不同液体管理策略对ARDS疗效的对照研究

Effect of different liquid management strategies on the prognosis of acute respiratory distress syndrome

关键词:  保守性液体管理策略  开放性液体管理策略  急性呼吸窘迫综合征（ARDS）  血管外肺水（EVLW）  预后

Key words:  [Key words] 　conservative fluid management strategy  open liquid management strategy  acute respiratory distress syndrome (ARDS)  extravascular lung water(EVLW)  prognosis

摘要:

目的　探讨不同液体管理策略对急性呼吸窘迫综合征（ARDS）预后的影响。方法　将2008年7月—2012年7月间入住大连大学附属中山医院的100例按1994年欧美联席会议所提出的诊断标准诊断，将ARDS患者随机分为保守性液体管理策略（CFMS）组与开放性液体管理策略（LFMS）组，各50例。对两组血管外肺水（EVLW）、死亡例数、机械通气时间以及住ICU的时间、术后患者生活质量等进行比较。结果　（1）CFMS组每日液体入量明显少于LFMS组（P<0.05），而液体出量明显大于LFMS组（P<0.05）；CFMS组每日出入量之间的差值均小于LFMS组（P<0.05）；CFMS组EVLW下降速度明显快于LFMS组（P<0.05）。（2）CFMS组与LFMS组病死率差异无显著性意义（P>0.05），但CFMS组机械通气时间、住ICU时间均明显小于LFMS组（P<0.05）。（3）根据QLQC-30生活质量评价标准，CFMS组各项得分均明显高于LFMS组（P<0.05）。结论　保守性液体管理策略在一定程度上能更好地降低患者EVLW，提高患者生活质量。

Abstract:

[Abstract] Objective　To study the effect of different fluid-management strategies on the patients with acute respiratory distress syndrome (ARDS). Methods　The patients (100 cases) with ARDS in our hospital from July 2008 to July 2012 were randomly divided into two groups: group CFMS (50 cases) and group LFMS (50 cases). The EVLW，mortality rate，mechanical ventilation time, ICU time and postoperative patients quality of life between the two groups were compared. Results　(1) the volume of liquid intake of the group CFMS in 24 hours was less than the group LFMS (P<0.05), the volume of liquid outtake of group CFMS in 24 hours was much more than the group LFMS (P<0.05). The dropping speed of EVLW in group CFMS was faster than the group LFMS LS (P<0.05). (2) The mortality rate between the two groups had no statistical difference (P>0.05), but mechanical ventilation time and ICU time of LFMS group were significantly less than CFMS group (P<0.05). (3) According to the QLQC-30 life quality evaluation standard, the quality indexes of the group LFMS were significantly higher than the CFMS group (P<0.05). Conclusion　The conservative fluid management strategy is much better to reduce lung water outside blood vessels and improves pulmonary function and life quality to some extent.