不同外源性呼气末正压对脓毒性休克患者血流动力学的影响  

Effect of extrinsic positive end expiratory pressure on hemodynamics in patients of septic shock

作　　者：赵滋苗[1] 陆军[1] 王飞[1] 丁月平[1] 叶肖琳[1] 马丹女[1] 

机构地区：[1]浙江中医药大学附属第二医院重症医学科,浙江杭州310005

出　　处：《中国医药导报》2013年第18期167-168,F0003,共3页China Medical Herald

摘　　要：目的研究不同水平的呼气末正压(PEEP)对机械通气的脓毒性休克患者血流动力学和氧代谢指标的影响。方法对象为浙江中医药大学附属第二医院重症医学科2011年1月-2012年8月收治的脓毒性休克患者,筛选其中符合脓毒性休克诊断标准,并需要机械通气辅助呼吸的患者,排除年龄<18岁或>80岁、妊娠、心律失常(不包括窦性心律失常)、存在股动脉置管的禁忌证、急性心功能不全、严重瓣膜病变疾病的患者,最终符合条件的患者共26例纳入研究。持续药物镇静,维持镇静-躁动评分(SAS)在3-4分。对26例行机械通气的脓毒性休克患者先后给PEEP 0、5、10、15 cm H2O(1 cm H2O=0.098 kPa),通气30 min后,记录四种不同数值的PEEP时对平均动脉压(MAP)、中心静脉压(CVP)、心排指数(CI)、全心舒张末期容积指数(GEDVI)、体循环阻力指数(SVRI)及氧合指数(PaO2/FiO2)等血流动力学和氧代谢指标的影响。结果 CVP及SVRI随着PEEP的增加而升高,呈显著正相关,且具有差异(r=0.710,P=0.001;r=0.295,P=0.002);CI随着PEEP的增加而降低,呈负相关,具有差异(r=-0.301,P=0.002);随着PEEP的升高,GEDVI略有降低,无明显相关性,无差异(r=-0.106,P=0.282)。PaO2/FiO2与呼气末正压呈现显著正相关,PEEP不同组间其PaO2/FiO2有差异(r=0.733,P=0.001)。结论脓毒性休克患者随PEEP增加,CI逐渐减少,CVP随着PEEP的增加而提升,而GEDVI未随着PEEP的升高而有明显变化,能在临床上有效评估心脏前负荷情况。在氧代谢方面,随着PEEP的增加,PaO2/FiO2得以提升。Objective To study the effect of extrinsic positive end expiratory pressure on hemodynamics in the patients of septic shock during continuous positive pressure mechanical ventilation.Methods Screening the septic shock patients with mechanical ventilation in ICU of the Second Affiliated Hospital of Zhejiang Chinese Medical University from January 2011 to August 2012,excluded age less eighteenth and more eighty,gravidity,having contraindication of putting tubal in femoral artery,acute heart failure,arrhythmia（not including sinus disorders）,and severe valve disease diseases.Ultimately 26 cases were included in the study.Sedative drugs continued to be given to maintain SAS in 3-4 grades in whole test process.26 patients of septic shock were included in this study.Patients were received continuous positive pressure mechanical ventilation with 0,5,10,15 cm H2O PEEP subsequently.Respiratory mechanics,arterial blood gas,and hemodynamics at 30 min after receiving continuous positive pressure mechanical ventilation with dif ferent PEEP were recorded and compared.Results With rising the degrees of PEEP,the correlation of SVRl and CVP with PEEP was positivistic（PEEP vs CVP： r=0.710,P=0.001,PEEP vs SVRI： r=0.295,P=0.002）,the overall correlation of CI with PEEP was negatively（r =-0.301,P=0.002）,meanwhile GEDVI remained in an original state,statistical significance between groups was found among CVP all the various degrees of PEEP.Without statistical signifi cance among groups were discovered between PEEP and SVRI,GEDVI,MAP and CI.The correlation of PaO2/FiO2 and PEEP was positivistic（r=0.733）,statistical significance among groups was found between PaO2/FiO2 and the various degrees of PEEP（P=0.001）.Conclusion In patients of septic shock during continuous positive pressure mechanical ventilation,the use of the lower PEEPe have no obviously effect on hemodynamics,while evidently lower CI and higher PaO2/FiO2 can be found in course of the use of the higher PEEPe.CVP has gone up with rising the degrees of PE

关 键 词：脓毒性休克 外源性呼气末正压 血流动力学 氧代谢 

分 类 号：R605.971[医药卫生—急诊医学]