呼气末正压对机械通气患者中心静脉压及髂总静脉压的影响

目的 观察不同呼气末正压(PEEP)水平对机械通气患者中心静脉压(CVP)和髂总静脉压(CIVP)及两者相关关系的影响.方法 将2007年2-8月收住重症加强治疗病房(ICU),无心肺疾患、循环稳定、无腹胀、无凝血功能异常,需机械通气的20例成年患者列为观察对象,采用自身对照,随机加用0、5和10 cm HzO(1 am H2O=0.098 kPa)PEEP,评估在此条件下,CVP、CIVP和两者压力阶差变化及其与机械通气压力变化间的相关关系.结果 CVP及CIVP随PEEP增加而增高,差异有统计学意义(P0.05);CVP及CIVP与机械通气各压力值变化呈正相关,但CVP及CIVP仅与平均气道压(Pmean)及PEEP有统计学意义(CVP与PEEP r=0.751,CIVP与PEEP r=0.685,CVP与Pmean r=0.634,CIVP与Pmena r=0.603,P均

Effect of positive end-expiratory pressure on central venous pressure and common iliac venous pressure in mechanically ventilated patients

OBJECTIVE: To evaluate the effects of positive end-expiratory pressure (PEEP) on central venous pressure (CVP) and common iliac venous pressure (CIVP), the relationship between CVP and CIVP, in order to analyze the correlationship between CVP or CIVP and airway pressure in patients during mechanical ventilation. METHODS: Twenty mechanically ventilated adult patients with steady circulatory state and without cardiopulmonary ailment, abdominal distention or coagulopathy were enrolled for the study from February to August in 2007. 0, 5, 10 cm H(2)O (1 cm H(2)O=0.098 kPa) PEEP was used randomly in all cases during mechanical ventilation. CVP, CIVP, the gradient between CVP and CIVP at each PEEP level were measured. Linear correlation and linear regression analysis were used to analyze relative changes between CVP and CIVP. The data of airway pressure in the patients with mechanical ventilation were obtained for evaluating their correlation with CVP or CIVP. RESULTS: CVP and CIVP increased as PEEP was elevated (P<0.05 or P<0.01). There was a significant linear correlation between CVP and CIVP at 0, 5, 10 cm H(2)O PEEP level (r was 0.620, 0.658 and 0.777, respectively, P<0.01). The linear regression equation was Y (CVP)=0.402+0.732X (CIVP). The mean difference between CVP and CIVP at 0, 5, 10 cm H(2)O PEEP level was (1.9+/-1.7), (2.3+/-1.3), and (1.9+/-1.1) mm Hg (1 mm Hg=0.133 kPa, respectively P>0.05). There was a positive correlation between CVP or CIVP and the airway pressure, but only mean airway pressure and PEEP showed significant linear correlation with CVP (r was 0.634, 0.603, respectively, P<0.01) and CIVP (r was 0.751, 0.685, respectively, P<0.01). No obvious change was found in mean arterial pressure, heart rate, and exiperatory tidal volume during the study. CONCLUSION: CVP and CIVP increased when PEEP is set