急性呼吸窘迫征患者液体平衡与预后的相关性研究

沈剑 钱娇 王君兰

【摘 要】 目的：分析急性呼吸窘迫綜合征（ARDS）患者液体平衡与预后的相关性，探讨ARDS患者液体平衡控制在其诊治中的临床意义。方法：选择医院2016年1月至2018年1月收治的106例ARDS患者作为研究对象。所有患者均由同一组医师团队严格按照指南推荐治疗方案进行治疗，统计不同时间段心输出量、氧合指数、液体出入量变化，采用Pearson分析确诊为ARDS后第1d、第2d、第7d液体量与CO、氧合指数的相关性。按照确诊为ARDS后不同时间点液体平衡正负将其分为液体正平衡组与负平衡两组，比较液体正平衡与负平衡患者存活率，分析与死亡率相关性。结果：106例死亡72例，死亡率67.92%。确诊治疗后第1d、第2d、第7d患者的CO、氧合指数逐渐增加，液体出入量明显降低，不同时间点比较差异有统计学意义（P<0.05）。Pearson分析显示，液体总出入量与CO、氧合指数呈负相关（r=-0.582、-0.718）。不同时间段液体正平衡患者存活率明显低于负平衡组患者（P<0.05），液体负平衡与死亡呈负相关（r=-0.865、-0.792、-0.738）。结论：ARDS患者液体平衡与患者心脏功能、呼吸功能关键指标关系密切，可客观反应患者心肺功能，液体平衡情况与患者预后高度相关，加强液体平衡控制对患者预后具有重要临床意义。

【关键词】 急性呼吸窘迫综合征；液体平衡；预后；相关性

[Abstract] Objective：To analyze the correlation between fluid balance and prognosis in patients with acute respiratory distress syndrome （ARDS） and to explore the clinical significance of fluid balance control in patients with ARDS. Methods：A total of 106 patients with ARDS who were hospitalized from January 2016 to January 2018 were selected as study subjects.All patients were treated by the same group of doctors in strict accordance with the guidelines recommended treatment program，statistics of cardiac output，oxygenation index， liquid in and out changes at different time intervals， using the pearson analysis confirmed as 1d， 2d， 7d after the ARDS liquid Quantity and CO， oxygenation index correlation.According to positive and negative fluid balance at different time points after diagnosis of ARDS， they were divided into two groups： positive fluid balance group and negative fluid balance group.The survival rate of patients with positive fluid balance and negative fluid balance was compared and the correlation with mortality was analyzed. Results：There were 72 deaths in 106 cases， and the mortality rate was 67.92%.The CO and oxygenation index of the patients on the 1st， 2nd， and 7th days after the diagnosis were gradually increased， and the amount of fluid in and out of the patients was significantly decreased.There was a statistically significant difference at different time points （P<0.05）. Pearson analysis showed a negative correlation between total liquid influx and CO and oxygenation index （r=-0.582，-0.718）.The survival rate of patients with positive fluid balance at different time periods was significantly lower than that of patients with negative balance （P<0.05）， and the negative balance of fluids was negatively correlated with death （r=-0.865， -0.792， -0.738）. Conclusion： The fluid balance of patients with ARDS is closely related to the key indicators of cardiac function and respiratory function， which can objectively reflect the patient's cardiopulmonary function.The fluid balance is highly related to the prognosis of patients.Strengthening fluid balance control has important clinical significance for the prognosis of patients.

[Key words]Acute respiratory distress syndrome； Liquid balance； Prognosis； Relevance

急性呼吸窘迫综合征（Acute respiratory distress syndrome ，ARDS）为多种严重疾病的常见并发症，具有高死亡率和致残率。目前临床较为明确的导致ARDS死亡的危险因素有：高APAcHEⅡ评分、多脏器功得、脓毒症、难以纠正的休克和低氧血症，这些因素可对患者的预后做出一定准确程度的预测[1]。但其预测预后的准确程度仍然不足以指导临床诊治，可能与ARDS的诱发因素和预后因素众多相关。近年来，ARDS的液体平衡与患者预后之间存在的密切关系得到临床的高度重视[2]。本研究探讨液体平衡与ARDS患者预后的相关性，以期为ARDS的诊治提供一定的参考。现将结果报道如下。

1 资料与方法

1.1 临床资料

选择医院2016年1月至2018年1月收治的106例ARDS患者作为研究对象。……