广东医学2017，Vol.38Issue(14)：2141-2146,6.
不同方法滴定呼气末正压对急性呼吸窘迫综合征患者循环动力学的影响
The hemodynamic influence of positive end expiratory pressures titrated by different methods on patients with acute respiratory distress syndrome
摘要
Abstract
Objective To investigate the hemodynamic influence of positive end expiratory pressures (PEEPs) titrated by different methods on patients with acute respiratory distress syndrome (ARDS).Methods A prospective self-control observational study was conducted.Moderate to severe ARDS patients in the early stage were enrolled from June 2014 to June 2016, who received recruitment maneuver and followed by a decremented PEEP trail, so as the optimal PEEPs were titrated using optimal oxygenation, best static pulmonary compliance and the lowest dead space fraction methods.The parameters of respiratory mechanics, blood gas analysis and hemodynamic were observed.Results Totally 19 patients were enrolled according to the criteria (13 male), with age of 49±11years old, acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score of 20.8±6.41.Among them, 12 patients were moderate ARDS and 9 were severe ARDS.The optimal PEEP titrated by optimal oxygenation (16.7±3.7 cmH2O) was significantly higher than the baseline (5.0±0.0 cmH2O), and the PEEPs titrated by best static pulmonary compliance (10.9±2.9 cmH2O) and lowest dead space fraction (11.5±3.8 cmH2O) (P<0.05).The optimal PEEP titrated by best oxygenation resulted in significant higher PaO2/FiO2 (313.7±88.5 mmHg) than the baseline (151.7±49.2 mmHg), and those using PEEPs titrated by best static pulmonary compliance (268.6±92.6 mmHg) and lowest dead space fraction (261.7±71.4 mmHg) (P<0.05);also significant lower pulmonary compliance (Cst) (49.7±12.25 mL/cmH2O) and higher dead space fraction (Vd/Vt) (58.9±15.87%) than those using best static pulmonary compliance method (63.3±9.88 mL/cmH2O and 53.3±11.63%) and lowest dead space fraction method (62.5±14.73 mL/cmH2O and 50.1±9.41%) (P<0.05).Compared with using best static pulmonary compliance method and lowest dead space fraction method, using best oxygenation method could result in significant increased CVP (18.6±5.9 vs.14.8±3.8 and 15.1±3.7 cmH2O, P<0.05), decreased cardiac output (CO) (3.81±1.32 vs.4.28±0.99 and 4.32±1.44 L/min, P<0.05) and delivery oxygen (DO2) (472.1±133.78 vs.501.8±99.89 and 509.4±103.47 mL/min, P<0.05).There was no significant difference in heart rate (HR) (95.3±9.5 vs.91.9±8.6 and 90.7±12.7 bpm), mean artery pressure (MAP) (64.9±14.4 vs.73.4±12.6 and 73.3±7.8 mmHg) or central venous saturation (ScvO2) (67.74±10.26 vs.70.53±11.54 and 68.87±15.64%) among the 3 methods (all P>0.05).Conclusion The optimal PEEP titrated by best oxygenation method is the highest one, but significantly reduces the CO and DO2.The optimal PEEPs titrated by best static pulmonary compliance and the lowest dead space fraction are lower but do not influence the CO and DO2 in ARDS patients.关键词
急性呼吸窘迫综合征/呼气末正压/肺顺应性/死腔/心输出量Key words
acute respiratory distress syndrome/positive end expiratory pressure/pulmonary compliance/dead space/cardiac output引用本文复制引用
黄丽萍,符晖,王桥生,汤石林,彭良善..不同方法滴定呼气末正压对急性呼吸窘迫综合征患者循环动力学的影响[J].广东医学,2017,38(14):2141-2146,6.基金项目
湖南省卫生计生委科研计划课题横向项目(编号:B2017055) （编号:B2017055）
