摘要
目的 寻找适宜的呼气末正压（PEEP）,研究不同机械通气方式对肝移植术后患者血流动力学及氧代谢动力学的影响。方法采用随机、单盲、交叉试验方法。选取11例背驮式肝移植术后呼吸机辅助通气患者为观察对象,经漂浮导管、桡动脉导管进行持续心排血量（CO）、平均肺动脉压（MPAP）、平均动脉血压（MABP）、中心静脉压（CVP）和气道压力监测。压力调节容量控制通气（PRVCV）的PEEP定为0、5、10和15cmH2O（1cmH2O=0.098kPa）,不同水平PEEP各用30min;交替使用PRVCV和压力控制同步间歇指令通气加压力支持通气（PC-SIMV＋PSV）各60min;观察4种PEEP水平和两种通气模式下血流动力学和氧代谢动力学指标的变化。结果不同水平PEEP时肝移植术后患者气道峰压、平均气道压、CVP及MPAP差异均有显著性,其中在PEEP为10cmH2O和15cmH2O时显著高于PEEP为0和5cmH2O时;不同水平PEEP对pH、动脉血二氧化碳分压（PaCO2）、动脉血氧分压（PaO2）、动脉血氧饱和度（SaO2）、氧供给（DO2）、氧消耗（VO2）、氧摄取率（O2ER）均无明显影响。PRVCV模式时平均气道压明显低于PC-SIMV＋PSV模式〔（8.78±1.53）cmH2O比（11.64±3.30）cmH2O,P〈0.05〕;PRVCV模式时VO2虽低于PC-SIMV＋PSV模式,但差异无显著性。两种通气模式对患者的其他血流动力学指标以及氧代谢动力学指标并无显著影响。结论 为减少对患者体循环及移植肝脏血液回流的影响,肝移植术后患者通气支持时宜选用5cmH2O的低水平PEEP。PRVCV模式可作为肝移植术后患者呼吸支持和脱机过渡较为理想的通气模式。
Objective To determine the impact of adaptive positive end expiratory pressure （PEEP） and mechanical ventilation on hemodynamics and oxygen kinetics in post - liver transplantation patients. Methods The study included 11 patients who accepted mechanical ventilation after piggyback liver transplantation. Swan- Ganz catheter and radial artery catheter were used to monitor the cardiac output （CO）, mean pulmonary arterial pressure （MPAP）, meanarterial blood pressure （MABP） and central venous pressure （CVP） and airuay pressure. After transplantation, PEEP of 0, 5, 10 and 15 cm H20 （1 cm H2O= 0. 098 kPa）was instituted to support the ventilation alternately. After 30 minutes, pressure regulated volume controlled ventilation （PRVCV） and pressure controlled synchronized intermiteat mandatory ventilation ＋ pressure support ventilation（PC- SIMV＋PSV） were used to support the ventilation alternately and the indexes of hemodynamics and oxygen kinetics were analyzed. Results The data showed that differences existed in peak airway pressure, mean airway pressure, CVP and MPAP when different levels of PEEP were used. These indexes were significantly higher in PEEP of 15 and 10 cm H2O than those in PEEP of 0 and 5 cm H2O. There were no differences in pH, partial pressure of carbon dioxide in arterial blood （PaCO2）, pressure of oxygen in arterial blood （PaO2）, arterial oxygen saturation （SaO2）, oxygen delivery （DO2）, oxygen consumption （VO2） and oxygen extraction rate （O2ER） at different levels of PEEP. The airway pressure was significantly lower under PRVCV pattern than those under PC -SIMVq-PSV pattern [（8.78±1.53） cm H2O vs. （11.64±3.30） cm H2O, P〈0.05]. There were no differences in other indexes between these two mechanical ventilation patterns. Conclusion These date suggested that a low level of PEEP （5 cm H2O） during mechanical ventilation should be used in post -liver transplantation patients in order to decrease the influence of PEEP on systemic circulation and hepatic regurgitation. PRVCV could be a more suitable mechanical ventilation pattern for patient after liver transplantation.
出处
《中国危重病急救医学》
CAS
CSCD
北大核心
2007年第7期404-407,共4页
Chinese Critical Care Medicine
关键词
呼气末正压
压力调节容量控制通气
压力控制同步间歇指令通气
压力支持通气
肝移植
血流动力学
氧代谢动力学
positive end expiratory pressure
pressure regulated volume controlled ventilation
pressure controlled synchronized intermiteat mandatory ventilation ＋pressure support ventilation
pressure support ventilation
liver transplantation
hemodynamics
oxygen kinetics
