中华急诊医学杂志
中華急診醫學雜誌
중화급진의학잡지
CHINESE JOURNAL OF EMERGENCY MEDICINE
2014年
9期
1013-1017
,共5页
杨田军%潘爱军%陶晓根%刘宝
楊田軍%潘愛軍%陶曉根%劉寶
양전군%반애군%도효근%류보
呼气末正压%急性呼吸窘迫综合征%腹内压%血流动力学
呼氣末正壓%急性呼吸窘迫綜閤徵%腹內壓%血流動力學
호기말정압%급성호흡군박종합정%복내압%혈류동역학
Positive end expiratory pressure%Acute respiratory disease syndrome%Intra-abdominal pressure%Hemodynamics
目的 明确逐渐增高的呼气末正压(PEEP)对伴有及不伴有腹腔高压的急性呼吸窘迫综合征患者血流动力学与腹腔压力的影响.方法 对18例入住安徽省立医院重症病房的急性呼吸窘迫综合征患者采用前瞻性对比研究.分别在5、10、15、20 cmH2O呼吸末正压水平通过PICCO测定患者胸腔血容积指数(ITBVI)、血管外肺水指数(EVLWI)以及每博变异率(SVV),同时测定腹内压的变化.结果 (1)高腹内压组EVLWI水平基本随PEEP增加而减少,但15 cmH2O与20 cmH2O之间差异无统计学意义(t=0.593,P=0.572).正常腹内压组患者EVLWI不随PEEP增加而变化.(2)两组患者SVV水平均随PEEP增加而增高,但腹内压正常组SVV在PEEP超过10 cmH2O后差异有统计学意义(PEEP 5 vs.PEEP 10,t=0.326,P=0.752.PEEP 10 vs.PEEP 15,t=-20.032,P＜0.01).(3)两组患者ITBVI在不同呼气末正压水平差异无统计学意义.(4) PEEP能显著增加两组患者的腹内压,对腹内压已经升高的患者影响程度更加明显.结论 PEEP能显著增加ARDS患者的腹内压,对既往已经存在腹内高压的患者,这种效果更加显著;不同PEEP水平能显著降低腹腔高压患者的EVLWI,但对腹内压正常患者影响不显著.
目的 明確逐漸增高的呼氣末正壓(PEEP)對伴有及不伴有腹腔高壓的急性呼吸窘迫綜閤徵患者血流動力學與腹腔壓力的影響.方法 對18例入住安徽省立醫院重癥病房的急性呼吸窘迫綜閤徵患者採用前瞻性對比研究.分彆在5、10、15、20 cmH2O呼吸末正壓水平通過PICCO測定患者胸腔血容積指數(ITBVI)、血管外肺水指數(EVLWI)以及每博變異率(SVV),同時測定腹內壓的變化.結果 (1)高腹內壓組EVLWI水平基本隨PEEP增加而減少,但15 cmH2O與20 cmH2O之間差異無統計學意義(t=0.593,P=0.572).正常腹內壓組患者EVLWI不隨PEEP增加而變化.(2)兩組患者SVV水平均隨PEEP增加而增高,但腹內壓正常組SVV在PEEP超過10 cmH2O後差異有統計學意義(PEEP 5 vs.PEEP 10,t=0.326,P=0.752.PEEP 10 vs.PEEP 15,t=-20.032,P＜0.01).(3)兩組患者ITBVI在不同呼氣末正壓水平差異無統計學意義.(4) PEEP能顯著增加兩組患者的腹內壓,對腹內壓已經升高的患者影響程度更加明顯.結論 PEEP能顯著增加ARDS患者的腹內壓,對既往已經存在腹內高壓的患者,這種效果更加顯著;不同PEEP水平能顯著降低腹腔高壓患者的EVLWI,但對腹內壓正常患者影響不顯著.
목적 명학축점증고적호기말정압(PEEP)대반유급불반유복강고압적급성호흡군박종합정환자혈류동역학여복강압력적영향.방법 대18례입주안휘성립의원중증병방적급성호흡군박종합정환자채용전첨성대비연구.분별재5、10、15、20 cmH2O호흡말정압수평통과PICCO측정환자흉강혈용적지수(ITBVI)、혈관외폐수지수(EVLWI)이급매박변이솔(SVV),동시측정복내압적변화.결과 (1)고복내압조EVLWI수평기본수PEEP증가이감소,단15 cmH2O여20 cmH2O지간차이무통계학의의(t=0.593,P=0.572).정상복내압조환자EVLWI불수PEEP증가이변화.(2)량조환자SVV수평균수PEEP증가이증고,단복내압정상조SVV재PEEP초과10 cmH2O후차이유통계학의의(PEEP 5 vs.PEEP 10,t=0.326,P=0.752.PEEP 10 vs.PEEP 15,t=-20.032,P＜0.01).(3)량조환자ITBVI재불동호기말정압수평차이무통계학의의.(4) PEEP능현저증가량조환자적복내압,대복내압이경승고적환자영향정도경가명현.결론 PEEP능현저증가ARDS환자적복내압,대기왕이경존재복내고압적환자,저충효과경가현저;불동PEEP수평능현저강저복강고압환자적EVLWI,단대복내압정상환자영향불현저.
Objective To investigate the effects of positive end-expiratory pressure (PEEP) on hemodynamics and intra-abdominal pressure in patients with acute respiratory distress syndrome (ARDS) with normal intra-abdominal pressure (IAP) and intra-abdominal hypertension (IAH) during mechanical ventilation under a incremental PEEP.Methods Eighteen ARDS patients with normal IAP or IAH treated in intensive care unit of Anhui Provincial Hospital were enrolled for study.At different PEEP levels (5,10,15,20 cmH2O),hemodynamic parameters including extravascular lung water index (EVLWI),intrathoracic blood volume index (ITBVI),stroke volume variation (SVV) and IAP were measured with PICCO technology.Results Compared with ARDS patients with normal IAP,the ARDS patients with IAH were characterized by:(1) EVLWI was decreasing under the increment of PEEP,but there was no significant difference between 15 cmH2O and 20 cmH2O (t =0.593,P =0.572).As PEEP was gradually escalated,EWLVI had no significant changes in patients with normal IAP.(2) SVV increased as PEEP was being titrated to higher level in both groups but in normal IAP group such effect was observed till PEEP above 10cmH2O (PEEP5 vs.PEEP10,t=0.326,P=0.752; PEEP,10 vs.PEEP 15,t=-20.032,P＜ 0.01).(3) There was no statistical difference in ITBVI between two groups at varied levels of PEEP.(4) PEEP could increase IAP levels and had much more profound effects on patients with IAH.Conclusions PEEP is a contributing factor changing IAP.It is necessary to take the level of PEEP into account as IAP variation is interpreted in patients under mechanical ventilation.Different PEEP levels can significantly affect the EVLWI in patients with IAH but not do not in ones with nomal IAP.
