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目的:探讨严格液体管理对重症肺炎心脏的保护作用及其可能机制。方法:157例重症肺炎患者随机分为液体管理组和对照组,行脉搏指示连续心输出量监测,评估心输出量(CO)、心指数(CI)、胸腔内血管容量、血管外肺水(EVLWI)的变化,试验前后测定血浆脑型利钠肽(BNP),测定纤支镜肺灌洗液中白细胞介素-6(IL-6)浓度,评估肺组织局部炎症,测定动脉血气评估氧合情况。结果:与对照组相比,液体管理组血浆BNP[(3 283.98±73.91)pg/ml∶(1 584.26±64.71)pg/ml,P<0.05],血流动力学CO[(3.47±0.14)L/(min.m2)∶(4.59±0.37)L/(min.m2),P<0.05]、CI[(3.45±0.24)∶(4.68±0.75),P<0.05]、EVLWI[(7.89±0.74)ml/kg∶(5.67±0.21)ml/kg,P<0.05]均差异有统计学意义,心功能好转,肺组织局部IL-6浓度[(197.51±11.24)pg/ml∶(146.84±10.22)pg/ml,P<0.05]明显下降,动脉血气氧分压[(85.32±14.35)mmHg(1mmHg=0.133kPa)∶(101.43±5.87)mmHg,P<0.05]提高,肺泡-动脉氧分压差[(15.38±3.61)mmHg∶(7.53±3.54)mmHg,P<0.05]下降,肺功能改善。结论:积极液体管理可保护心功能,原因与其改善肺功能、降低炎症反应及改善氧合有关。
Objective: To explore the protective effect of strict fluid management on severe pneumonia and its possible mechanism. Methods: One hundred and fifty-seven patients with severe pneumonia were randomly divided into liquid management group and control group. The cardiac output was monitored with pulse rate. The cardiac output (CO), cardiac index (CI), intrathoracic vascular volume, extravascular lung water EVLWI) were measured before and after the test. Plasma BNP was measured before and after the test. Interleukin-6 (IL-6) concentration in bronchoalveolar lavage fluid was measured to evaluate local inflammation in lung tissue. Together situation. Results: Compared with the control group, the plasma levels of BNP [(3 283.98 ± 73.91) pg / ml: (1 584.26 ± 64.71) pg / ml, P 0.05] and hemodynamic CO [(3.47 ± 0.14) (4.59 ± 0.37) L / (min.m2), P <0.05], CI [(3.45 ± 0.24) :( 4.68 ± 0.75), P <0.05] and EVLWI [(7.89 ± 0.74) ml / kg: (5.67 ± 0.21) ml / kg, P <0.05]. There was a significant difference between the two groups in the improvement of cardiac function and the level of IL-6 in lung tissue [(197.51 ± 11.24) pg / ml:(146.84 ± 10.22) pg / ml, P <0.05]. The partial pressure of oxygen in arterial blood gas [(85.32 ± 14.35) mmHg (1mmHg = 0.133kPa) :( 101.43 ± 5.87) mmHg, P < The pressure drop [(15.38 ± 3.61) mmHg: (7.53 ± 3.54) mmHg, P <0.05] decreased and pulmonary function improved. Conclusion: Positive fluid management can protect heart function, which is related to improving lung function, reducing inflammation and improving oxygenation.