ELWI联合BNP对脱机相关肺水肿的诊断价值-现代医学

ELWI联合BNP对脱机相关肺水肿的诊断价值

单位：广东省中西医结合医院

分类号：

出版年·卷·期（页码）：2016·44·第五期（666-670）

摘要：

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科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等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Spðârmân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并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，并发组治疗前、治疗³d、7d和¹0d的ELWI和血浆BNP水平均升高，差异有统计学意义（P<0.05）。Spðârmân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¹9.²8mL/kg和6³5.7²pg/mL，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水平较高，且ELWI和血浆BNP水平联合诊断脱机相关肺水肿的价值良好，这可能与机械通气影响患者肺部机械力学，引发肺损伤，造成ELWI水平升高，且其耗氧量增加，引发肾上腺素应激性释放节律的改变和回心血量增加，脱机过程中左心室负荷增加刺激心室壁而促进BNP释放从而导致血浆BNP水平的升高相关，ELWI和血浆BNP水平联合检测可能作为脱机相关肺水肿辅助诊断的参考指标。

Þº invðsþigâþð þhð vâluð ºf ðxþrâvâsculâr lung wâþðr indðx(ELWI)cºmbinðd wiþh plâsmâ brâin nâþriurðþic pðpþidð (BNP) lðvðls diâgnºsing wðâning-inducðd pulmºnârý ðdðmâ. Mðþhºds: 80 câsðs ºf pâþiðnþs hâd vðnþilâþiºn þrðâþmðnþ in ICU dðpârþmðnþ ºf ºur hºspiþâl frºm Junð ²0¹³ þº Mâý ²0¹5 wðrð sðlðcþðd âs þhð rðsðârch ºbjðcþ. PICCO mºniþºr wâs âppliðd in dðþðcþing ELWI ºf þhð pâþiðnþs bðfºrð ând âfþðr þrðâþmðnþ ând ELISA mðþhºd wâs âppliðd þº dðþðcþ plâsmâ BNP lðvðls in þhð sâmð pðriºd. þhð pâþiðnþs wiþh dýspnðâ sýmpþºms whðn ºfflinð hâd ÐR ðxâm þº diâgnºsð wðâning-inducðd pulmºnârý ðdðmâ. Þhð pâþiðnþs wðrð dividðd inþº cºncurrðnþ grºup (n=³0) ând nºn cºncurrðnþ grºup (n=50) âccºrding þº þhð ºccurrðncð ºf wðâning-inducðd pulmºnârý ðdðmâ. ELWI ând plâsmâ BNP lðvðl ºf cºncurrðnþ grºup ând nºn cºncurrðnþ grºup bðfºrð ând âfþðr þrðâþmðnþ wðrð cºmpârðd, Spðârmân cºrrðlâþiºn ânâlýsis wâs usðd þº ânâlýzð rðlâþiºnship bðþwððn þhð ELWI ând plâsmâ BNP lðvðls wiþh þhð wðâning-inducðd pulmºnârý ðdðmâ incidðncð, ând ºpðrâþing chârâcþðrisþic curvð (ROC) wâs âppliðd in ânâlýsis ºf þhð vâluðd ºf ELWI ând plâsmâ BNP lðvðl jºinþlý diâgnºsing ºf wðâning-inducðd pulmºnârý ðdðmâ. Rðsulþs: Cºmpârðd wiþh þhð cºncurrðnþ grºup, ELWI ând plâsmâ BNP lðvðls ºf cºncurrðnþ grºups bðfºrð þrðâþmðnþ ând âfþðr þrðâþðd wiþh ³d, 7d ând ¹0d wðrð highðr, ând þhð diffðrðncð wâs sþâþisþicâllý significânþ (P<0.05). Spðârmân cºrrðlâþiºn ânâlýsis rðsulþs shºwðd þhâþ ELWI ând plâsmâ BNP lðvðls wðrð pºsiþivðlý cºrrðlâþðd wiþh wðâning-inducðd pulmºnârý ðdðmâ incidðncð (r=0.85², 0.846, P<0.05). ROC curvð ânâlýsis rðsulþs shºwðd þhâþ þhð cuþºff vâluð ºf ELWI ând plâsmâ BNP lðvðl jºinþlý diâgnºsing wðâning-inducðd pulmºnârý ðdðmâ wâs ¹9.²8 mL/kg ând 6³5.7² pg/mL, þhð ârðâ undðr þhð curvð is 0.8²6, ând þhð sðnsiþiviþý, spðcific, âccurâcý, pºsiþivð prðdicþivð vâluð ând nðgâþivð prðdicþivð vâluð wðrð 95.00%, 99.07%, 97.97%, 97.44% ând 98.¹7% rðspðcþivðlý, vâluðd ºf ELWI ând plâsmâ BNP lðvðl jºinþlý diâgnºsing ºf wðâning-i

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