【2017年整理】创伤后毛细血管渗漏综合征的.doc

PAGE 创伤后毛细血管渗漏综合征的 血流动力学变化规律及意义 Hemodynamic Changes and Significance of Post-Traumatic Capillary Leak Syndrome 杨万杰 任朝来 张如梅 YANG Wan-jie REN Chao-lai ZHANG Ru-mei. 天津市第五中心医院（中国 300450） Department of Intensive Care Unit ,the Fifth Center Hospital in Tian jin（China 300450） 中图分类号：R641 文献标识码：A 文章编号：1818－0086（2009）06 摘要：目的 用脉搏指示的连续心排量（PiCCO）监护仪分析创伤后毛细血管渗漏综合征（CLS）血流动力学变化规律及意义。方法 回顾分析36例创伤后CLS患者，根据其预后分为存活组和死亡组，另设对照组20例。分析各组手术后液体平衡量、胸内血容积指数（ITBI）和血管外肺水指数（ELWI）在组内和组间的差异及相关性。结果 ①术后当天，存活组外周组织水肿明显，ITBI降低， ELWI较对照组无增高（P＞0.05）。②术后第2天和第3天， 存活组ITBI达到正常范围，ELWI则超出正常范围（P 0.01）。③术后第4天，存活组ITBI增高， 但ELWI较第3天降低（P 0.01）。④死亡组术后各天ITBI均低于正常组和对照组，而ELWI持续增高（P 均 0.01）。⑤存活组术后第0~3天，ITBI与ELWI呈正相关（r = 0.789，P 0.01），术后第4~5天，两参数无相关。对照组和死亡组在术后不同时期两参数均无相关。结论 创伤后CLS患者的不同时期，肺循环与体循环之间存在特殊的变化规律，在指导液体治疗和判断预后方面有重要临床意义。 关键词：创伤；毛细血管渗漏综合征；脉搏指示的连续心排量；血流动力学 Abstract： Objective To investigate hemodynamic changes and significance of post-traumatic capillary leak syndrome (CLS) by pulse index continuous cardiac output (PiCCO) monitor. Methods Retrospectively analyze 36 cases with post-traumatic CLS, we divided the patients into survival group and death group according to their prognosis, and at the same time we set up control group of 20 cases. We analyzed the difference and relevance of fluid balance, intrathoracic blood volume index (ITBI) and extravascular lung water index (ELWI) among the three groups. Results ①Severe generalized edema and decreased ITBI appeared in the survival group on the day of surgery, and the ELWI was not higher than the control group (P＞0.05). ②On the second day and the third day after surgery, the ITBI reached the normal range and the ELWI exceeded the normal range in the survival group (P 0.01). ③On the fourth day, the ITBI increased, but the ELWI decreased in the survival group compared with the third day (P 0.01). ④The ITBI in the dead group was lower than those in the survival group and the control group. The ELWI in the dead group increased continually (all P 0.