發(fā)布時(shí)間：2018-05-05 04:10

  本文選題：急性呼吸窘迫綜合征 + 血管外肺水指數(shù)��； 參考：《濱州醫(yī)學(xué)院》2014年碩士論文

【摘要】：目的分析血管外肺水指數(shù)(EVLWI)、腫瘤壞死因子-α(TNF-α)、E-選擇素、血管抑制因子-2與急性呼吸窘迫綜合征(ARDS)的相關(guān)性,判斷EVLWI與TNF-α、E-選擇素的相關(guān)性,探討EVLWI、TNF-α、E-選擇素、血管抑制因子-2在ARDS病情嚴(yán)重程度及預(yù)后判斷的參考價(jià)值。方法選擇淄博市中心醫(yī)院2013年1月至12月期間收治的ARDS患者(有36例患者入選),進(jìn)行PICCO監(jiān)測(cè),根據(jù)PICCO監(jiān)測(cè)指標(biāo)EVLWI的高低分為兩組,EVLWI ≥14ml/kg組和EVLWI/14ml/kg組,監(jiān)測(cè)記錄患者EVLWI、PVPI、CI、ITBVI等血流動(dòng)力學(xué)指標(biāo),觀察患者血?dú)夥治鼋Y(jié)果記錄氧合指數(shù)、計(jì)算APACHE Ⅱ評(píng)分,應(yīng)用ELISA方法檢測(cè)兩組患者血清TNF-α、E-選擇素、血管抑制因子-2(Vasostatin-2)水平。結(jié)果1. EVLWI≥14l/kg組患者APACHE Ⅱ評(píng)分值、28天病死率、ICU住院時(shí)間均較EVLWI14ml/kg組高,同時(shí)血清TNF-α、E-選擇素的水平也較EVLWI14ml/kg組高,氧合指數(shù)較EVLWI14ml/kg組低,差異均具有統(tǒng)計(jì)學(xué)意義(P均03333301)。2.分析兩組中28天內(nèi)仍存活的20例患者(存活組),在入組后經(jīng)72小時(shí)積極治療后EVLWI明顯下降,氧合指數(shù)較前升高,且TNF-α、 E-選擇素水平均較前下降,差異均有統(tǒng)計(jì)學(xué)意義(P均0.01)。而死亡組16例患者經(jīng)72小時(shí)積極治療后EVLWI、 TNF-α、E-選擇素水平較前無下降,氧合指數(shù)較前無改善,差異無統(tǒng)計(jì)學(xué)意義(P均0.05)。3. EVLWI與PVPI、EVLWI與TNF-α、EVLWI與E-選擇素均呈顯著正相關(guān)(P均0.01),EVLWI與氧合指數(shù)有明顯負(fù)相關(guān)關(guān)系(P0.01)。結(jié)果顯示兩組患者血管抑制因子-2水平無統(tǒng)計(jì)學(xué)差異(p0.05)。結(jié)論ARDS患者EVLWI與TNF-α、E-選擇素均具有相關(guān)性,EVLWI、TNF-α、E-選擇素水平越高患者28天病死率越高、ICU住院時(shí)間越長。EVLWI、TNF-α、E-選擇素可以對(duì)ARDS病情嚴(yán)重程度及預(yù)后判斷提供參考價(jià)值。本研究顯示血管抑制因子-2與EVLWI水平無相關(guān)性。
[Abstract]:Objective to analyze the correlation between extravascular pulmonary water index (EVLWIJ), tumor necrosis factor- 偽 (TNF- 偽) -Eselectin (TNF- 偽), vascular suppressor factor (-2) and acute respiratory distress syndrome (ARDS), to determine the correlation between EVLWI and TNF- 偽 -Eselectin, and to explore the relationship between EVLWI- 偽 TNF- 偽 E-selectin (EVLWI- 偽 TNF- 偽 Eselectin) and acute respiratory distress syndrome (ARDS). The reference value of vascular suppressor-2 in the severity and prognosis of ARDS. Methods 36 patients with ARDS admitted from January to December 2013 in Zibo Central Hospital were selected for PICCO monitoring. According to the PICCO monitoring index, EVLWI was divided into two groups: EVLWI 鈮，

本文編號(hào)：1846124