呼气末正压对机械通气患者中心静脉压及髂总静脉压的影响  

Effect of positive end-expiratory pressure on central venous pressure and common iliac venous pressure in mechanically ventilated patients

作　　者：曹枫[1] 刘先福[1] 陈荣琳[1] 王晓川[1] 

机构地区：[1]深圳市龙岗中心医院(深圳市第九人民医院)综合ICU,广东518116

出　　处：《中国危重病急救医学》2008年第6期341-344,共4页Chinese Critical Care Medicine

基　　金：广东省深圳市科技计划资助项目（200703082）

摘　　要：目的观察不同呼气末正压（PEEP）水平对机械通气患者中心静脉压（CVP）和髂总静脉压（CIVP）及两者相关关系的影响。方法将2007年2-8月收住重症加强治疗病房（ICU），无心肺疾患、循环稳定、无腹胀、无凝血功能异常，需机械通气的20例成年患者列为观察对象，采用自身对照，随机加用0、5和10cm H2O（1cm H2O=0．098kPa）PEEP，评估在此条件下，CVP、CIVP和两者压力阶差变化及其与机械通气压力变化间的相关关系。结果CVP及CIVP随PEEP增加而增高，差异有统计学意义（P〈0．05或P〈0．01）；CVP及CIVP在各PEEP水平下均呈直线正相关关系[0、5和10cm H2O PEEP时相关系数（r）值分别为0．620、0．658和0．777，P均〈0．01]，回归方程为：CVP估计值=0．402＋0．732×CIVP值。CIVP高于CVP约2mmHg（1mmHg=0．133kPa），此差值不受PEEP影响，差异无统计学意义（P〉0．05）；CVP及CIVP与机械通气各压力值变化呈正相关，但CVP及CIVP仅与平均气道压（Pmean）及PEEP有统计学意义（CVP与PEEP r=0．751，CIVP与PEEP r=0．685，CVP与Pmean r=0．634，CIVP与Pmena r=0．603，P均〈0.01）。试验中患者平均动脉压、心率及呼出潮气量（VTe）无明显变化。结论无心肺疾患及腹胀、循环稳定的机械通气患者，加用≤10cm H2O PEEP时，可致CVP及CIVP相应增高，但两者仍保持直线正相关关系，两者间差值也不受影响，对患者血流动力学亦无影响。机械通气时，对CVP及CIVP影响最明显的是PEEP及Pmean。Objective To evaluate the effects of positive end-expiratory pressure （PEEP） on central venous pressure （CVP） and common iliac venous pressure （CIVP）, the relationship between CVP and CIVP, in order to analyze the correlationship between CVP or CIVP and airway pressure in patients during mechanical ventilation. Methods Twenty mechanically ventilated adult patients with steady circulatory state and without cardiopulmonary ailment, abdominal distention or coagulopathy were enrolled for the study from February to August in 2007. 0, 5, 10 cm H2O （1 cm H2O=0. 098 kPa） PEEP was used randomly in all cases during mechanical ventilation. CVP, CIVP, the gradient between CVP and CIVP at each PEEP level were measured. Linear correlation and linear regression analysis were used to analyze relative changes between CVP and CIVP. The data of airway pressure in the patients with mechanical ventilation were obtained for evaluating their correlation with CVP or CIVP. Results CVP and CIVP increased as PEEP was elevated （P〈0.05 or P〈0.01）. There was a significant linear correlation between CVP and CIVP at 0, 5, 10 cm H2O PEEP level （r was 0. 620, 0. 658 and 0. 777, respectively, P〈0.01）. The linear regression equation was Y （CVP） 0. 402-0. 732X （CIVP）. The mean difference between CVP and CIVP at 0, 5, 10 cm H2O PEEP level was （1.9±1.7）, （2.3±1.3）, and （1.9±1.1） mm Hg （1 mm Hg 0.133 kPa, respectively P〈0.05）. There was a positive correlation between CVP or CIVP and the airway pressure, but only mean airway pressure and PEEP showed significant linear correlation with CVP （r was 0. 634, 0. 603, respectively, P〈0.01） and CIVP （r was 0. 751, 0. 685, respectively, P〈0.01）. No obvious change was found in mean arterial pressure, heart rate, and exiperatory tidal volume during the study. Conclusion CVP and CIVP increased when PEEP is set ≤10 cm HzO in mechanical ventilated patients, whose circulatory status is steady and who do not have cardiopumonary ailment or abdomina

关 键 词：机械通气 呼气末正压 中心静脉压 髂总静脉压 

分 类 号：R459.6[医药卫生—治疗学]