中华急诊医学杂志
中華急診醫學雜誌
중화급진의학잡지
CHINESE JOURNAL OF EMERGENCY MEDICINE
2010年
2期
145-149
,共5页
徐海燕%彭劲民%胡小芸%杜斌
徐海燕%彭勁民%鬍小蕓%杜斌
서해연%팽경민%호소예%두빈
呼气末正压%前负荷%中心静脉压%血流动力学%全心舒张末期容积
呼氣末正壓%前負荷%中心靜脈壓%血流動力學%全心舒張末期容積
호기말정압%전부하%중심정맥압%혈류동역학%전심서장말기용적
Positive end-expiratory pressure%Preload%Central venous pressure%Hemodynamics%Global end-diastolic volume
目的 探讨不同水平的呼气末正压(PEEP)对接受机械通气的感染性休克患者心脏前负荷的影响.方法 采用前瞻性、干预性的研究方法对北京协和医院MICU 15例行机械通气的感染性休克患者应用跨肺热稀释法及持续脉搏轮廓的方法进行血流动力学监测(PiCCOplus).所有患者采用容量控制通气,血流动力学稳定后,每隔1 h递增PEEP水平,PEEP从0增加20 cmH_2O(如果能耐受),根据不同的PEEP水平分为5组(0,5,10,15,20 cmH_2O).应用one-way ANOVA和Pearson's行统计分析及相关分析,观察在不同水平的PEEP对心脏前负荷的影响及其相关性.结果 15例感染性休克患者,男10例(67%),女5例(33%),年龄(67.6±19.5)岁,APACHEⅡ评分(22.1±7.5)分,基础PEEP水平(8.5±3.6)cmH_2O,基础PaO_2/FiO_2(225.6±89.2)mmHg,ICU病死率67%.随着PEEP的升高,CVP明显升高,不同水平的PEEP组差异具有统计学意义(p=0.002),而GEDI无明显变化,各组间差异无统计学意义.以PEEP0为基础值,不同PEEP水平的CVP,CI,GEDI与基础值之差为增量,发现△CI和△GEDI呈明显的正相关(r=0.6),而△CI和△CVP无明显的相关性.结论 在高PEEP存在的情况下,GEDI能够有效地评价心脏的前负荷.
目的 探討不同水平的呼氣末正壓(PEEP)對接受機械通氣的感染性休剋患者心髒前負荷的影響.方法 採用前瞻性、榦預性的研究方法對北京協和醫院MICU 15例行機械通氣的感染性休剋患者應用跨肺熱稀釋法及持續脈搏輪廓的方法進行血流動力學鑑測(PiCCOplus).所有患者採用容量控製通氣,血流動力學穩定後,每隔1 h遞增PEEP水平,PEEP從0增加20 cmH_2O(如果能耐受),根據不同的PEEP水平分為5組(0,5,10,15,20 cmH_2O).應用one-way ANOVA和Pearson's行統計分析及相關分析,觀察在不同水平的PEEP對心髒前負荷的影響及其相關性.結果 15例感染性休剋患者,男10例(67%),女5例(33%),年齡(67.6±19.5)歲,APACHEⅡ評分(22.1±7.5)分,基礎PEEP水平(8.5±3.6)cmH_2O,基礎PaO_2/FiO_2(225.6±89.2)mmHg,ICU病死率67%.隨著PEEP的升高,CVP明顯升高,不同水平的PEEP組差異具有統計學意義(p=0.002),而GEDI無明顯變化,各組間差異無統計學意義.以PEEP0為基礎值,不同PEEP水平的CVP,CI,GEDI與基礎值之差為增量,髮現△CI和△GEDI呈明顯的正相關(r=0.6),而△CI和△CVP無明顯的相關性.結論 在高PEEP存在的情況下,GEDI能夠有效地評價心髒的前負荷.
목적 탐토불동수평적호기말정압(PEEP)대접수궤계통기적감염성휴극환자심장전부하적영향.방법 채용전첨성、간예성적연구방법대북경협화의원MICU 15례행궤계통기적감염성휴극환자응용과폐열희석법급지속맥박륜곽적방법진행혈류동역학감측(PiCCOplus).소유환자채용용량공제통기,혈류동역학은정후,매격1 h체증PEEP수평,PEEP종0증가20 cmH_2O(여과능내수),근거불동적PEEP수평분위5조(0,5,10,15,20 cmH_2O).응용one-way ANOVA화Pearson's행통계분석급상관분석,관찰재불동수평적PEEP대심장전부하적영향급기상관성.결과 15례감염성휴극환자,남10례(67%),녀5례(33%),년령(67.6±19.5)세,APACHEⅡ평분(22.1±7.5)분,기출PEEP수평(8.5±3.6)cmH_2O,기출PaO_2/FiO_2(225.6±89.2)mmHg,ICU병사솔67%.수착PEEP적승고,CVP명현승고,불동수평적PEEP조차이구유통계학의의(p=0.002),이GEDI무명현변화,각조간차이무통계학의의.이PEEP0위기출치,불동PEEP수평적CVP,CI,GEDI여기출치지차위증량,발현△CI화△GEDI정명현적정상관(r=0.6),이△CI화△CVP무명현적상관성.결론 재고PEEP존재적정황하,GEDI능구유효지평개심장적전부하.
Objective To investigate the effect of PEEP on cardiac preload in patients with septic shock undergoing mechanical ventilation.Method In a prospective clinical trial,we enrolled 15 patients with septic shock admitted to medical intensive care unit(MIGU),Peking Union Medical College Hospital(PUMCH)from Sept 2007 to Mar 2008.All patients were mechanically ventilated with volume control mode.Hemodynamics was monitored by the transpulmonary thermodilution technique and pulse contour analysis(PiCCOplus).PEEP was increased from 0 to 20 emH_2O(if tolerated),by 5 cmH_2O.The effect of PEEP on cardiac preload was analyzed by one-way ANOVA and Pearson's correlation analysis.Results Fifteen patients were enrolled,with 5 females and 10 males.Mean age was(67.6±19.5)years old,APACHE Ⅱ score was(22.1±7.5),baseline PaO_2/FiO_2(225.6±89.2)mmHg at PEEP of(8.5±3.6)cmH_2O.The ICU mortauty was 67%.With increasing level of PEEP,CVP increased significantly(P=0.002),while GEDI did not show any significant change.In addition,ΔCI positively correlated with △GEDI(r=0.6),hut not with ΔCVP.Conclusions GEDI,rather than CVP,could provide vaud estimates of cardiac preload at high PEEP.
