中华危重病急救医学
中華危重病急救醫學
중화위중병급구의학
Chinese Critical Care Medicine
2014年
5期
335-338
,共4页
急性呼吸窘迫综合征%呼气末正压%脑血管自动调节功能%脑血流
急性呼吸窘迫綜閤徵%呼氣末正壓%腦血管自動調節功能%腦血流
급성호흡군박종합정%호기말정압%뇌혈관자동조절공능%뇌혈류
Acute respiratory distress syndrome%Positive end-expiratory pressure%Cerebrovascular autoregulation%Cerebral blood flow
目的 探讨不同呼气末正压(PEEP)水平对急性呼吸窘迫综合征(ARDS)患者脑血流和脑血管自动调节功能的影响.方法 采用前瞻性观察研究方法,选择2013年1月1日至10月1日江西省人民医院重症医学科住院的中重度ARDS患者,观察不同PEEP水平下血流动力学、肺机械力学、肺气体交换指标的变化;采用经颅多普勒(TCD)检测大脑中动脉的血流速度,并计算屏气指数(BHI).结果 共有35例ARDS患者入选,将PEEP水平由(6.4±1.0) cmH2O(1 cmH2O=0.098 kPa)提高到(14.5±2.0) cmH2O后,患者氧合指数明显改善[mmHg(1 mmHg=0.133 kPa):324.7± 117.2比173.4±95.8,t=5.913,P=0.000];气道峰压(PIP)、气道平台压(Pplat)及中心静脉压(CVP)均明显升高[PIP(cmH2O):34.7±9.1比26.1±7.9,t=4.222,P=0.000; Pplat(cmH2O):30.5±8.4比22.2±7.1,t=4.465,P=0.000; CVP(mmHg):12.1±3.5比8.8±2.2,t=4.723,P=0.000];但并不会影响患者的心率(次/min:85.5±19.1比82.7±17.3,t=0.643,P=0.523)和平均动脉压(mmHg:73.5±12.4比76.4± 15.1,t=0.878,P=0.383)以及大脑中动脉血流速度[收缩期峰值速度(Vmax,cm/s):91.26±17.57比96.64±18.71,t=1.240,P=0.219;舒张期速度(Vmin,cm/s):31.54±7.71比33.87±8.53,t=1.199,P=0.235;平均速度(Vmean,cm/s):51.19±12.05比54.27±13.36,t=1.013,P=0.315].入组时共有18例患者BHI＜ 1.0,提示脑血管舒缩反应性欠佳;随着PEEP增加,BHI值略有下降(0.78±0.16比0.86±0.19,t=1.905,P=0.061).结论 相当部分不合并中枢神经系统病变的中重度ARDS患者本身就存在脑血管自动调节功能下降,选择一个相对较高的PEEP并不会进一步损害患者脑血管自动调节功能.
目的 探討不同呼氣末正壓(PEEP)水平對急性呼吸窘迫綜閤徵(ARDS)患者腦血流和腦血管自動調節功能的影響.方法 採用前瞻性觀察研究方法,選擇2013年1月1日至10月1日江西省人民醫院重癥醫學科住院的中重度ARDS患者,觀察不同PEEP水平下血流動力學、肺機械力學、肺氣體交換指標的變化;採用經顱多普勒(TCD)檢測大腦中動脈的血流速度,併計算屏氣指數(BHI).結果 共有35例ARDS患者入選,將PEEP水平由(6.4±1.0) cmH2O(1 cmH2O=0.098 kPa)提高到(14.5±2.0) cmH2O後,患者氧閤指數明顯改善[mmHg(1 mmHg=0.133 kPa):324.7± 117.2比173.4±95.8,t=5.913,P=0.000];氣道峰壓(PIP)、氣道平檯壓(Pplat)及中心靜脈壓(CVP)均明顯升高[PIP(cmH2O):34.7±9.1比26.1±7.9,t=4.222,P=0.000; Pplat(cmH2O):30.5±8.4比22.2±7.1,t=4.465,P=0.000; CVP(mmHg):12.1±3.5比8.8±2.2,t=4.723,P=0.000];但併不會影響患者的心率(次/min:85.5±19.1比82.7±17.3,t=0.643,P=0.523)和平均動脈壓(mmHg:73.5±12.4比76.4± 15.1,t=0.878,P=0.383)以及大腦中動脈血流速度[收縮期峰值速度(Vmax,cm/s):91.26±17.57比96.64±18.71,t=1.240,P=0.219;舒張期速度(Vmin,cm/s):31.54±7.71比33.87±8.53,t=1.199,P=0.235;平均速度(Vmean,cm/s):51.19±12.05比54.27±13.36,t=1.013,P=0.315].入組時共有18例患者BHI＜ 1.0,提示腦血管舒縮反應性欠佳;隨著PEEP增加,BHI值略有下降(0.78±0.16比0.86±0.19,t=1.905,P=0.061).結論 相噹部分不閤併中樞神經繫統病變的中重度ARDS患者本身就存在腦血管自動調節功能下降,選擇一箇相對較高的PEEP併不會進一步損害患者腦血管自動調節功能.
