摘要
目的探讨全麻下全髋关节置换术左侧卧位时,呼气末正压(PEEP)通气对功能性血流动力学指标的影响。方法选择2013年3-8月择期行右侧全髋关节置换术的患者20例,静吸复合麻醉,左侧卧位,观察机械通气加用PEEP时各指标的变化。分别记录使用PEEP前(P0)以及PEEP水平为4cmH2O(P4)、6cmH2O(P6)、8cmH2O(P8)、10cmH2O(P10)、12cmH2O(P12)、14cmH2O(P14)时动态性血流动力学参数每搏量变异(SVV)、动脉脉压变异(PPV)以及循环参数心指数(CI)、平均动脉压(MAP)、心率(HR)的变化。结果随PEEP水平的升高,SVV、PPV逐渐增加,且与PEEP呈正相关(r=0.507,r=0.359,P<0.01),CI逐渐降低,且与PEEP呈负相关(r=-0.108,P<0.05),而MAP、HR无明显变化(P>0.05)。结论临床应用SVV和PPV等指标监测容量状况时,应考虑PEEP对其数值的影响,以免造成对机体循环容量状态的误判。
Objective To investigate the effect of positive end-expiratory pressure （PEEP） on functional hemodynamic parameters in patients lying in left lateral position during operation （right side total hip arthroplasty） under general anesthesia. Methods Twenty patients undergoing right side total hip arthroplasty lying in left lateral position under general anesthesia from March to August of 2013 were enrolled in the present study. The mechanical ventilation and PEEP were used in all of the patients, the functional hemodynamic parameters including stroke volume variation （SVV） and pulse pressure variation （PPV）, and the circulatory parameters consisting of cardiac index （CI）, mean arterial pressure （MAP） and heart rate （HR） under PEEP levels of 0cmHzO （P0）, 4cmHzO （P4）, 6cmH20 （P6）, 8cmH20 （Ps）, 10cmH2O （P10）, 12cmH20 （P12） and 14cmH20 （P14） were recorded. Results Along with the elevation of PEEP, SVV and PPV increased and exhibited a positive correlation with PEEP levels （r=0.S07, r=0.359, P〈0.01）, while CI gradually lowered, and it exhibited a negative correlation with PEEP levels （r=-0.108, P〈0.0S）. MAP and HR showed no significant change with different PEEP levels （P〉0.05）. Conclusion The influence of PEEP on SVV and PPV must be considered when they are used to monitor volume status in order to avoid misjudgment of volume status.
出处
《解放军医学杂志》
CAS
CSCD
北大核心
2014年第4期320-323,共4页
Medical Journal of Chinese People's Liberation Army
关键词
正压呼吸
每搏量变异
动脉脉压变异
positive-pressure respiration
stroke volume variation
pulse pressure variation
