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目的:探讨肺血管功能障碍对急性肺损伤（ALI）患者预后的影响。方法:拟入组2017年6月至2019年6月在武汉市第一医院重症医学科接受肺动脉导管监测的ALI患者。记录患者一般资料；临床和血流动力学指标〔中心静脉压（CVP）、肺动脉楔压（PAWP）、肺动脉收缩压（sPAP）、肺动脉舒张压（dPAP）、平均肺动脉压（mPAP）、心排血指数（CI）〕；急性生理学与慢性健康状况评分Ⅱ（APACHEⅡ）；动脉血气参数〔pH值、血氧分压（POn 2）、血二氧化碳分压（PCOn 2）、氧合指数（PaOn 2/FiOn 2）〕；是否存在休克；呼吸机参数〔气道平台压（Plat）、呼气末正压（PEEP）〕等。计算肺动脉血氧饱和度、肺血管功能指标〔跨肺血管梯度（TPG）和肺血管阻力指数（PVRi）〕。分析60 d不同预后以及TPG是否增高（≥12 mmHg定义为TPG升高，1 mmHg＝0.133 kPa）患者TPG、PVRi与机械通气时间、重症监护病房（ICU）住院时间、心血管日和60 d病死率之间的关系。n 结果:共65例患者纳入研究，其中男性30例，女性35例；年龄（48.9±15.2）岁；60 d存活48例，死亡17例，60 d病死率为26.2%。在基线资料中，不同预后两组患者心肺功能测量值，如CVP、sPAP、dPAP、PAWP、CI等差异均无统计学意义，死亡组APACHEⅡ评分、休克比例、TPG和PVRi均较存活组显著升高〔APACHEⅡ（分）：34±9比28±11，休克：52.9%比25.0%，TPG（mmHg）：16.2±1.9比14.6±2.1，PVRi（kPa·s·Ln -1）：31.8±4.2比29.7±3.5，均n P<0.05〕。47例TPG≥12 mmHg患者的60 d病死率显著高于18例TPG<12 mmHg患者（34.0%比5.6%），机械通气时间和ICU住院时间也明显延长（d：17±9比11±8，16±5比12±5），心血管日也明显增加（d：23±7比18±6），差异均有统计学意义（均n P<0.05）。Pearson相关分析显示，PVRi与机械通气时间、ICU住院时间及心血管日均具有显著相关性（n r1＝0.317，n P1＝0.030；n r2＝0.277，n P2＝0.005；n r3＝0.285，n P3＝0.002）。在个体多因素Logistic回归模型中，最高PVRi是60 d死亡的危险因素〔优势比（n OR）＝30.5，95%可信区间为20.4～43.1，n P＝0.023〕。n 结论:肺血管功能障碍在ALI患者中很常见，并且与不良结局独立相关。“,”Objective:To investigate the effect of pulmonary vascular dysfunction in the prognosis of patients with acute lung injury (ALI).Methods:Patients with ALI who underwent pulmonary artery catheterization in the department of critical care medicine of Wuhan NO.1 Hospital from June 2017 to June 2019 were enrolled. The general information, clinical and hemodynamic indexes [central venous pressure (CVP), pulmonary artery wedge pressure (PAWP), pulmonary artery systolic pressure (sPAP), pulmonary artery diastolic pressure (dPAP), mean pulmonary artery pressure (mPAP), cardiac index (CI)], acute physiology and chronic health evaluation Ⅱ (APACHEⅡ) score, arterial blood gas parameters [pH, partial pressure of oxygen (POn 2), partial pressure of carbon dioxide (PCOn 2), oxygenation index (PaOn 2/FiOn 2)], whether there was shock or not; ventilator parameters [platform pressure (Plat), positive end-expiratory pressure (PEEP)], etc. were recorded. Pulmonary artery oxygen saturation, pulmonary vascular function indexes [transpulmonary potential gradient (TPG) and pulmonary vascular resistance index (PVRi)] were calculated. The relationship between TPG, PVRi and mechanical ventilation time, the length of intensive care unit (ICU) stay, cardiovascular days and 60-day mortality were analyzed in patients with different prognosis of 60-day and whether the TPG increased (≥12 mmHg was defined as elevated TPG, 1 mmHg = 0.133 kPa).n Results:A total of 65 patients were included in the study, including 30 males and 35 females; aged (48.9±15.2) years old. Forty-eight cases survived in 60-days, 17 died, and the 60-day mortality was 26.2%. At the baseline, there were no significant differences in cardiopulmonary function measurements, such as CVP, sPAP, dPAP, PAWP, CI, etc. between the two groups of patients with different prognosis. The APACHEⅡ score, shock ratio, TPG and PVRi of the death group were significant higher than those of the survival group [APACHEⅡ: 34±9 vs. 28±11, shock: 52.9% vs. 25.0%, TPG (mmHg): 16.2±1.9 vs. 14.6±2.1, PVRi (kPa·s·Ln -1): 31.8±4.2 vs. 29.7±3.5, all n P < 0.05]. The 60-day mortality of 47 patients with TPG ≥ 12 mmHg was significantly higher than that of 18 patients with TPG < 12 mmHg (34.0% vs. 5.6%), and the mechanical ventilation time and the length of ICU stay were also significantly longer (days: 17±9 vs. 11±8, 16±5 vs. 12±5), and the cardiovascular days also increased significantly (days: 23±7 vs. 18±6), and the differences were statistically significant (all n P < 0.05). Pearson correlation analysis showed that PVRi was significantly correlated with mechanical ventilation time, the length of ICU stay and cardiovascular days ( n r1 = 0.317, n P1 = 0.030; n r2 = 0.277, n P2 = 0.005; n r3 = 0.285, n P3 = 0.002). In the individual multivariate Logistic regression model, the highest PVRi was an independent risk factor for the 60-day mortality [odds ratio (n OR) = 30.5, 95% confidence interval was 20.4-43.1, n P = 0.023].n Conclusion:Pulmonary vascular dysfunction is common in ALI patients and is independently associated with adverse outcomes.