CAJ | 학술논문

目的观察肺复张(RM)对颅内压(ICP)、脑灌注压(CPP)及平均动脉压(MAP)的影响.方法选择因严重颅脑疾患伴肺损伤需要进行机械通气的6例患者,在进行RM的同时进行持续ICP、MAP、中心静脉压(CVP)、脉搏血氧饱和度(SpO2)等监测.RM采用压力控制通气模式,逐步提升呼气末正压(PEEP)的方法.结果 6例患者共进行22例次RM,2例次分别在3 cm H2O(1 cm H2O=0.098 kPa)和6 cm H2O PEEP水平出现MAP、CPP显著降低而终止.其余20例次RM中不同PEEP水平相应的MAP、CVP、ICP、CPP平均值与基础值相比差异均无统计学意义(P均>0.05);MAP与CPP呈高度相关性(r=0.706,P=0.000).20例次RM中,单次RM内参数间呈高度相关性的比例:MAP与CPP占85%(17/20);PEEP与CVP占75%(15/20);PEEP与ICP占75%(15/20);PEEP与CPP占40%(8/20).22例次RM中MAP随PEEP变化有6种趋势:8例次相对稳定;6例次随PEEP增加而降低,然后随PEEP降低而逐渐回升;2例次随PEEP增加而升高,随PEEP降低逐渐回到基础值;2例次随PEEP增加而降低,PEEP降低后MAP不能相应升高;2例次随PEEP增加而增加,在PEEP降到基础值后MAP仍维持在高水平;2例次随PEEP增加MAP急剧降低而终止RM.11例次RM中ICP随PEEP升高而升高,随PEEP降低而降低;6例次在RM过程中无明显变化;3例次RM后ICP处于高值末回到基线.12例次RM中CPP随PEEP升高而降低,随PEEP降低而增加,并随PEEP回到基线时恢复到基础值;6例次无明显变化;2例次CPP维持在低值,分别在PEEP回到基线后10 min、20 min恢复到基础值.结论 RM对MAP、ICP、CPP的影响存在明显的个体差异.ICP监测有助于保障脑部疾患合并肺损伤患者RM实施的安全性.
목적 관찰폐복장(RM)대로내압(ICP)、뇌관주압(CPP)급평균동맥압(MAP)적영향.방법 선택인엄중로뇌질환반폐손상수요진행궤계통기적6례환자,재진행RM적동시진행지속ICP、MAP、중심정맥압(CVP)、맥박혈양포화도(SpO2)등감측.RM채용압력공제통기모식,축보제승호기말정압(PEEP)적방법.결과 6례환자공진행22례차RM,2례차분별재3 cm H2O(1 cm H2O=0.098 kPa)화6 cm H2O PEEP수평출현MAP、CPP현저강저이종지.기여20례차RM중불동PEEP수평상응적MAP、CVP、ICP、CPP평균치여기출치상비차이균무통계학의의(P균>0.05);MAP여CPP정고도상관성(r=0.706,P=0.000).20례차RM중,단차RM내삼수간정고도상관성적비례:MAP여CPP점85%(17/20);PEEP여CVP점75%(15/20);PEEP여ICP점75%(15/20);PEEP여CPP점40%(8/20).22례차RM중MAP수PEEP변화유6충추세:8례차상대은정;6례차수PEEP증가이강저,연후수PEEP강저이축점회승;2례차수PEEP증가이승고,수PEEP강저축점회도기출치;2례차수PEEP증가이강저,PEEP강저후MAP불능상응승고;2례차수PEEP증가이증가,재PEEP강도기출치후MAP잉유지재고수평;2례차수PEEP증가MAP급극강저이종지RM.11례차RM중ICP수PEEP승고이승고,수PEEP강저이강저;6례차재RM과정중무명현변화;3례차RM후ICP처우고치말회도기선.12례차RM중CPP수PEEP승고이강저,수PEEP강저이증가,병수PEEP회도기선시회복도기출치;6례차무명현변화;2례차CPP유지재저치,분별재PEEP회도기선후10 min、20 min회복도기출치.결론 RM대MAP、ICP、CPP적영향존재명현적개체차이.ICP감측유조우보장뇌부질환합병폐손상환자RM실시적안전성.
Objective To explore the impact of lung recruitment maneuver (RM) on intracranial pressure (ICP), cerebral perfusion pressure (CPP) and mean arterial pressure (MAP). Methods RM was performed and ICP, MAP, central venous pressure (CVP), saturation of arterial oxygen (SpO2) were monitored continuously in 6 severe cerebral injury patients combined with lung injury, who were indicated for mechanical ventilation and meeting the criteria for intracranial pressure monitoring. RM included pressure control ventilation with stepwise increase in positive end-expiratory pressure (PEEP). Results RM was performed for 22 times in 6 patients, among them two were moribund due to sharp drop of blood pressure and CPP. In the remaining 20 attempts, the mean values of MAP, CVP, ICP, CPP measured at each PEEP level showed no significant difference compared with baseline values (all P>0.05). MAP was significantly correlated with CPP (r=0.706, P=0.000). In the remaining RMs, a correlation between MAP and CPP accounted for 85% (17/20) of total RMs, that between PEEP and CVP accounted for 75% (15/20), that between PEEP and ICP accounted for 75% (15/20), and that between PEEP and CPP existed in 40% (8/20). In a total of 22 cases, there were 6 patterns of response of MAP to alteration in PEEP: MAP maintained relatively stable in 8 case, MAP decreased when PEEP increased and increased when PEEP decreased in 6 case; in 2 cases MAP elevated with increase in PEEP, and drop to baseline with decrease in PEEP, in 2 cases it fell with increase in PEEP but it did not rise with decrease in PEEP, in 2 cases it rose with increase in PEEP but remained at a high level with PEEP decreased to baseline, in 2 cases, MAP dropped abruptly with increase in PEEP resulting in termination of RM. In 11 cases, ICP increased with increase in PEEP and decreased with lowering of PEEP. ICP maintained stable in 6 cases, and ICP maintained at a high level and did not return to baseline after RM in 3 cases. CPP decreased with increase in PEEP and increased when PEEP decreased, and it returned to baseline when PEEP was back to baseline in 12 case. CPP kept constant in 6 case. In 2 cases, CPP remained at a low level, and it returned to baseline 1020 minutes after PEEP was lowered to baseline. Conclusion There is considerable individual difference in impact of RM on MAP, ICP and CPP in patients with cerebral. ICP monitoring is helpful to assure safety of RM in patients with cerebral injury complicated with lung injury.