不同呼气末正压水平对重型颅脑损伤合并急性呼吸窘迫综合征患者的影响  

Effect of Different Levels Positive End-expiratory Pressure on the Patients with Severe Craniocerebral Injury Complicated with Acute Respiratory Distress Syndrome

作　　者：康新[1] 伏光辉[1] 王建伟[1] 刘宇梁[1] 王文学[1] 

机构地区：[1]连云港市东方医院,江苏连云港222042

出　　处：《中外医学研究》2016年第29期6-8,共3页CHINESE AND FOREIGN MEDICAL RESEARCH

摘　　要：目的：探讨不同的呼气末正压（PEEP）水平对重型颅脑损伤合并急性呼吸窘迫综合征（ARDS）患者肺气体交换、脑灌注、颅内压的影响。方法：以20例重型颅脑损伤合并ARDS患者为研究对象,GCS评分为38分,记录不同PEEP下颅内压（ICP）、脑灌注压（CPP）、动脉血氧分压（PaO2）、动脉血二氧化碳分压（PaCO2）、氧合指数（PaO2/FiO2）。结果：当PEEP由4 cm H2O升至8 cm H2O时,ICP无明显变化,至12 cm H2O以上时ICP较PEEP为4 cm H2O时,差异有统计学意义（12 cm H2O时P〈0.05,16 cm H2O时P〈0.01）。随PEEP增加,PaO2呈上升趋势,PEEP为8、12、16 cm H2O时同4 cm H2O时比较,差异有统计学意义（P〈0.01）;PEEP为8、12、16 cm H2O时同4 cm H2O时比较,PaCO2差异有统计学意义（P〈0.01）;PaO2/FiO2随PEEP增加增大,PEEP为8、12、16 cm H2O时同4 cm H2O时比较,差异有统计学意义（P〈0.01）;MAP、CPP随PEEP的升高,呈下降趋势,PEEP为8、12、16 cm H2O时同4 cm H2O时比较,差异有统计学意义（P〈0.01）。结论：使用PEEP在416 cm H2O范围治疗重型颅脑损伤合并ARDS患者,为相对安全范围,治疗应个体化调节。Objective：To explore the effect of different levels positive end-expiratory pressure on air exchange,cerebral perfusion and intracranial pressure of the patients with cerebral injury complicated with acute respiratory distress syndrome.Method：20 patients with severe craniocerebral injury complicated with ARDS were studied,whose GCS scores were 3 to 8 points.Their intracranial pressure（ICP）,cerebral perfusion pressure（CPP）,arterial partial pressure of oxygen（PaO2）,partial pressure of carbon dioxide in artery（PaCO2） and oxygenation index（PaO2/FiO2） were recorded.Result：When PEEP was increased from 4 to 8 cm H2O,ICP had no obvious change,but to more than 12 cm H2O,the differences were statistically significant（increased to 12 cm H2O,P〈0.05,to 16 cm H2O,P〈0.01）.With the increase of PEEP,PaO2 was rised,as PEEP was increased to 8,12 and 16 cm H2O,compared to 4 cm H2O,the differences were statistically significant（P〈0.01）.When PEEP was increased to 8,12 and 16 cm H2O,the PaCO2 was statistically significant compared to 4 cm H2O（P〈0.01）.PaO2/FiO2 increased with the rising of PEEP,When PEEP was increased to 8,12 and 16 cm H2O,the difference was statistically significant compared to 4 cm H2O（P〈0.01）.There was a downward trend of MAP and CPP when PEEP was increased,when PEEP was increased to 8,12 and 16 cm H2O,the difference was statistically significant compared to 4 cm H2O（P〈0.01）.Conclusion：When PEEP is increased from 4 to 16 cm H2O,it is relatively in a safe range,the treatment shall be individualized.

关 键 词：呼气末正压 重型颅脑损伤 急性呼吸窘迫综合征 气体交换 脑灌注压 颅内压 

分 类 号：R651.15[医药卫生—外科学] R563.8[医药卫生—临床医学]