呼气末正压对急性呼吸窘迫综合征患者腹腔内压的影响  

作　　者：张磊[1] 吕光宇[1] 张友华[1] 

机构地区：[1]广西省柳州市人民医院重症医学科,广西柳州545006

出　　处：《世界中医药》2016年第B03期553-554,共2页World Chinese Medicine

基　　金：广西壮族自治区卫生厅自筹经费科研课题：腹腔间隔室综合征腹压监测与临床干预研究,课题编号：Z2012582.

摘　　要：目的对不同呼气末正压（PEEP）对急性呼吸窘迫征患者腹腔内压的影响进行研究。方法：选取急性呼吸窘迫征患者93例，根据患者腹腔压力（IAP）分为3组（A组为IAP正常组，B组为IAP I级组，c组为IAP II级组），每组各31例。根据患者情况应用最佳氧合法滴定出患者最佳呼气末正压。结果：3组患者较滴定前，氧合指数（OI）、腹腔压力（IAP）、气道平台压（Pplat）、血乳糖（BLA）、心率（HR）、明显升高（P〈0．01），c组变化较A、B组变更为明显（P〈0．05）；3组患者平均动脉压（MAP）变化较滴定前下降（P〈0．05）；3组患者肺静态顺应性（Cst）较滴定前明显改善（P〈0．05），但滴定后3组间肺静态顺应性无明显差异（P〉O．05）；C组患者住院时间较A、B组明显较长（P〈0．01），3组患者死亡率无显著差异（P〉0．05）。结论：根据急性呼吸窘迫综合征患者的个体情况选择最佳PEEP可对患者腹内压及氧合水平具有一定的改善作用，但随着患者腹内压的增高，所需最佳呼气末正压也随之增高，而较高的呼气末正压对患者的预后可造成不利影响，应根据个体化情况慎重选择。Objective The effect of positive end expiratory pressure （PEEP） on the abdominal pressure in patients with acute respiratory distress syndrome. Meth-ods： Selected 2014 June 2016 January in our hospital with acute respiratory distress syndrome in 93 cases, according to the patients with intra-abdominal pres-sure （LAP） divided into 3 groups （group a normal LAP group, group B LAP grade I group, group C for LAP in II Group）, each with 31 cases in each. According tothe patient＇s condition, the best method of oxygen was used to titration the best end expiratory pressure. The oxygen index （OI）, hemodynamics and respiratorymechanics, 28 day mortality, ICU length of stay were compared between the 3 groups before and after the titration of the best end expiratory pressure. Results：Compared three groups of patients before titrating oxygenation index （OI）, intra-abdominal pressure （lAP）, plateau airway pressure （pplat）, blood lactose （BLA）,heart rate （HR）, increased significantly （P〈0.01）, and group C changes compared with the A, B group changed significantly （P〈0.05）; 3 groups of patients withmean arterial pressure （map） was before titration decreased（P〈0.05）; group 3 patients with lung static compliance （CST） than before titration improved significantly（P〈0.05）, but the titration after 3 group between static lung compliance had no significant difference （P 〉 0.05）; C group patients hospitalized time than the A, Bgroup was significantly longer （P〈0.O1）, 3 groups of mortality in patients with no significant difference （P 〉 0.05）. Conclusion： According to acute respiratory dis-tress comprehensive syndrome with individual choose the best peep can be for patients with intra-abdominal pressure and oxygen synthetic level has certain ef-fect, but with increased intra-abdominal pressure, the best expiratory positive end expiratory pressure increased, and high end expiratory positive pressure to thepatient＇s prognosis can cause adverse ef

关 键 词：呼气末正压 急性呼吸窘迫征 腹腔内压 

分 类 号：R563[医药卫生—呼吸系统]