机械通气患者体位及呼气末正压对中心静脉压的影响

Effect of Posture and Positive End-expiratory Pressure on Central Venous Pressure in Patients with Mechanical Ventilation

目的:探讨机械通气时呼气末正压(PEEP)及体位对中心静脉压(CVP)的影响。方法:选择20例呼吸衰竭的机械通气患者,经右锁骨下静脉或颈内静脉置入中心导管,观察PEEP为0、5cmH2O时平卧位及30°半卧位时CVP的变化。结果:相同PEEP条件下,两种体位的CVP均无明显变化(P>0.05)。相同体位条件下,两种水平PEEP的CVP均无明显变化(P>0.05)。结论:体位为平卧位与30°半卧位相比对CVP无明显影响。PEEP 0与PEEP5cmH2O相比对CVP无明显影响。因此在测量CVP时,可维持原有≤30°的体位以及≤5的PEEP值,以增加患者的舒适性,减少改变体位及调节呼吸机PEEP参数带来的对病情的影响,减少护理工作量。

Objective：To investigate the effect of posture and different positive end-expiratory pressure （PEEP） on central venous pressure （CVP） in patients with mechanical ventilation. Methods： Twenty cases of respiratory failure with mechanical ventilation were enrolled in this study. Vessel was inserted via subclavian vein or internal jugular vein in every one, then CVP was measured with a backrest elevation of 30° or with a supine flat position under different PEEP conditions of 0,5cmH2 O. Results.There were no differences in CVP between the two positions at the same PEEP condition （P〉0. 05）,and between the different PEEP conditions in the same position. Conclusion. CVP was not influenced by the different posture and PEEP conditions. Maintaining of posture （≤ 30°）and PEEP（≤ 5cmH2O） when measuring CVP could improve safety and comfort of patients, and. reduce the work of nursing.