摘要
目的 探讨低潮气量加呼气末正压 (PEEP)通气对重症胸外伤致急性肺损伤患者血流动力学和氧代谢的影响。方法 对 12例胸外伤致急性肺损伤患者采用低潮气量加PEEP通气 ,并依次增加PEEP( 0、5、10、15及 2 0cmH2 O)。通过Swan Gaze导管监测血流动力学和氧代谢参数。结果 与机械通气前比较 ,PEEP在 5～ 10cmH2 O范围内 ,心输出量 (CO)、心脏指数 (CI)和平均血压 (MBP)明显增加 ,心率 (HR)下降 (P <0 0 1) ;当PEEP增加到 15～ 2 0cmH2 O时 ,CO和CI下降 ,HR、肺动脉压(PAP)、体循环阻力 (SVR)和肺循环阻力 (PVR)增加 (P <0 0 1) ;PEEP在 5～ 10cmH2 O范围内 ,肺静态顺应性 (Cst)增加 (P <0 0 1) ;PEEP增加到≥ 15cmH2 O时 ,Cst下降。结论 对重症胸外伤致急性肺损伤患者给予低潮气量加适当PEEP( 5～ 10cmH2 O)通气可减少对呼吸和血流动力学的影响。
Objective To explore the effects of low tidal volume ventilation with positive end-expiratory pressure on the hemodynamic and oxygen metabolism in patients with acute lung injury (ALI) due to chest trauma.Methods 12 patients of ALI (score≥2.0) was ventilated with low tidal volume and positive end expiratory pressure (PEEP) at various levels of PEEP (0,5,10,15,20 cm H 2O).The parameters of hemodynamic and oxygen metabolism were monitored by Swan-Ganz catheter.Results In the range of PEEP from 5 to 10 cm H 2O the cardiac output (CO),cardiac index (CI) ,and MBP were gradually increased while heart rate (HR) was significantly decreased (P<0.01).When the level of PEEP exceeded 15 cm H 2O CO and CI were significantly decreased meanwhile HR,PAP,SVR and PVR were significantly increased (P<0.01).In the range of PEEP from 5 to 10 cm H 2O the compliance static (Cst) was gradually increased (P<0.01) but significantly decreased at the level of PEEP exceeding 15 cm H 2O.Conclusion Low tidal volume ventilation with proper level of PEEP has minimal adverse effects on pneumodynamics and hemodynamic in patients with ALI resulted from chest trauma.
出处
《中国呼吸与危重监护杂志》
CAS
2004年第3期170-172,共3页
Chinese Journal of Respiratory and Critical Care Medicine
