Objective The aim of positive fluid management of cardiac protective effects,and to explore the mechanism of action in patients with severe pneumonia. Methods 157 cases of patients with severe pneumonia were randomly divided into fluid management and control groups. Pulse line indicates the continuous cardiac output monitoring( PiCCO) monitored hemodynamic changes in indicators of cardiac output( associated with underlying cardiac output,CO) ,cardiac index( CI) , intrathoracic vascular ca-pacity( ITBV1) ,extravascular lung water( EVLWI) and to guided fluid management, determinated plasma brain natriuretic peptide( natriuretic peptide.BNP) to assess cardiac function by fluid management before and after the research, determinated bronchoscopy lung lavage fluid interleukin 6 concentration and assessed the local inflammation of the lung tissue and monitored arterial blood gas analysis, row chest CT e-valuation of pulmonary lesions before and after the recovery. Results Compared with the control group, the fluid management group of plasma brain natriuretic peptide(3283. 98 ±73.91 vs 1584.26 ±64.71 ,P <0.05),hemodynamic CO(3.47±0. 14 vs 4.59 ±0. 37 ,P <0.05) ,CI(3.45 ±0. 24 vs 4.68 ±0. 75 ,P <0.05).EVI,Wl(7.89±0.74 vs 5.67 ±0.2. P <0.05) , lung tissue partial of IL-6( 197. 51 ±11.24 vs 146. 84 ± 10. 22,P <0. 05) .decreased significantly,arterial blood gas partial pressure of oxygen( 85. 32 ± 14. 35 vs 101.43 ±5.87,P<0. 05) increase, alveolar-arterial oxygen difference( 15.38 ±3.61 vs 7. 53 ± 3.54,P<0. 05) decreased and significant improved in chest CT imaging of pulmonary lesions. Conclusions Active fluid management can protected cardiac function,and its improved in lung function,reduced inflammation and improved the oxygen.%目的 探讨严格液体管理对重症肺部感染患者心肺保护作用及其可能的机制.方法 将157例重症肺部感染患者随机分为液体管理组和对照组,用脉搏指示连续心输出量监测(PiCCO)的方法检测血流动力学变化指标[心输出量(CO)、心指数(CI)、胸腔内血管容量( ITBVI)、血管外肺水(EVLWI)]并指导液体管理;实验前后测定患者血浆脑型利钠肽(BNP),评估液体管理对患者心功能的影响；测定纤支镜肺灌洗液中白细胞介素(IL)-6的浓度,以评估肺组织局部炎症情况,监测动脉血气分析；实验前后行胸部CT检查评价肺部病变恢复情况.结果 与对照组比较,液体管理组血浆脑型利钠肽、血流动力学指标( CO、CI、EVLWI)和肺组织局部IL-6水平均明显下降(P＜0.05),动脉血气氧分压升高(P＜0.05),肺泡-动脉氧分压差下降(P＜0.05),肺部病变和肺功能明显改善.结论 积极液体管理可保护重症肺部感染患者的心肺功能,其原因可能与降低炎症反应及改善氧合有关.
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