	1 048±284^cd

组　别	例数	ICU住院时间/d	ICU病死率	28 d病死率
高EVLWI组	13	23.6±6.6	9(69.2)	10(76.9)
低EVLWI组	9	15.3±5.2	3(33.3)	4(44.4)
t/χ²	?	4.04	5.12	3.98
P值	?	P<0.05	P<0.05	P<0.05

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