摘要目的 探讨血管外肺水指数(EVLWI)和肺血管通透性指数(PVPI)与急性呼吸窘迫综合征(ARDS)柏林定义严重程度分级的关系.方法 对2012年7月至2014年7月收住宁夏医科大学总医院ICU符合ARDS柏林定义的患者70例,依据ARDS柏林定义分为轻度组(20例)、中度组(30例)和重度组(20例).记录患者入院24 h内急性生理和慢性健康状况(APACHEⅡ)评分和序贯器官衰竭(SOFA)评分,脉搏指示剂持续心排血量监测技术(PiCCO)监测3组患者入院1～4dEVLWI和PVPI,并绘制受试者工作特征曲线(ROC曲线),比较ROC曲线下面积(AUC).同步行血气分析并计算氧合指数(OI),分析EVLWI和PVPI与OI的相关性.结果 轻、中和重度组ARDS患者不同时相点EVLWI、PVPI及OI的组间比较:随着ARDS严重程度的分级加重,3组患者任一时相点EVLWI和PVPI均明显升高,OI明显降低(均P＜0.05).轻、中和重度组ARDS患者EVLWI、PVPI及OI动态变化趋势的组内比较:轻度组1～4 d EVLWI和PVPI随时间逐渐下降(均P＜0.05),中度组仅PVPI下降,EVLWI无明显下降(P＞0.05),重度组EVLWI和PVPI均无明显下降趋势(均P＞0.05),而3组1～4 d OI随时间变化均有升高(均P＜0.01).3组ARDS患者1～4 d PVPI对预后评价的AUC分别为0.594、0.643、0.723和0.816,以入院第4天PVPI＞2.95作为判断预后的最佳临界值,其敏感度为70％,特异度为92％.3组所有ARDS患者1～4 d EVLWI和PVPI与OI呈现明显的负相关[(r=-0.685,P=0.000)和(r=-0.631,P=0.000)].结论 EVLWI和PVPI能够良好的反映ARDS柏林定义严重程度分级,且PVPI的动态变化趋势优于EVLWI.

abstractsObjective To explore the correlation of severity classification of acute respiratory distress syndrome (ARDS) by the Berlin definition with extra vascular lung water index (EVLWI) and pulmonary vascular permeability index (PVPI).Methods A total of 70 cases with ARDS at intensive care unit of our hospital from July 2012 to July 2014 were divided into three groups of mild (n =20),moderate (n =30) and severe (n =20) according to the Berlin definition.The scores of acute physiology and chronic health evaluation (APACHE) Ⅱ and sequential organ failure assessment (SOFA) within 24 h of admission were recorded.And the values of EVLWI and PVPI of three groups from Day 1-4 were monitored by pulse indicator continuous cardiac output (PiCCO).Receiver operating characteristic (ROC) curve was drawn for these parameters and the area under curve was compared.Meanwhile blood gas was analyzed and oxygenation index (OI) calculated.And the correlations of EVLWI and PVPI with OI were analyzed.Results Comparisons of EVLWI,PVPI and OI were made for three groups at different timepoints:As the severity of ARDS aggravated,EVLWI and PVPI of three groups increased significantly at any timepoint while OI decreased sharply (P ＜ 0.05).EVLWI and PVPI declined gradually from Day 1-4 in mild ARDS group (P ＜ 0.05),PVPI declined dramatically (P ＜ 0.05) while EVLWI showed no obvious change in moderate ARDS group (P ＞ 0.05).There was no sharp decline of EVLWI or PVPI in severe ARDS group (P ＞ 0.05).And OI increased significantly from Day 1-4 in three groups (P ＜ 0.01).The area under ROC curve (AUC) for PVPI in evaluating the prognosis of three groups was 0.594,0.643,0.723 and 0.816 respectively.PVPI ＞ 2.95 at Day 4 of admission was used as the best threshold value for judging prognosis.And the sensitivity was 70％ and specificity 92％.OI had negative correlation with EVLWI and PVPI in three groups from Day 1-4 [(r=-0.685,P=0.000) and (r=-0.631,P=0.000)].Conclusion Both EVLWI and PVPI reflect adequately the severity of ARDS by the Berlin definition.And the dynamic trend of PVPI is superior to that of EVLWI.