PEEP值设定对麻醉中呼气末肺容量和氧合程度的影响

Influence of PEEP on End-expiratory Lung Volume and Degree of Oxygenation during Anesthesia

目的探讨PEEP值设定对麻醉中呼气末肺容量和氧合程度的影响,为临床合理设定PEEP值,提高治疗效果提供依据。方法 26例因体外循环心内直视术麻醉时急性呼吸窘迫综合征(ARDS)行插管通气治疗,根据氧合情况,缓慢、连续递增PEEP(人工控制)以及估计由最大限度氧运输决定的最佳PEEP,以满足最好的全身动脉或恢复肺部顺应性。结果随着PEEP压力水平的不断增高,PO2水平呈上升趋势,而PCO2在压力为0.9时最高,各组间的差异具有统计学意义。患者体内CI水平随着压力的增加而降低,在PEEP为0.9kPa时各组间DO2水平变化不明显,PEEP为1.6kPa时较压力为0组出现明显下将,差异具有显著性(P<0.05)。结论 PEEP治疗体外循环心内直视术后ARDS患者PaO2有一定提高,但高压力水平的PEEP反而会使DO2下降。所以应使用依次递增的方法 ,根据患者的具体状况确定最佳的PEEP值。

Objective To evaluate the value of setting PEEP on end-expiratory lung volume and the degree of oxygenation during anesthesia,providing basis for clinical settings and improving treatment.Methods Totally 26 patients were carried open heart surgery anesthesia with acute respiratory distress syndrome （ARDS） catheterization ventilation.Optimal PEEP was decided according to oxygenation,the slow,continuous incremental PEEP （manual control） and the estimated maximum oxygen transport,to meet or restore pulmonary arterial compliance.Results With the increase of PEEP pressure,PO2 levels rising,and reach maximum pressure is 0.9,the differences among the groups was statistically significant.The level of the body in patients with CI decreased with the increase of pressure,the PEEP was 0.9kPa DO2 levels between each group did not change significantly.Compared to 0KPa group,PEEP increasing significantly in 1.6kPa （P0.05 ）.Conclusion PaO2 increased PEEP treatment of ARDS undergoing open heart surgery patients,but will droped when PEEP pressure was high.Therefore,the method should be used gradually increased,according to the specific conditions of patients to determine the optimal PEEP value.