本文選題：ARDS + 氧合指數(shù)�。� 參考：《廣西醫(yī)科大學(xué)》2012年碩士論文

【摘要】：目的探討急性呼吸窘迫綜合征(ARDS)患者氧合指數(shù)與血管外肺水的相關(guān)性,研究ARDS患者用血管外肺水來反映其氧合情況,應(yīng)用血管外肺水新指標(biāo)代替氧合指數(shù),更科學(xué)地指導(dǎo)ICU護(hù)士對(duì)ARDS患者的監(jiān)護(hù),減輕病人的痛苦,減少病人成本費(fèi)用、降低護(hù)士的工作量。 方法本實(shí)驗(yàn)納入2010年1月至2011年12月收住于廣西醫(yī)科大學(xué)第一附屬醫(yī)院重癥醫(yī)學(xué)科二區(qū)行脈搏輪廓溫度稀釋連續(xù)心輸出量測量技術(shù)(PiCCO)監(jiān)測的急性呼吸窘迫綜合征(ARDS)患者43例作為研究對(duì)象。入住后收集患者一般情況資料包括性別、年齡、職業(yè)、婚姻狀況、文化程度、經(jīng)濟(jì)狀況、原發(fā)病、病情危重程度、治療方法等。收治我科后利用多功能監(jiān)護(hù)儀常規(guī)監(jiān)測患者的心率、血壓、呼吸頻率、血氧飽和度(SPO2)。入住我科24h內(nèi),征得患者及家屬同意,排除禁忌癥后行脈搏輪廓溫度稀釋連續(xù)心輸出量測量(PiCCO)監(jiān)測。利用經(jīng)肺熱稀釋技術(shù)監(jiān)測患者的非連續(xù)性參數(shù)：全心舒張末期容積(GEDV)、胸腔內(nèi)血容量(ITBV)、血管外肺水(EVLW)、肺血管通透性指數(shù)(PVPI)。每8小時(shí)用經(jīng)肺熱稀釋測定作一次校正。在患者出現(xiàn)連續(xù)心排血量變化與病情變化較大時(shí)加測校正一次。ARDS患者在每次經(jīng)肺熱稀釋監(jiān)測全心舒張末期容積(GEDV)、胸腔內(nèi)血容量(ITBV)、血管外肺水(EVLW)、肺血管通透性指數(shù)(PVPI)時(shí),護(hù)士穿刺橈動(dòng)脈行血?dú)夥治?通過PaO2/FiO2來計(jì)算其氧合指數(shù)(OI)。同時(shí)記錄多功能監(jiān)護(hù)儀監(jiān)測到的患者的心率、平均動(dòng)脈壓、呼吸頻率、血氧飽和度(SPO2)。另外記錄ARDS患者行血?dú)夥治�、PiCCO監(jiān)測的次數(shù),計(jì)算ARDS患者行血?dú)夥治觥iCCO監(jiān)測的成本費(fèi)用。 收集病人相關(guān)資料,建立數(shù)據(jù)庫,運(yùn)用描述性分析、t檢驗(yàn)、方差分析、卡方檢驗(yàn)、回歸與相關(guān)、多元線性回歸分析等統(tǒng)計(jì)方法,對(duì)ARDS病人的氧合指數(shù)(OI)、全心舒張末期容積(GEDV)、胸腔內(nèi)血容量(ITBV)、血管外肺水(EVLW)、肺血管通透性指數(shù)(PVPI),呼吸頻率、血氧飽和度(SPO：)、平均動(dòng)脈壓進(jìn)行分析。另外統(tǒng)計(jì)分析ARDS患者行血?dú)夥治�、PiCCO監(jiān)測的次數(shù),比較ARDS患者行血?dú)夥治觥iCCO監(jiān)測的成本費(fèi)用。 結(jié)果 1、ARDS氧合指數(shù)相關(guān)因素的Pearson單因素分析ARDS患者氧合指數(shù)與血氧飽和度呈正相關(guān)(p0.05)；ARDS患者氧合指數(shù)與呼吸頻率、血管外肺水、肺血管通透性指數(shù)負(fù)相關(guān)(p0.05)；與心率、平均動(dòng)脈壓、胸腔內(nèi)血容量、全心舒張末期容積無關(guān)(p0.05)。 2、ARDS患者氧合指數(shù)與相關(guān)因素的簡單線性回歸分析ARDS患者氧合指數(shù)與呼吸頻率、血氧飽和度、血管外肺水、肺血管通透性指數(shù)存在直線關(guān)系(P0.05),氧合指數(shù)與心率、平均動(dòng)脈壓、胸腔內(nèi)血容量、全心舒張末期容積無關(guān)(P0.05)。 3、ARDS患者氧合指數(shù)相關(guān)因素的多元線性回歸分析ARDS患者氧合指數(shù)與平均動(dòng)脈壓、血管外肺水、肺微血管通透性指數(shù)線性回歸關(guān)系有統(tǒng)計(jì)學(xué)意義(p0.05),ARDS患者氧合指數(shù)與平均動(dòng)脈壓、血管外肺水、肺微血管通透性指數(shù)具有顯著相關(guān)性。 4、ARDS患者血管外肺水相關(guān)因素的多元線性回歸分析ARDS患者血管外肺水與肺血管通透性指數(shù)線性回歸關(guān)系有統(tǒng)計(jì)學(xué)意義(p0.05),胸腔內(nèi)血容量、全心舒張末期容積對(duì)ARDS患者血管外肺水無影響(p0.05)。 5、血?dú)夥治霰O(jiān)測與PiCCO監(jiān)測的效價(jià)比較血?dú)夥治龀杀締蝺r(jià)約為169元,PiCCO監(jiān)測成本單價(jià)約為220元。43例ARDS患者人均行血?dú)夥治龃螖?shù)為35.74±9.299次,人均行PiCCO監(jiān)測次數(shù)為24.42±6.423次,兩者比較差異有統(tǒng)計(jì)學(xué)意義(t=6.571,p=0.000)。43例ARDS患者人均行血?dú)夥治隹傎M(fèi)用為6040.77±1571.615元,43例ARDS患者人均行行PiCCO監(jiān)測費(fèi)用5372.09±1412.961元,兩費(fèi)用比較差異有統(tǒng)計(jì)學(xué)意義(t=2.075,p=0.041)。 結(jié)論 1、ARDS的氧合指數(shù)與平均動(dòng)脈壓、血管外肺水、肺血管通透性指數(shù)顯著相關(guān)。血管外肺水對(duì)氧合指數(shù)的影響最大,是ARDS患者氧合指數(shù)的決定因素。ARDS患者氧合指數(shù)與全心舒張末期容積(GEDV).胸腔內(nèi)血容量無關(guān)。 2、ARDS患者監(jiān)測能夠利用血管外肺水新指標(biāo)代替氧合指數(shù)。血管外肺水較氧合指數(shù)更具優(yōu)越性。
