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目的:探讨血管外肺水指数(ELWI)联合血浆脑钠肽(BNP)水平对脱机相关肺水肿的诊断价值。方法:选取2013年6月至2015年5月于我院ICU进行通气治疗的患者80例为研究对象,采用PICCO监测患者治疗前后的ELWI并采用ELISA法检测同期血浆BNP水平,对脱机时出现呼吸困难症状患者进行床边摄胸片检查确诊脱机相关肺水肿的发生情况,根据患者脱机相关肺水肿发生情况分为并发组(n=30)和非并发组(n=50)。比较并发组和非并发组治疗前后的ELWI和血浆BNP水平,采用Spearman相关分析法分析ELWI和血浆BNP水平与脱机相关肺水肿发生率的关系,采用受试者操作特性曲线(ROC)分析ELWI和血浆BNP水平联合诊断脱机相关肺水肿的价值。结果:与非并发组比较,并发组治疗3、7和10 d的ELWI和血浆BNP水平均升高,差异有统计学意义(P<0.05)。Spearman相关分析结果显示,ELWI和血浆BNP水平与脱机相关肺水肿发生率均呈正相关(r=0.852、0.846,P<0.05)。ROC曲线分析结果显示,ELWI和血浆BNP水平联合诊断脱机相关肺水肿的临界值为19.28 ml·kg-1和635.72 pg·ml-1,曲线下面积为0.826,敏感度、特异度、准确性、阳性预测值和阴性预测值分别为95.00%、99.07%、97.97%、97.44%和98.17%,ELWI和血浆BNP水平联合诊断脱机相关肺水肿的价值良好。结论:脱机相关肺水肿患者的ELWI和血浆BNP水平联合诊断脱机相关肺水肿的价值良好,可能作为脱机相关肺水肿辅助诊断的参考指标。
Objective: To investigate the value of extravascular lung water index (ELWI) combined with plasma brain natriuretic peptide (BNP) in the diagnosis of off-line pulmonary edema. Methods: From June 2013 to May 2015, 80 patients with ventilator in ICU of our hospital were selected as research objects. The ELWI of patients before and after treatment was monitored by PICCO and plasma BNP level was measured by ELISA. Patients with dyspnoea who underwent bedside radiographs to diagnose the occurrence of offline pulmonary edema were divided into concurrent group (n = 30) and non-concurrent group (n = 50) according to the incidence of offline pulmonary edema. ELWI and plasma BNP levels in both concurrent and non-concurrent groups were compared. Spearman correlation analysis was used to analyze the association between ELWI and plasma BNP levels and the incidence of offline-associated pulmonary edema. Eligible participants were analyzed by ROC, And plasma BNP levels in the diagnosis of off-line pulmonary edema. Results: Compared with the non-concurrent group, the levels of ELWI and plasma BNP in the concurrent group at 3, 7 and 10 d after treatment were significantly increased (P <0.05). Spearman correlation analysis showed that ELWI and plasma BNP levels were positively correlated with the incidence of off-line related pulmonary edema (r = 0.852,0.846, P <0.05). ROC curve analysis showed that the critical value of ELWI and plasma BNP levels in diagnosing off-line pulmonary edema was 19.28 ml · kg-1 and 635.72 pg · ml-1, respectively. The area under the curve was 0.826. The sensitivity, specificity and accuracy , The positive predictive value and negative predictive value were 95.00%, 99.07%, 97.97%, 97.44% and 98.17%, respectively. The value of ELWI and plasma BNP in the diagnosis of stroke-associated pulmonary edema was good. Conclusions: The combination of ELWI and plasma BNP levels in patients with offline-associated pulmonary edema may be of value in the diagnosis of offline-associated pulmonary edema and may serve as a reference for the diagnosis of offline-associated pulmonary edema.