肝移植术后呼吸衰竭患者呼气末正压通气的应用与体会

对3例肝移植术后呼吸衰竭患者合理应用呼气末正压通气进行总结，在不同呼气末正压状况下通气20min．观察患者动脉血气、血流动力学情况．并根据测定结果调节至最佳呼气末正压参数。认为呼气末正压在10～12cmH2O范围内能较好地维持患者动脉血氧分压，对系统血流动力学的影响也最小。护理上应注意在使用呼气末正压通气期间加强血流动力学的监护，密切观察血压及中心静脉压变化．加强机械通气的一般管理，防止漏气脱管，加强移植肝功能的监测。

Application and experience of positive end-expiratory pressure in respiratory failure patients with liver transplantation

The authors summarized the experience in using positive end-expiratory pressure (PEEP) in 3 respiratory failure patients with liver transplantation. The ventilation continued for 20 min at different PEEP, with arterial blood air and hemodynamic states observed and PEEP parameters adjusted to their best based on test results. The authors argued PEEP at 10-12 cmH2O could better maintain oxygen pressure of hemoglobin in artery and render less impact on hemodynamics. The nursing measures included hemodynamic monitoring during use of PEEP, close observation the changes of blood pressure and central venous pressure, enhanced mana-gement of mechanical ventilation, prevention of tube's shedding and leakage, enhanced monitoring of transplant's function.