呼气末正压对不同呼吸系统顺应性患者中心静脉压的影响

目的探讨呼气末正压（PEEP）对不同呼吸系统顺应性患者中心静脉压（CVP）的影响。 方法将2017年11月至2018年2月入住东南大学附属中大医院重症医学科需要监测CVP的55例机械通气患者依据呼吸系统静态顺应性（Crs）分为高顺应性组［Crs ≥ 0.63 ml/（cmH₂O?kg），1 cmH₂O=0.098 kPa］和低顺应性组［Crs < 0.63 ml/（cmH₂O?kg）］，分别观察2组患者PEEP在5、10、15 cmH₂O下的CVP、心率、血压及呼吸力学的变化。 结果高顺应性组和低顺应性组患者CVP均随着PEEP增加而升高，差异具有统计学意义（P<0.05）。高顺应性组患者PEEP分别在5、10、15 cmH₂O时，CVP分别为（8.4±2.7）、（10.3±2.5）、（12.2±2.5）cmH₂O，差异具有统计学意义（P<0.05）。低顺应性组PEEP分别在5、10、15 cmH₂O时，CVP分别为（9.6±2.9）、（11.0±2.8）、（12.2±2.7）cmH₂O，差异具有统计学意义（P<0.05）。与低顺应性组患者相比，高顺应性组患者CVP随着PEEP增加而升高更为显著，差异具有统计学意义（P<0.05）。 结论对于机械通气患者，PEEP的增加会引起CVP的增加，呼吸系统顺应性高的患者CVP增加更为显著。

Effect of positive end-expiratory pressure on the central venous pressure of patients with different respiratory system compliance

ObjectiveTo investigate the effect of positive end-expiratory pressure on the central venous pressure in patients with different respiratory system compliance. MethodsIn this prospective study, 55 patients under mechanical ventilation and CVP monitoring were enrolled. According to the respiratory system static compliance(Crs), the patients were divided into high compliance group [Crs≥0.63 ml/(cmH₂O?kg)] and low compliance group [Crs<0.63 ml/(cmH₂O?kg)]. The value of CVP, heart rate, blood pressure and respiratory mechanics were recorded at a PEEP level of 5, 10, 15 cmH₂O respectively. ResultsCVP elevated with PEEP increased in both high compliance and low compliance groups (P<0.05); In patients with high compliance, the CVP was (8.4±2.7), (10.3±2.5), (12.2±2.5) cmH₂O at a PEEP level of 5, 10, 15 cmH₂O (P<0.05). Similarly, CVP was (9.6±2.9), (11.0±2.8), (12.2±2.7) cmH₂O at a PEEP level of 5, 10, 15 cmH₂O (P<0.05) respectively in patients with low compliance. With PEEP increased, CVP in the high compliance group increased more significantly compared to patients with low compliance (P<0.05). ConclusionFor patients receiving mechanical ventilation, the CVP value was affected by the increase of PEEP especially in patients with high respiratory compliance.