[Abstract]:Objective to investigate the correlation between oxygenation index and extravascular pulmonary water in patients with acute respiratory distress syndrome (ARDS), to study the oxygenation of ARDS patients with extravascular lung water, and to replace oxygenation index by the new index of extravascular lung water, and to guide the monitoring of ARDS patients by ICU nurses so as to reduce the patient's pain and reduce the cost of the patients. Reduce the workload of the nurses.
Methods from January 2010 to December 2011, 43 patients with acute respiratory distress syndrome (PiCCO) monitored by pulse contours temperature dilution continuous cardiac output (PiCCO) were enrolled in the two district of the First Affiliated Hospital of Guangxi Medical University. 43 cases of acute respiratory distress syndrome (acute respiratory distress syndrome) were investigated. No, age, occupation, marital status, educational level, economic condition, primary disease, critical degree, treatment method, etc. after our department, we used a multifunction monitor to routinely monitor the heart rate, blood pressure, respiratory rate, and blood oxygen saturation (SPO2). Check in our family 24h, obtain the consent of the patients and their families, and remove the pulse contour temperature after the contraindication. Dilute continuous cardiac output measurement (PiCCO) monitoring. Non continuous parameters of patients were monitored by pulmonary thermo dilution technique: full cardiac end diastolic volume (GEDV), intrapleural volume of blood volume (ITBV), extravascular lung water (EVLW), pulmonary vascular permeability index (PVPI). A correction was performed every 8 hours by pulmonary thermo dilution measurement. Continuous cardiac output was observed in patients. When the change and the condition of the disease were large,.ARDS patients were monitored at the end diastolic volume (GEDV), intrapleural blood volume (ITBV), extravascular pulmonary water (EVLW), and pulmonary vascular permeability index (PVPI). The nurse punctured the radial artery for blood gas analysis, and the oxygen index (OI) was calculated by PaO2/FiO2. At the same time, the number of oxygen index (OI) was recorded. At the same time, the nurses were recorded more. The heart rate, average arterial pressure, respiratory frequency and blood oxygen saturation (SPO2) were monitored by the function monitor. In addition, the blood gas analysis of the patients with ARDS, the number of PiCCO monitoring, the blood gas analysis of the ARDS patients and the cost of PiCCO monitoring were calculated.
