不同呼气末正压对脓毒性休克患者血流动力学的影响
卢军锋,欧阳侃,冯为民
摘要(Abstract)：
目的观察脓毒性休克患者进行机械通气时,不同水平呼气末正压对血流动力学的影响作用。方法对象为20例药物镇静的机械通气脓毒性休克患者。采用双相正压通气(BILEVEL)模式,按照随机顺序,将每位患者的呼气末正压(PEEP)值设置为PEEP0组、PEEP5组、PEEP10组、PEEP15组。设定好PEEP后,调整PEEP高压(PEEPh),通气20 min,测定并记录血流动力学指标。每次调整为下一个PEEP前,调整为基础通气20 min,再进行下一步试验。结果随着PEEP增加,心排出量指数(CI)、胸腔内血容积指数(ITBVI)、平均动脉压(MAP)降低(P<0.01),外周血管阻力指数(SVRI)、中心静脉压(CVP)增加(P<0.05)。PEEP5组与PEEP0组相比,ITBVI明显增加(P<0.05);PEEP10组与PEEP0组相比,SVRI、CVP明显增加(P<0.05);PEEP15组与PEEP0组相比,CI、ITBVI、MAP明显降低,SVRI、CVP明显增加(P<0.05);PEEP10组与PEEP5组相比,ITBVI降低(P<0.05);PEEP15组与PEEP5组相比,CI、ITBVI、MAP降低,SVRI、HR增加(P<0.05);PEEP15组与PEEP10组相比,CI、ITBVI、MAP降低(P<0.05)。PEEP和血管外肺水指数(EVLWI)、心率之间无相关性,EVLWI各组间相比亦无统计学差异(P>0.05)。结论对于机械通气的脓毒性休克患者,随PEEP增加,心输出量逐渐减少,当PEEP增加至15 cmH2O时心排出量减少显著,因此脓毒症休克患者实施机械通气的时尽量控制PEEP水平在15 cmH2O之内。
关键词(KeyWords)： 脓毒性休克;呼气末正压;血流动力学
基金项目(Foundation):
作者(Author): 卢军锋,欧阳侃,冯为民
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