목적 탐토불동호기말정압(PEEP)수평대급성호흡군박종합정(ARDS)환자뇌혈류화뇌혈관자동조절공능적영향.방법 채용전첨성관찰연구방법,선택2013년1월1일지10월1일강서성인민의원중증의학과주원적중중도ARDS환자,관찰불동PEEP수평하혈류동역학、폐궤계역학、폐기체교환지표적변화;채용경로다보륵(TCD)검측대뇌중동맥적혈류속도,병계산병기지수(BHI).결과 공유35례ARDS환자입선,장PEEP수평유(6.4±1.0) cmH2O(1 cmH2O=0.098 kPa)제고도(14.5±2.0) cmH2O후,환자양합지수명현개선[mmHg(1 mmHg=0.133 kPa):324.7± 117.2비173.4±95.8,t=5.913,P=0.000];기도봉압(PIP)、기도평태압(Pplat)급중심정맥압(CVP)균명현승고[PIP(cmH2O):34.7±9.1비26.1±7.9,t=4.222,P=0.000; Pplat(cmH2O):30.5±8.4비22.2±7.1,t=4.465,P=0.000; CVP(mmHg):12.1±3.5비8.8±2.2,t=4.723,P=0.000];단병불회영향환자적심솔(차/min:85.5±19.1비82.7±17.3,t=0.643,P=0.523)화평균동맥압(mmHg:73.5±12.4비76.4± 15.1,t=0.878,P=0.383)이급대뇌중동맥혈류속도[수축기봉치속도(Vmax,cm/s):91.26±17.57비96.64±18.71,t=1.240,P=0.219;서장기속도(Vmin,cm/s):31.54±7.71비33.87±8.53,t=1.199,P=0.235;평균속도(Vmean,cm/s):51.19±12.05비54.27±13.36,t=1.013,P=0.315].입조시공유18례환자BHI＜ 1.0,제시뇌혈관서축반응성흠가;수착PEEP증가,BHI치략유하강(0.78±0.16비0.86±0.19,t=1.905,P=0.061).결론 상당부분불합병중추신경계통병변적중중도ARDS환자본신취존재뇌혈관자동조절공능하강,선택일개상대교고적PEEP병불회진일보손해환자뇌혈관자동조절공능.
Objective To explore the influence of different positive end-expiratory pressure (PEEP) levels on cerebral blood flow (CBF) and cerebrovascular autoregulation in patients with acute respiratory distress syndrome (ARDS).Methods A prospective study was conducted.Moderate or severe ARDS patients admitted to Department of Critical Care Medicine of Jiangxi Provincial People's Hospital from January 1st,2013 to October 1st,2013 were enrolled.The changes in hemodynamics,respiratory mechanics and gas exchange under different levels of PEEP were observed.CBF velocity of middle cerebral artery (MCA) was measured using transcranial Doppler (TCD),and breath-holding index (BHI) was also calculated.Results 35 patients with ARDS were included.The oxygenation index (OI),peak inspiratory pressure (PIP),plat pressure (Pplat) and central venous pressure (CVP) were markedly elevated [OI (mmHg,1 mmHg=0.133 kPa):324.7± 117.2 vs.173.4± 95.8,t=5.913,P=0.000; PIP (cmH2O):34.7 ± 9.1 vs.26.1 ± 7.9,t=4.222,P=0.000; Pplat (cmH2O):30.5 ± 8.4 vs.22.2 ± 7.1,t=4.465,P=0.000; CVP (mmHg):12.1 ± 3.5 vs.8.8 ± 2.2,t=4.723,P=0.000] when PEEP was increased from (6.4 ± 1.0) cmH2O to (14.5-± 2.0) cmH2O (1 cmH2O=0.098 kPa).But no significant difference in the heart rate (beats/min:85.5 ± 19.1 vs.82.7 ± 17.3,t=0.643,P=0.523),mean arterial pressure (mmHg:73.5 ± 12.4 vs.76.4 ± 15.1,t=0.878,P=0.383) and CBF velocity of MCA [peak systohc flow velocity (Vmax,cm/s):91.26 ± 17.57 vs.96.64 ± 18.71,t=1.240,P=0.219; diastolic flow velocity (Vmin,cm/s) 31.54 ±7.71 vs.33.87 ±8.53,t=1.199,P=0.235; mean velocity (Vmean,cm/s) 51.19 ± 12.05 vs.54.27 ± 13.36,t=1.013,P=0.315] was found.18 patients with BHI＜0.1 at baseline demonstrated that cerebral vasomotor reactivity was poor.BHI was slightly decreased with increase in PEEP (0.78 ± 0.16 vs.0.86 ± 0.19,t=1.905,P=0.061).Conclusions Some of moderate or severe ARDS patients without central nervous system disease have independent of preexisting cerebral autoregulation impairment.However,independent of preexisting cerebral autoregulation may not further be impaired when a high PEEP was chosen.