Collect patient related data, establish a database, use descriptive analysis, t test, ANOVA, chi square test, regression and correlation, multiple linear regression analysis and other statistical methods for ARDS patients' oxygenation index (OI), full cardiac end diastolic volume (GEDV), thoracic blood volume (ITBV), extravascular lung water (EVLW), pulmonary vascular permeability index (PVPI), and respiratory index (PVPI). Frequency, blood oxygen saturation (SPO:) and mean arterial pressure were analyzed. In addition, the blood gas analysis of ARDS patients, the number of PiCCO monitoring, the blood gas analysis of ARDS patients and the cost of PiCCO monitoring were compared.
Result
1, Pearson single factor analysis of ARDS oxygenation index related factors, the oxygenation index of ARDS patients was positively correlated with oxygen saturation (P0.05); the oxygenation index of patients with ARDS was negatively correlated with respiratory frequency, extravascular lung water and pulmonary vascular permeability index (P0.05), and was not related to heart rate, mean arterial pressure, intrathoracic blood volume, and total ventricular end diastolic volume (P0.05).
2, simple linear regression analysis of oxygenation index and related factors in patients with ARDS, ARDS patients' oxygenation index and respiratory frequency, oxygen saturation, extravascular lung water, pulmonary vascular permeability index have a linear relationship (P0.05), oxygenation index and heart rate, mean arterial pressure, intrathoracic blood volume, and total ventricular end diastolic volume (P0.05).
3, multivariate linear regression analysis of oxygenation index related factors in ARDS patients, the linear regression relationship between ARDS patients' oxygenation index and mean arterial pressure, extravascular pulmonary water and pulmonary microvascular permeability index was statistically significant (P0.05). The oxygenation index of ARDS patients was significantly correlated with the mean arterial pressure, extravascular pulmonary water and pulmonary microvascular permeability index.
4, multivariate linear regression analysis of the water related factors of the extravascular lung in ARDS patients, the linear regression relationship between the extravascular pulmonary water and the pulmonary vascular permeability index in ARDS patients was statistically significant (P0.05). The blood volume in the thoracic cavity and the end diastolic volume of the heart had no effect on the extravascular pulmonary water of the patients with ARDS (P0.05).
5, the cost of blood gas analysis and PiCCO monitoring compared the cost of blood gas analysis cost about 169 yuan, PiCCO monitoring cost is about 220 yuan.43 cases of ARDS patients per capita blood gas analysis is 35.74 + 9.299 times, per capita PiCCO monitoring number of 24.42 + 6.423 times, the difference is statistically significant (t=6.571, p=0.000).43 case ARDS patients The total cost of per capita blood gas analysis was 6040.77 + 1571.615 yuan. The cost of PiCCO monitoring in 43 cases of ARDS patients was 5372.09 + 1412.961 yuan, and the two cost was statistically significant (t=2.075, p=0.041).
conclusion
1, the oxygenation index of ARDS was significantly related to the mean arterial pressure, the extravascular lung water and the pulmonary vascular permeability index. The effect of the extravascular lung water on the oxygenation index was the largest, which was the determinant of the oxygenation index in patients with ARDS and the oxygenation index of.ARDS patients and the total cardiac end diastolic volume (GEDV). The blood volume in the thoracic cavity was not related.
2, monitoring of ARDS patients can use extravascular lung water index instead of oxygenation index. Extravascular lung water is more advantageous than oxygenation index.
【學(xué)位授予單位】：廣西醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2012
【分類號(hào)】：R563.8

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本文編號(hào)：2036032