高龄老年呼衰患者有创机械通气时血液动力学的影响

Hemodynamic change in elderly patients with respiratory failure who are on traumatic mechanical ventilation

目的探讨高龄呼衰患者机械通气使用对血液动力学的影响。方法54例入选对象均使用有创机械通气纠正呼衰,在病情稳定时监测呼吸力学和无创心功能。设定机械通气VT按12ml/kg、10ml/kg、8ml/kg、6ml/kg,PEEP为0、5、8、10cmH2O,及为PEEPi 75%、100%、125%共28种通气状况时,高龄患者机械通气时血液动力学的变化。结果1.高龄患者在VT达≥10ml/kg时,在PEEP设定为0～10cmH2O范围内;或PEEP≥10cmH2O时,VT设定在6～12ml/kg范围内时,均可产生较高的气道峰压和吸气平台压,产生HR和CVP增高,SBP、DBP、CI和CO下降等血流动力学异常。2.同样,PEEP设定为PEEPi125%时,VT分别为每公斤体重6、8、10、12ml时,SBP、DBP、CO和CI逐渐降低,HR、CVP与VT成正相关。当VT设定为12ml/kg,PEEP为PEEPi的125%时,表现为气道峰压和吸气末平台压明显高,肺顺应性低。并出现SBP、DBP、CO和CI明显下降,HR和CVP增高等血液动力学的改变。3.若PEEP和VT同时增大时,气道峰压和吸气末平台压升高更明显,肺顺应性更低;患者的SBP、DBP、CI、CO下降更明显,HR和CVP增高幅度更大。结论通过本临床研究我们发现高龄呼衰患者有创机械通气时潮气量等于或大于10ml/kg时、PEEP等于或大于10cmH2O或为PEEPi 125%时,易出现血液动力学的影响;

Objective To examine the influence of traumatic mechanical ventilation on hemodynamic change of old older patients with respiratory failure. Methods In 54 old oldest patients （over 80 years） with respiratory failure who were on mechanical ventilation, respiratory mechanics and noninvasive heart function were monitored when the patients＇ conditions were stable. Given VT at 2ml/kg, 10 ml/kg, 8 ml/kg and 6 ml/kg, PEEP at 0, 5, 8 and 10 cmH2O and PEEPi at 75%, 100%, and 125%, altogether 28 modes of mechanical ventilation were designed to observe hemodynamic change in these patients. Results We analyzed homodynamic when the patients applied mechanical ventilation for respiratory failure patients of the great ages. 1） When VT was ≥10 ml/kg and PEEP was set at 0～10 cmH2O, or when VT was 6～12 ml/kg and PEEP was 〉10 cmH2O, the respiratory tract produced high peak pressure and the inspiration platform pressure, with which HR and CVP increased, and SBP, DBP, CI and CO decreased. 2） When PEEP was equal to 125% of PEEPi, VT was set at 6～12 ml/kg, SBP, DBP, CO and CI declined, the correlating being negative. While VT was positively correlated with HR and CVP. When VT was set at 12 ml/kg and PEEP was set at 125% of PEEPi, the peak pressure and the inspiration platform pressure were significantly elevated, when lung compliance was lower. SBP, DBP, CI and CO decreased significantly, while HR and CVP increased significant. 3） If PEEP and VT were simultaneously increased, the peak pressure and the inspiration platform pressure were further higher. The lung compliance further went down. SBP, DBP, CI and CO were further decreased. HR and CVP were further increased. Conclusions In old oldest patients with respiratory failure who are on traumatic mechanical ventilation, hemodynamics is likely to change unfavorably when VT is ≥ 10 ml/kg, PEEP is 〉 10 cmH2O and/or endogenous PEEP was 125% of PEEPi.