呼吸末正压对ARDS患者腹内压及血流动力学的影响  

Effects of positive end-expiratory pressure on hemodynamics and intra-abdominal pressure in patients with acute respiratory distress syndrome with and without intra-abdominal hypertension

作　　者：杨田军[1] 潘爱军[1] 陶晓根[1] 刘宝[1] 

机构地区：[1]安徽省立医院ICU, 合肥230001

出　　处：《中华急诊医学杂志》2014年第9期1013-1017,共5页Chinese Journal of Emergency Medicine

摘　　要：目的 明确逐渐增高的呼气末正压（PEEP）对伴有及不伴有腹腔高压的急性呼吸窘迫综合征患者血流动力学与腹腔压力的影响.方法 对18例入住安徽省立医院重症病房的急性呼吸窘迫综合征患者采用前瞻性对比研究.分别在5、10、15、20 cmH2O呼吸末正压水平通过PICCO测定患者胸腔血容积指数（ITBVI）、血管外肺水指数（EVLWI）以及每博变异率（SVV）,同时测定腹内压的变化.结果 （1）高腹内压组EVLWI水平基本随PEEP增加而减少,但15 cmH2O与20 cmH2O之间差异无统计学意义（t=0.593,P=0.572）.正常腹内压组患者EVLWI不随PEEP增加而变化.（2）两组患者SVV水平均随PEEP增加而增高,但腹内压正常组SVV在PEEP超过10 cmH2O后差异有统计学意义（PEEP 5 vs.PEEP 10,t=0.326,P=0.752.PEEP 10 vs.PEEP 15,t=-20.032,P＜0.01）.（3）两组患者ITBVI在不同呼气末正压水平差异无统计学意义.（4） PEEP能显著增加两组患者的腹内压,对腹内压已经升高的患者影响程度更加明显.结论 PEEP能显著增加ARDS患者的腹内压,对既往已经存在腹内高压的患者,这种效果更加显著;不同PEEP水平能显著降低腹腔高压患者的EVLWI,但对腹内压正常患者影响不显著.Objective To investigate the effects of positive end-expiratory pressure （PEEP） on hemodynamics and intra-abdominal pressure in patients with acute respiratory distress syndrome （ARDS） with normal intra-abdominal pressure （IAP） and intra-abdominal hypertension （IAH） during mechanical ventilation under a incremental PEEP.Methods Eighteen ARDS patients with normal IAP or IAH treated in intensive care unit of Anhui Provincial Hospital were enrolled for study.At different PEEP levels （5,10,15,20 cmH2O）,hemodynamic parameters including extravascular lung water index （EVLWI）,intrathoracic blood volume index （ITBVI）,stroke volume variation （SVV） and IAP were measured with PICCO technology.Results Compared with ARDS patients with normal IAP,the ARDS patients with IAH were characterized by：（1） EVLWI was decreasing under the increment of PEEP,but there was no significant difference between 15 cmH2O and 20 cmH2O （t =0.593,P =0.572）.As PEEP was gradually escalated,EWLVI had no significant changes in patients with normal IAP.（2） SVV increased as PEEP was being titrated to higher level in both groups but in normal IAP group such effect was observed till PEEP above 10cmH2O （PEEP5 vs.PEEP10,t=0.326,P=0.752; PEEP,10 vs.PEEP 15,t=-20.032,P〈 0.01）.（3） There was no statistical difference in ITBVI between two groups at varied levels of PEEP.（4） PEEP could increase IAP levels and had much more profound effects on patients with IAH.Conclusions PEEP is a contributing factor changing IAP.It is necessary to take the level of PEEP into account as IAP variation is interpreted in patients under mechanical ventilation.Different PEEP levels can significantly affect the EVLWI in patients with IAH but not do not in ones with nomal IAP.

关 键 词：呼气末正压 急性呼吸窘迫综合征 腹内压 血流动力学 

分 类 号：R563.8[医药卫生—呼吸系统]