机械通气患者呼气末正压对中心静脉压的影响

【目的】评价机械通气时不同水平呼气末正压(PEEP)对中心静脉压(CVP)的影响。【方法】选择46例行机械通气并监测CVP患者,在不同水平PEEP(0、2、4、6、8、10、12、15、18cmH2O)时,分别测定CVP及心率(HR)、平均动脉压(MAP)、呼吸频率(RR)、经皮脉搏血氧饱和度(SpO2),脱机后再次测量各值并比较其差异性。【结果】PEEP对CVP有非常显著的影响(P<0.01)。PEEP≥12cmH2O患者的SpO2与PEEP≤4cmH2O时有显著性差异(P<0.01)。HR、MAP、RR与在不同PEEP相比较则差异无统计学意义。脱机与机械通气各项观察指标相比较有非常显著性差异(P<0.01)。【结论】随着PEEP水平增加,CVP逐渐增加。脱机测量CVP对患者不利,维持患者原PEEP水平测量CVP,可增加患者的安全性。

Effect of Positive End Expiratory Pressure on Central Venous Pressure in Patients with Mechanical Ventilation

Objective] To evaluate the effect of positive end expirtory pressure (PEEP) on central venous pressure(CVP) in patients with mechanical ventilation. Methods] Forty six patients with mechanical ventilation and CVP monitoring were studied. CVP, heart rate (HR), mean arterial pressure (MAP),respiration rate(RR) and oxygen saturation of pulse(SpO2) at various PEEP levels were recorded.Each item was recorded again after weaning of mechanical ventilation. Results]CVP increased gradually by the increment of PEEP,and was significantly higher than that in condition when PEEP was 15 cmH2O(P<0.01).There was a significant difference in SpO2 between when PEEP was above 12 cmH2O and PEEP was under 4 cmH2O.There was no difference in HR, MAP and RR under different PEEP conditions(P>0.05).There were significant differences in every item between weaning of mecharical ventilation and mechanical vertilation. Conclusion] CVP increases gradually with PEEP. Weaning of mechanical ventilation would be harmful for measuring CVP. Maintaining of PEEP when measuring CVP could improve safety of patients.