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目的血管外肺水指数(EVLWI)和肺毛细血管通透性指数(PVPI)在急性脑梗死并发神经源性肺水肿(NEP)患者中的动态监测及临床意义。方法收集2012年6月~2014年3月收入本院的45例急性脑梗死并发神经源性肺水肿(NEP)患者,在常规治疗的基础上运用脉搏指数持续心输出量监护仪(PICCO)进行血流动力学监测,监测在发病第1、3、5和7 d血流动力学指标EVLWI、PVPI、CI、SVRI、d Pmax、CFI、GEDI、和ITBV的动态变化,并分析发病第3 d EVLW与GCS、PVPI的相关性。结果第3 d EVLWI开始升高,然后逐渐升高,至第7 d达到9.8±0.6,与第1 d比较具有明显差异(P<0.05);患者发病第3 d EVLWI与GCS评分呈正相关(r=0.517,P<0.05),与肺毛细血管通透性呈负相关(r=-0.5,P≤0.05)。结论急性重症脑梗死患者EVLWI明显升高,病情越重EVLWI水平越高,神经源性肺水肿(NEP)是急性重症脑梗死患者严重的并发症;EVLWI与肺毛细血管通透性指数以及脑梗死严重程度密切相关。
Objective To investigate the dynamic monitoring and clinical significance of extravascular lung water index (EVLWI) and pulmonary capillary permeability index (PVPI) in patients with acute cerebral infarction complicated with neurogenic pulmonary edema (NEP). Methods Forty-five patients with acute cerebral infarction complicated with neurogenic pulmonary edema (NEP) admitted to our hospital from June 2012 to March 2014 were enrolled in this study. The patients were followed up on a routine basis with a pulse rate continuous cardiac output monitor (PICCO) Hemodynamic monitoring was performed to monitor the dynamic changes of hemodynamics EVLWI, PVPI, CI, SVRI, d Pmax, CFI, GEDI and ITBV on the 1st, 3rd, 5th and 7th days of onset. EVLW and GCS, PVPI relevance. Results On the third day, EVLWI began to increase and then gradually increased to 9.8 ± 0.6 on the 7th day, which was significantly different from that on the 1st day (P <0.05). EVLWI was positively correlated with the GCS score on the 3rd day = 0.517, P <0.05) and negatively correlated with pulmonary capillary permeability (r = -0.5, P≤0.05). Conclusion The EVLWI in patients with acute severe cerebral infarction was significantly higher than that in patients with more severe EVLWI. Neurogenic pulmonary edema (NEP) was a serious complication in patients with acute severe cerebral infarction. EVLWI was associated with pulmonary capillary permeability index and cerebral infarction The severity is closely related.