| 詹赞.不同水平呼气末正压对急性呼吸窘迫综合征合并腹腔高压病人的呼吸功能及血流动力学影响[J].安徽医药,2017,21(7):1284-1286. |
| 不同水平呼气末正压对急性呼吸窘迫综合征合并腹腔高压病人的呼吸功能及血流动力学影响 |
| Effects of different levels of positive end expiratory pressure on respiratory function and hemodynamics in patients with acute respiratory distress syndrome complicated with abdominal hypertension |
| 投稿时间：2016-05-25 |
| DOI： |
| 中文关键词: 呼气末正压 急性呼吸窘迫综合征 腹腔高压 呼吸功能 血液动力学 |
| 英文关键词: Positive end expiratory pressure Acute respiratory distress syndrome Abdominal hypertension Respiratory function Hemodynamics |
| 基金项目: |
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| 中文摘要: |
| 目的 探索不同水平呼气末正压(PEEP)对急性呼吸窘迫综合征(ARDS)合并腹腔高压(IAH)病人呼吸功能和血液动力学影响。方法 选择重症监护病房(ICU)收治的54例ARDS病人为研究对象,并根据腹腔压力(IAP)将其分作3组,即IAP正常组(13例)、IAP Ⅰ级组(22例)和IAP Ⅱ级组(19例)。按照最佳氧合法滴定最佳PEEP水平,监测各项指标变化并进行组间比较。结果 IAP Ⅰ级组和IAP Ⅱ级组病人滴定后IAP、血乳酸(BLA)、心率(HR)和PEEP均较滴定前明显增加,平均动脉压(MAP)较滴定前明显减少(P<0.05),且滴定后各指标两组间比较差异有统计学意义(P<0.05)。3组病人滴定后氧合指数(OI)、气道平台压(Pplat)、静态肺顺应性(Cst)均较滴定前明显增加,且IAP Ⅰ级组OI、Pplat较IAP正常组明显增加,IAP Ⅱ级组OI、Pplat较其他两组均有明显增加,上述均差异有统计学意义(P<0.05)。IAP Ⅰ级组、IAP Ⅱ级组病人机械通气时间和ICU住院时间均较IAP正常组明显增加,均差异有统计学意义(P<0.05)；而3组病人28 h病死率比较差异无统计学意义(P＞0.05)。结论 PEEP可改善ARDS合并IAH病人氧合状态,且IAP越高则需要PEEP水平越高,但使用高水平PEEP会导致IAP增加,且对病人血流动力学和呼吸功能产生不良影响,对预后无改善。 |
| 英文摘要: |
| Objective To explore the effects of different levels of positive end expiratory pressure (PEEP) on respiratory function and hemodynamics in patients with acute respiratory distress syndrome (ARDS) complicated with abdominal hypertension (IAH).Methods Fifty-four cases of ARDS patients were selected as the research object,and according to the intra-abdominal pressure (IAP),they were divided into three groups,IAP normal group (13 cases),the IAP Ⅰ level group (22 cases) and IAP Ⅱ group (19 cases).According to the best PEEP level of the best oxygen legal titration,monitoring the changes of the indicators and the comparison between groups.Results The level of IAP,BLA,HR and PEEP in the IAP Ⅰ group and IAP Ⅱ group were increased significantly than those before titration (P<0.05),and each index between the two groups had statistically significant difference (P＜0.05).OI,Pplat,Cst in the 3 groups after titration were increased significantly than those before titration,and OI,Pplat in IAP Ⅰ grade group increased significantly than IAP normal group,OI,Pplat in the IAP Ⅱ levels were obviously increased than that in the other two groups,the differences were statistically significant (P＜0.05).The mechanical ventilation and ICU stay of IAP Ⅰ groupand IAP Ⅱ group were significantly increased compared with normal IAP group,the differences were statistically significant (P＜0.05);and 28 h mortality difference of 3 groups were not statistically significant (P＞0.05).Conclusions PEEP can improve patients′ oxygenation state of ARDS complicated with IAH and the higher of the IAP need PEEP level is higher,but the use of higher PEEP levels will lead to an increase in IAP and have adverse effects on the hemodynamics and respiratory function,no improvement on the prognosis. |
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