急性低氧血症对呼吸衰竭患者中心静脉压的影响  

Effect of acute hypoxemia on central venous pressure in patients with respiratory failure

作　　者：刘辉 张渊 陈腾飞 周飞虎 张政波[2] Liu Hui;Zhang Yuan;Chen Tengfei;Zhou Feihu;Zhang Zhengbo(Department of Critical Care Medicine,1st Medical Center,Chinese PLA General Hospital,Beijing 100853,China;Big Data Center,Science Innovation Research Faculty,Chinese PLA General Hospital,Beijing 100853,China;Department of Critical Care Medicine,Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital Medical University,Beijing 100010,China)

机构地区：[1]中国人民解放军总医院第一医学中心重症医学科,北京100853 [2]中国人民解放军总医院转化医学部大数据中心,北京100853 [3]首都医科大学北京中医院重症医学科,北京100010

出　　处：《中国医师杂志》2022年第3期383-386,共4页Journal of Chinese Physician

基　　金：军委后勤保障部卫生局应用基础研究项目(20BJZ27);解放军总医院第二医学中心应用基础研究项目(ZXD2002)。

摘　　要：目的论证急性低氧血症对使用呼吸机辅助的呼吸衰竭患者中心静脉压(CVP)的影响。方法回顾性分析危重患者医学信息数据库Ⅲ(MIMICⅢ)的临床资料。探讨急性低氧血症对CVP以及血管舒张压(DBP)的影响。将氧合指数(OI)100和200作为2个界限值。OI≤100为重度呼吸衰竭,100<OI≤200为中度呼吸衰竭。比较氧合恶化的患者在界限值前后6 h的CVP和DBP,观察差异是否有统计学意义。结果共筛选508例重度呼吸衰竭患者,1117例中度呼吸衰竭患者。应用多元线性回归对患者的PEEP和心率进行校正之后,急性低氧血症发生的观察窗口期内,中度、重度缺氧患者的CVP明显升高(P=0.04、0.02),但DBP没有明显改变(P=0.29、0.31)。结论急性低氧血症可能促进呼吸衰竭患者的CVP升高。Objective To examine the influence of acute hypoxemia on central venous pressure(CVP)and diastolic blood pressure(DBP)in critical patients assisted by mechanical ventilation.Methods We retrospectively analyzed the clinical data of critical patients assisted by mechanical ventilation in Medical Information Mart for Intensive CareⅢ(MIMIC-Ⅲ)database.Influence of acute hypoxemia on CVP and diastolic blood pressure(DBP)were evaluated.Hypoxemia was defined according to oxygenation index(OI)(OI≤100 as severe,100<OI≤200 as moderate).Two cutoff values were set at OI=100 and OI=200.The primary outcomes were the difference between mean CVP,mean DBP 6 hours after the onset of hypoxemia and 6 hours before the event.Results Among all critical patients assisted by mechanical ventilation,508 patients met criteria of severe hypoxemia,and 1117 patients met criteria of moderate hypoxemia.After adjusting positive expiratory end pressure(PEEP)and heart rate by multiple linear regression,CVP in patients with moderate and severe hypoxia increased significantly during the observation window of acute hypoxemia(P=0.04,0.02),but DBP did not change significantly(P=0.29,0.31).Conclusions Acute hypoxemia could increase CVP and probably pulmonary circulation resistance in respiratory failure patients.

关 键 词：低氧 呼吸功能不全 中心静脉压 机械通气 

分 类 号：R563.8[医药卫生—呼吸系统]