創(chuàng)傷后毛細血管滲漏綜合征的(存儲版)
【正文】 he survival group pared with the third day (P ). ④The ITBI in the dead group was lower than those in the survival group and the control group. The ELWI in the dead group increased continually (all P ). ⑤From the day of surgery to the third day after surgery, the ELWI was positively correlated with the ITBI in the survival group (r = , P ), and there was no correlation from the fourth day to the fifth day after surgery. There was no correlation between ELWI and ITBI in different stages in the death group or control group. Conclusion There is special law between pulmonary circulation and systemic circulation in different stages of posttraumatic CLS patients, which has important clinical significance at guiding the liquid treatment and evaluating prognosis. Key words： trauma；capillary leak syndrome；pulse index continuous cardiac output；Hemodynamics創(chuàng)傷后毛細血管滲漏綜合征（capillary leak syndrome, CLS）是嚴重創(chuàng)傷后常見的一組綜合征。排除標準：年齡小于18歲，合并心源性、肝源性、腎源性的全身水腫，合并神經源性肺水腫，度過創(chuàng)傷后CLS各期后死于后期并發(fā)癥者。s)男 女對照組(n=20)12 8177。※※死亡組(n=14)10 4177。 統(tǒng)計學處理：。 術后第4天，存活組出現(xiàn)負平衡，ITBI較第3天增高，但差異無顯著性（P＞）；ELWI較第3天反而降低（P ）。 變化規(guī)律 通過上述結果，發(fā)現(xiàn)創(chuàng)傷后CLS不同階段有如下規(guī)律。同樣減低的有效循環(huán)血量，同樣減低的肺毛細血管靜水壓，而ELWI增高，考慮此組患者肺淋巴系統(tǒng)的回吸收功能發(fā)生障礙。說明肺毛細血管的通透性也恢復了正常。遵循上述規(guī)律，即使尿量較多也敢于限制補液，如果ITBI增高還可以給予利尿治療。根據(jù)上述規(guī)律，通過PiCCO監(jiān)測來調整液體治療，在創(chuàng)傷后CLS各期維持較恰當?shù)难h(huán)狀態(tài)，可較好地解決創(chuàng)傷后CLS各期中的液體治療矛盾，減少并發(fā)癥，在基礎與臨床之間架起了一道有益橋梁。同時，不必追求ITBI完全達到正常，以避免ELWI增高。說明毛細血管通透性恢復，組織間的水分和大分子物質自靜脈和淋巴系統(tǒng)回吸收入血管，有效循環(huán)血量恢復，腎臟的灌注恢復，尿量自行增多。在肺毛細血管的通透性增高的情況下，之所以ELWI無明顯增高，是因為體循環(huán)明
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