不同呼气末正压对全心舒张末容积指数和中心静脉压指导感染性休克患者容量治疗效果的影响  

Effects of different positive end-expiratory pressures on efficacy of volume therapy guided by global end diastolic volume index and central venous pressure in patients with septic shock

作　　者：韩玉[1] 代庆春[1] 沈洪丽[1] 苗晓云[1] 回志[1] 吴忠荣[1] 张晓卫[1] 

机构地区：[1]河北省沧州市中心医院重症医学科,061001

出　　处：《中华麻醉学杂志》2014年第1期65-67,共3页Chinese Journal of Anesthesiology

摘　　要：目的 评价不同呼气末正压（PEEP）对全心舒张末容积指数（GEDVI）和中心静脉压（CVP）指导感染性休克患者容量治疗效果的影响.方法 感染性休克后并发呼吸衰竭患者25例,性别不限,年龄18～64岁,急性生理和慢性健康状况评分13～31分,气管插管后行容量控制通气,PEEP5～ 15 cmH2O,维持脉搏血氧饱和度＞90％,根据PEEP水平不同分为低PEEP（5～ 10 cmH2O）组与高PEEP（11 ～ 15 cmH2 O）组.经30 min输注6％羟乙基淀粉200/0.5 6 ml/kg进行容量治疗.经右颈内静脉或锁骨下静脉穿刺置管,用于监测CVP,采用脉搏指示剂持续心排血量监测技术监测GEDVI,记录容量治疗前、后CVP和GEDVI,并计算二者变化率.结果 与容量治疗前比较,低PEEP组容量治疗后CVP和GEDVI升高,高PEEP组容量治疗后GEDVI升高（P＜0.05）,而CVP差异无统计学意义（P＞0.05）.与低PEEP组比较,高PEEP组CVP变化率降低（P＜0.05）,而GEDVI变化率差异无统计学意义（P＞0.05）.结论 高PEEP可降低CVP指导感染性休克患者容量治疗的效果,而对GEDVI指导的效果无影响.Objective To compare the effect of different positive end-expiratory pressures （PEEPs） on the efficacy of volume therapy guided by global end-diastolic volume index （GEDVI） and central venous pressure （CVP） in patients with septic shock.Methods Twenty-five patients with septic shock complicated with respiratory failure,of both sexes,aged 18-64 yr,were enrolled in the study.Their APACHE [[scores were 13-31.The patients were endotracheally intubated and underwent volume-controlled ventilation,PEEP was 5-15 cmH2O,and pulse oxygen saturation was maintained 〉 90 %.The patients were divided into low PEEP （5-10 cmH2 O） group and high PEEP （11-15 cmH2 O） group depending on the different PEEP levels.6 % hydroxyethyl starch （200/0.5）6 ml/kg was infused over 30 min for volume therapy.Right internal jugular vein or subclavian vein was cannulated for CVP monitoring,and GEDVI was continuously monitored by pulse indicator continuous output monitoring （PiCCO） technology.CVP and GEDVI were recorded before and after volume therapy and the changing rate was calculated.Results Compared with CVP and GEDVI before volume therapy,CVP and GEDVI were significantly increased after volume therapy in low PEEP group （P 〈 0.05）,and GEDVI was increased after volume therapy （P 〈 0.05） and no significant change was found in CVP after volume therapy in high PEEP group （P 〉 0.05）.Compared with low PEEP group,the changing rate of CVP was significantly decreased （P 〈 0.05）,and no significant change was found in the changing rate of GEDVI in high PEEP group （P 〉 0.05）.Conclusion High PEEP can decrease the efficacy of volume therapy guided by CVP,while exerts no effect on the efficacy of volume therapy guided by GEDVI in patients with septic shock.

关 键 词：正压呼吸 心排血量 中心静脉压 补液疗法 休克 脓毒性 

分 类 号：R459.7[医药卫生—急诊医学]