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正确地监测血管外肺水(EVLW)是早期诊断和治疗重症脓毒症的重要方法。20世纪90年代出现的单一经肺热指示剂技术(PiCCO),因其简便易行而深受临床医师的重视。多项研究已证实PiCCO测量的EVLW和传统金标准称重法相比有良好的相关性。临床上现行的急性肺损伤的评价方法(如胸部X线片、氧合法)不能监测到少于100%～200%的EVLW变化,而临床研究证实PiCCO对10%～20%的EVLW变化高度敏感,因而其能准确地监测到早期肺水肿,对重症脓毒症患者,PiCCO能提供其他检查所不能提供的临床信息。现就EVLW的概念、监测原理和方法及其临床意义进行介绍。
Correct monitoring of extravascular lung water (EVLW) is an important method of early diagnosis and treatment of severe sepsis. The single transpulmonary thermal indicator technique (PiCCO) that emerged in the 1990s was highly regarded by clinicians for its ease of use. Several studies have demonstrated that the PiCCO measured EVLW has a good correlation with the traditional gold standard weighing method. Clinically, current evaluation methods for acute lung injury (such as chest radiography, oxygenation) can not detect changes in EVLW of less than 100% to 200%, and clinical studies have confirmed that PiCCO is highly sensitive to EVLW changes of 10% to 20% , So it can accurately detect early pulmonary edema, and in patients with severe sepsis, PiCCO can provide clinical information that other tests can not provide. Now EVLW concept, monitoring principles and methods and their clinical significance are introduced.