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目的：探讨液体负平衡对感染性休克合并急性肺损伤(ALI)患者早期复苏及预后的影响。方法：将2010 年1 月~2014 年9 月我院急诊外科收治的84 例感染性休克合并ALI的患者随机分为治疗组和对照组，每组各42 例患者。治疗组采用出入量负平衡方式进行液体管理，对照组采用出入量平衡方式进行液体管理。观察和比较两组治疗前后氧合指数(PaO2/FiO2)、中心静脉压 (CVP)、平均动脉压(MAP)、心指数(CI)、血管外肺水指数(ELWI)及APACHEⅡ评分的变化，记录和比较两组的机械通气时间、ICU 住院时间、多器官功能障碍综合征(MODS)的发生率及28 d的病死率。结果：入院后3 d、7 d，治疗组的MAP 较对照组明显降低， ELWI、PaO2/FiO2则明显升高(P<0.05)；治疗前、治疗后6 h，两组的APACHEⅡ评分比较均无显著性差异(P>0.05)，而治疗组治疗后 24 h、48 h的APACHEⅡ评分较对照组则明显降低(P<0.05)；与对照组比较，治疗组的机械通气时间、ICU住院时间显著缩短， MODS 发生率明显降低(P<0.05)。结论：在维持循环稳定和保证器官灌注的前提下，液体负平衡有助于减轻感染性休克合并ALI 患者的心肺损伤，促进患者早期复苏，改善患者的预后。

英文摘要:

Objective:To explore the impact of negative fluid balance on early resuscitation and prognosis of patients with septic shock combined with acute lung injury (ALI).Methods:82 patients with septic shock combined with ALI who received treatment in the department of emergency surgery of our hospital from January 2010 to September 2014 were randomly divided into two groups. The treatment group (n=42) was given fluid management of negative fluid balance, while the control group (n=42) was given fluid management of fluid balance. The level of PaO2/FiO2, CVP, MAP, CI and ELWI and score of APACHEⅡ were observed and compared before and after treatment, the time of mechanical ventilation, hospital stays of ICU, incidence of MODS and mortality within 28 days were also recorded.Results:Compared with the control group, the level of MAP on the 3rd, 7th day after admission in treatment group was reduced, but ELWI, PaO2/FiO2 were increased (P<0.05). There was no significant difference in the score of APACHEⅡ before treatment and at 6 h after treatment in both groups(P>0.05), while it became significant at 24 h, 48 h after treatment(P<0.05). Compared with the control group, the time of mechanical ventilation, hospital stays of ICU were shortened, the incidence of MODS was reduced (P<0.05).Conclusion:On the basis of cycle stability and organ perfusion, negative fluid balance could help patients with septic shock combined with ALI to ease lung damage, promote the early resuscitation and improve the prognosis.

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