呼气末正压通气对急性呼吸窘迫综合征患者氧利用率的影响  

Effect of PEEP on oxygen utilization coefficient in patients with acute respiratory distress syndrome

作　　者：霍开秀[1] 王晓川[2] 黄兴国 谢江霞[1] 丘自挺[1] 

机构地区：[1]深圳市龙岗区人民医院ICU,广东省深圳518172 [2]广东省深圳市龙岗中心医院ICU [3]广东省深圳市龙岗区计划服务生殖中心

出　　处：《中国基层医药》2009年第1期8-9,共2页Chinese Journal of Primary Medicine and Pharmacy

基　　金：基金项目：广东省深圳市龙岗区科研基金项目（200139）

摘　　要：目的探讨呼气末正压通气（PEEP）对急性呼吸窘迫综合征（ARDS）患者氧利用率（O2UC）的影响。方法选择28例ARDS机械通气患者，放置中心静脉导管，依次调节PEEP为0、5、10、15和20cmH2O五种不同压力水平，分别采动静脉血查血气并计算O2UC，记录心率及平均动脉血压（MBP）等变化。同时抽取30例健康人动静脉血（1次）查血气计算O2UC作为对照。结果（1）ARDS患者五种不同水平的PEEP，其O2UC与健康人O2UC相比均明显下降（P〈0．05或P〈0．01）。（2）在PEEP为15cmH2O时，O2UC值显著低于PEEP为0cmH2O时的02UC（P〈0．05）；PEEP为20cmH2O时，O2UC则非常显著地降低（P〈0．01）。PEEP为5、10cmH2O时，O2UC差异无统计学意义（与PEEP为0cmH2O时比较，P〉0．05）。（3）当PEEP在15cmH2O及20cmH2O时，MBP明显下降（P〈0．05或P〈0．01），HR却明显上升（P〈0．05或P〈0．01）。结论过高PFEP会导致ARDS患者氧利用率的进一步下降，不能真正纠正患者体内组织细胞的缺氧状态，必须寻找最佳PEEP，并适当增加血容量及有效心输出量，才能真正改善患者的缺氧状态。Objective To observe the effects of positive end-expiratory pressure（PEEP） on oxygen utilization coefficient in patients with acute respiratory distress syndrome（ARDS）. Methods 28 ARDS patients with mechanical ventilation were studied. Catheter of central vein was laid. Increment levels of PEEP （ 0,5,10, 15 and 20cmH2 O） were applied sequentially. Hemodynamics and oxygen metabolism parameters were measured and calculation of O2 UC [ O2 UC = （SaO2 -SvO2 ）/SaO2 ] were carried out respectively. O2 UC in 30 normal subject groups were carried out. Results Arterial oxygen tension （ PaO2 ） increased significantly （ P 〈 0. 05 ） at PEEP 5 cmH2O. Oxygen utilization coefficient（ O2 UC）, heart rate（HR） and mean blood pressure （MBP） were not significantly different （P 〉 0. 05） at PEEP 10cmH2O. At PEEP 15cmH2O, O2 UC and HR increased significantly （P 〈 0. 05 ）, but MBP reduced obviously（P 〈 0. 05）. Conclusions Too high PEEP can result in oxygen utilization coefficient of ARDS patient descend furthur, can not really correct oxygen dificiency condition in patients＇ organization cell. The optimal PEEP should be found, and blood capacity should be appropriately increased.

关 键 词：机械通气 急性呼吸窘迫综合征 氧利用率 

分 类 号：R563[医药卫生—呼吸系统]