摘要
目的评估呼气末正压（PEEP）对中枢性呼吸衰竭患者血流动力学参数如中心静脉压（CVP）、平均动脉压（MAP）和心率（HR）的影响。方法2009年6月至2011年5月期间32例上海浦东新区浦南医院神经外科ICU中枢性呼吸衰竭患者入选此项前瞻性自身对照研究，其中男19例，女13例，年龄（58．8±13．9）岁，GCS评分≤8分。排除严重心、肺、心包疾病，及人机对抗、应用血管活性药物及血容量过高或过低等情况。所有患者予同步间隙指令通气（SIMV），在随机选择的PEEP水平（0、3、6、9、12、15cmH20，1cmH20=0．098kPa）记录患者CVP、MAP及HR的变化，每个PEEP水平间隔10min。采用单因素方差分析和一元线性回归模型对数据进行分析。结果CVP随PEEP增加而增高，PEEP与CVP检测值呈正相关（R=0．468，P=0．000），一元线性回归方程为：CVP（cmH2O）=7．870＋0．344×PEEP（cmH2O）。在不同PEEP水平时，MAP差异无统计学意义（F=1．390，P=0．227）。MAP和HR与PEEP无线性相关（R=0．042和0．160，P=0．413和0．002）。结论PEEP可使中枢性呼吸衰竭患者CVP检测值偏高，而对MAP无明显影响。该结果可对实施PEEP条件下检测的CVP值进行动态客观评估提供量化参考。
Objective To evaluate the impact of positive end-expiratory pressure （PEEP） on hemodynamic variables including central venous pressure （CVP） , mean arterial pressure （MAP） and heart rate （HR） in patients with central respiratory failure treated by mechanical ventilation. Methods Thirty two neurosurgieal patients with central respiratory failure, male 19, female 13, mean age （58.8 ± 13.9 ） years, GCS ≤ 8 points, were enrolled in this prospective, self-control study between June 1,2009, and May 31, 2011. Patients were excluded in cases of severe cardiopulmonary disorders, pericardial diseases, person machine confrontation, administration of vasoactive drugs, and hypervolemia or hypovolemia. On admission to neurosurgical intensive care unit, all patients were mechanically ventilated in the mode of synchronized intermittent mandatory ventilation. Hemodynamic effects of six randomly set levels of end-expiratory pressures （0, 3, 6, 9, 12, 15 cm H20, every 10 min, lcm H：O =0.098 kPa） were studied in all patients. CVP, MAP and HR were recorded at each of the six end-expiratory pressure levels. One-way analysis of variance and simple linear regression model were used for data analysis. Results The levels ofcentral venous pressure were elevated with increase in end-expiratory pressures. CVP levels were positively correlated with the levels of PEEP （ R = 0. 468, P = 0. 000）, with a simple linear regression equation expressed as： CVP （cm H2O） =7.870 ±0.344 xPEEP （cm H20）, The levels of MAP showed no statistically significant changes at different PEEP levels （ F = 1. 390, P = 0. 227 ）. No linear correlation between MAP, HR and PEEP levels was found （R = 0.042 and 0.160, P = 0.413 and 0.002）. Conclusions CVP values would be overestimated during mechanical ventilation at different PEEP levels in mechanically ventilated patients due to central respiratory failure, positive correlation existed between CVP values and PEEP levels, whereas MAP was unaffected by different PEEP levels. This study could probably offer a quantitative reference for correct assessment of such a hemodynamic variable as CVP for mechanically ventilated patients without discontinuance of PEEP. Further studies are needed to determine whether these findings could be confirmed in a prospective manner.
出处
《中华急诊医学杂志》
CAS
CSCD
北大核心
2012年第11期1247-1250,共4页
Chinese Journal of Emergency Medicine
基金
上海市浦东新区卫生局卫生科技基金（PW2009A-16）
关键词
呼气末正压
中心静脉压
中枢性呼吸衰竭
机械通气
Positive end-expiratory pressure
Central venous pressure
Central respiratory failure
Mechanical ventilation
