胸内压监测指导心脏外科术后患者机械通气策略的应用价值

目的：探讨在心脏外科术后患者中通过胸引管直接测量胸腔内压力的方法测定跨肺压并以此实施机械通气策略的临床应用价值。方法：以南京医科大学附属南京医院重症医学科1年来收治的心脏外科术后80例患者为研究对象，通过前瞻性队列研究，分析各组病例食道压、胸内压、氧合状况、呼吸力学参数、相关并发症发生率等指标的差异。结果：通过胸引管直接测量的胸内压值与食道压具有显著相关性（r=0.832），依据胸内压调节PEEP的设置，实验组与对照组取得了同样良好的机械通气治疗效果（P > 0.05）。结论：利用胸引管监测胸内压的方法可以准确测定跨肺压值，有效指导心脏外科术后患者机械通气策略的实施。

The Practical Value of Mechanical Ventilation Management Guided by Intrathoracic Pressure Monitoring to Patients after Cardiac Surgery

Objective: To discuss the effect of directly measuring intrathoracic pressure by thoracic drainage tube for determining transpulmonary pressure and management of mechanical ventilation to patients after cardiac surgery. Method: The study included 80 patients after cardiac surgery in our hospital last years. The differences of esophageal pressure, intrathoracic pressure, oxygenation status, respiratory mechanics parameters, the incidence rate of complication beteewn each groups were compared and analyzed by prospective cohort study. Results: There is a pronounced correlation between the intrathoracic pressure measured by thoracic drainage tube and esophageal pressure in self-control(r=0.832). The patients who setting PEEP guided by intrathoracic pressure received good result as same as the control group (P>0.05). Conclusion: The method that directly measuring intrathoracic pressure by thoracic drainage tube can accurately determine the transpulmonary pressure, and guide mechanical ventilation strategy in patients after cardiac surgery effectively.