中华麻醉学杂志
中華痳醉學雜誌
중화마취학잡지
CHINESE JOURNAL OF ANESTHESIOLOGY
2014年
1期
65-67
,共3页
韩玉%代庆春%沈洪丽%苗晓云%回志%吴忠荣%张晓卫
韓玉%代慶春%瀋洪麗%苗曉雲%迴誌%吳忠榮%張曉衛
한옥%대경춘%침홍려%묘효운%회지%오충영%장효위
正压呼吸%心排血量%中心静脉压%补液疗法%休克,脓毒性
正壓呼吸%心排血量%中心靜脈壓%補液療法%休剋,膿毒性
정압호흡%심배혈량%중심정맥압%보액요법%휴극,농독성
Positive-pressure respiration%Cardiac output%Central venous pressure%Fluid therapy%Shock,septic
目的 评价不同呼气末正压(PEEP)对全心舒张末容积指数(GEDVI)和中心静脉压(CVP)指导感染性休克患者容量治疗效果的影响.方法 感染性休克后并发呼吸衰竭患者25例,性别不限,年龄18～64岁,急性生理和慢性健康状况评分13～31分,气管插管后行容量控制通气,PEEP5～ 15 cmH2O,维持脉搏血氧饱和度＞90％,根据PEEP水平不同分为低PEEP(5～ 10 cmH2O)组与高PEEP(11 ～ 15 cmH2 O)组.经30 min输注6％羟乙基淀粉200/0.5 6 ml/kg进行容量治疗.经右颈内静脉或锁骨下静脉穿刺置管,用于监测CVP,采用脉搏指示剂持续心排血量监测技术监测GEDVI,记录容量治疗前、后CVP和GEDVI,并计算二者变化率.结果 与容量治疗前比较,低PEEP组容量治疗后CVP和GEDVI升高,高PEEP组容量治疗后GEDVI升高(P＜0.05),而CVP差异无统计学意义(P＞0.05).与低PEEP组比较,高PEEP组CVP变化率降低(P＜0.05),而GEDVI变化率差异无统计学意义(P＞0.05).结论 高PEEP可降低CVP指导感染性休克患者容量治疗的效果,而对GEDVI指导的效果无影响.
目的 評價不同呼氣末正壓(PEEP)對全心舒張末容積指數(GEDVI)和中心靜脈壓(CVP)指導感染性休剋患者容量治療效果的影響.方法 感染性休剋後併髮呼吸衰竭患者25例,性彆不限,年齡18～64歲,急性生理和慢性健康狀況評分13～31分,氣管插管後行容量控製通氣,PEEP5～ 15 cmH2O,維持脈搏血氧飽和度＞90％,根據PEEP水平不同分為低PEEP(5～ 10 cmH2O)組與高PEEP(11 ～ 15 cmH2 O)組.經30 min輸註6％羥乙基澱粉200/0.5 6 ml/kg進行容量治療.經右頸內靜脈或鎖骨下靜脈穿刺置管,用于鑑測CVP,採用脈搏指示劑持續心排血量鑑測技術鑑測GEDVI,記錄容量治療前、後CVP和GEDVI,併計算二者變化率.結果 與容量治療前比較,低PEEP組容量治療後CVP和GEDVI升高,高PEEP組容量治療後GEDVI升高(P＜0.05),而CVP差異無統計學意義(P＞0.05).與低PEEP組比較,高PEEP組CVP變化率降低(P＜0.05),而GEDVI變化率差異無統計學意義(P＞0.05).結論 高PEEP可降低CVP指導感染性休剋患者容量治療的效果,而對GEDVI指導的效果無影響.
목적 평개불동호기말정압(PEEP)대전심서장말용적지수(GEDVI)화중심정맥압(CVP)지도감염성휴극환자용량치료효과적영향.방법 감염성휴극후병발호흡쇠갈환자25례,성별불한,년령18～64세,급성생리화만성건강상황평분13～31분,기관삽관후행용량공제통기,PEEP5～ 15 cmH2O,유지맥박혈양포화도＞90％,근거PEEP수평불동분위저PEEP(5～ 10 cmH2O)조여고PEEP(11 ～ 15 cmH2 O)조.경30 min수주6％간을기정분200/0.5 6 ml/kg진행용량치료.경우경내정맥혹쇄골하정맥천자치관,용우감측CVP,채용맥박지시제지속심배혈량감측기술감측GEDVI,기록용량치료전、후CVP화GEDVI,병계산이자변화솔.결과 여용량치료전비교,저PEEP조용량치료후CVP화GEDVI승고,고PEEP조용량치료후GEDVI승고(P＜0.05),이CVP차이무통계학의의(P＞0.05).여저PEEP조비교,고PEEP조CVP변화솔강저(P＜0.05),이GEDVI변화솔차이무통계학의의(P＞0.05).결론 고PEEP가강저CVP지도감염성휴극환자용량치료적효과,이대GEDVI지도적효과무영향.
Objective To compare the effect of different positive end-expiratory pressures (PEEPs) on the efficacy of volume therapy guided by global end-diastolic volume index (GEDVI) and central venous pressure (CVP) in patients with septic shock.Methods Twenty-five patients with septic shock complicated with respiratory failure,of both sexes,aged 18-64 yr,were enrolled in the study.Their APACHE [[scores were 13-31.The patients were endotracheally intubated and underwent volume-controlled ventilation,PEEP was 5-15 cmH2O,and pulse oxygen saturation was maintained ＞ 90 ％.The patients were divided into low PEEP (5-10 cmH2 O) group and high PEEP (11-15 cmH2 O) group depending on the different PEEP levels.6 ％ hydroxyethyl starch (200/0.5)6 ml/kg was infused over 30 min for volume therapy.Right internal jugular vein or subclavian vein was cannulated for CVP monitoring,and GEDVI was continuously monitored by pulse indicator continuous output monitoring (PiCCO) technology.CVP and GEDVI were recorded before and after volume therapy and the changing rate was calculated.Results Compared with CVP and GEDVI before volume therapy,CVP and GEDVI were significantly increased after volume therapy in low PEEP group (P ＜ 0.05),and GEDVI was increased after volume therapy (P ＜ 0.05) and no significant change was found in CVP after volume therapy in high PEEP group (P ＞ 0.05).Compared with low PEEP group,the changing rate of CVP was significantly decreased (P ＜ 0.05),and no significant change was found in the changing rate of GEDVI in high PEEP group (P ＞ 0.05).Conclusion High PEEP can decrease the efficacy of volume therapy guided by CVP,while exerts no effect on the efficacy of volume therapy guided by GEDVI in patients with septic shock.
