摘要
目的研究不同水平呼气末正压（PEEP）对急性呼吸窘迫综合征（ARDS）合并腹腔高压（IAH）患者的呼吸功能及血流动力学影响。方法选取重症监护病房（ICU）中30例中度ARDS患者，根据腹腔压力（IAP）分为3组：IAP正常组；IAPI级组，IAP12-15mmHg；IAPII级组，IAP16-20mmHg。每组10例。按最佳氧合法滴定出最佳PEEP水平。监测、对比各组患者滴定最佳PEEP水平前后氧合指数（oU、呼吸力学及血流动力学，比较患者28d死亡率及ICU住院时间。结果各组患者的0I较滴定前均显著升高（P〈0．01），滴定后IAPII级组的OI较其他组显著升高（P〈0．05）；各组患者的肺静态顺应性（Cst）均较滴定前明显改善（P〈0．05），但各组患者滴定后的Cst无显著差异；IAPⅡ级组滴定后的PEEP、IAP、血乳酸、心率、气道平台压显著高于滴定前及其他组（P〈0．05），平均动脉压显著低于滴定前及其他组（P〈0．01），且ICU住院时间最长（P〈0．01）；各组患者28d死亡率无显著差异（P〉0．05）。结论使用PEEP可显著改善ARDS合并IAH患者的氧合，IAP越高则需使用的PEEP水平越高。要达到较好的氧合状况需使用较高水平的PEEP，但使用高水平PEEP会导致IAP明显升高，对血流动力学造成不良影响，对预后无改善。
Objective To investigate different levels of positive end-expiratory pressure （PEEP） on respiratory function and hemodynamics in patients with acute respiratory distress syndrome （ARDS） complicated with intra-abdominal hypertension （IAH）. Methods Thirty patients with moderate ARDS admitted in ICU between January 2012 and December 2014 were recruited in the study. They were divided into three groups according to intra-abdominal pressure （lAP） ,including 10 patients with normal abdominal pressure as a normal lAP group,10 patients with lAP of 12 - 15 mm Hg as an IAP I group,and 10 patients with lAP of 16 - 20 mm Hg as an lAP Ⅱ group. The optimal level of PEEP was titrated according to the best oxygenation methods. The changes of oxygenation index （OI）, respiratory mechanics and hemodynamies before and after the optimal level of PEEP were monitored and compared in all groups. The 28-day mortality and ICU stay were also compared. Results The OI after titration was significantly improved compared to baseline in all groups （ all P 〈 0. 01 ）. The OI after titration in the IAP Ⅱ group was significantly higher than that in other two groups （ all P 〈 0.05 ）. The static lung compliance （Cst） after titration significantly improved than baseline in all groups （ all P 〈 0.05 ）, but no significant difference was revealed among three groups （ all P 〉 0. 05 ）. In the lAP II group, the levels of PEEP, IAP, blood lactate, heart rate and airway plateau pressure after titration were significantly increased than baseline but higher than those in other two groups（ all P 〈0. 05 ） ,while the level of mean arterial pressure was significantly decreased and significantly lower than those in other two groups（ all P 〈 0. 01 ）. Meanwhile, the ICU stay was longest in the IAP Ⅱ group （P 〈 0. 01 ）. There was no significant difference in 28-day mortality among three groups （ all P 〉 0.05 ）. Conclusions PEEP can significantly improve oxygenation in patients with ARDS complicated with IAH. The higher the IAP is, the higher the PEEP level is required. However the higher PEEP will significantly increase IAP which will cause adverse impacts on hemodynamics and can not improve the prognosis.
出处
《中国呼吸与危重监护杂志》
CAS
北大核心
2015年第3期282-285,共4页
Chinese Journal of Respiratory and Critical Care Medicine
基金
广西壮族自治区卫生厅科研课题(编号:Z 2012582)
关键词
急性呼吸窘迫综合征
呼气末正压
腹腔压力
Acute respiratory distress syndrome
Positive end-expiratory pressure
Intra-abdominal pressure
