正压机械通气时腹内压与胸内压的相关性

Correlation between intra-abdominal and intra-plural pressure in patients with positive pressure ventilation

目的探讨正压机械通气时,患者在麻醉肌松状态下,不同PEEP时腹内压与胸内压的相关性。方法 20例手术后尚处于麻醉肌松状态下,并行机械通气的患者,均留置胸腔闭式引流管和导尿管,在PEEP分别为0 cmH_2O_5 cmH_2O,10 cmH_2O和15 cmH_2O时,进行间接腹内压和直接胸内压测定。结果所有20例患者的初始腹内压为(8.15±3.46)mmHg,初始胸内压为(9.31±5.72) mmHg,增加PEEP后,腹内压,胸内压均升高。当PEEP分别为5 cmH_2O,10 cmH_2O和15 cmH_2O时,腹内压分别增加至(8.31±3.66) mmHg,(9.92±3.75) mmHg和(12.46±5.55) mmHg,胸内压分别增加至(9.15±5.93) mmHg,(12.23±6.29) mmHg和(16.23±5.99) mmHg。不同PEEP时,腹内压各组间两两比较,差异有统计学意义(P<0.05)。20例患者的腹内压与胸内压之间的相关性进行分析,其Pearson相关系数R^2=0.789,且P<0.01,两者存在较强的正相关性。结论在机械通气的过程中,提高PEEP值,能增加患者的腹内压。故对机械通气的患者,有必要实行腹内压监测。不同PEEP时,腹内压与胸内压具有较强的正相关性。

Objective To assess the correlation of intra-abdominal pressure（IAP） with intra-pleural pressure（IPP） in patients under anesthesia and muscle relaxant condition with different positive endexpiratory pressure（PEEP）.Methods In 20 mechanically ventilated patients who were anesthetic and muscle relaxed with closed drainage and catheter.Abdominal pressure were measured with indirect method and intrapleural pressure were measured with direct method at a sequentially increasing PEEP （0,5,10 and 15 cmH_20）.Results The IAP was 8.15±3.46 mmHg at PEEP 0（zero endexpiratory pressure,ZEEP）,8.31±3.66 mmHg at PEEP 5,9.92±3.75 mmHg at PEEP 10 and 12.46±5.55 mmHg at PEEP 15（P 0.05 vs ZEEP）.The IPP was 9.31±5.72 mmHg at PEEP 0 （ZEEP）,9.15±5.93 mmHg,at PEEP 5,12.23±6.29 mmHg at PEEP 10 and 16.23±5.99 mmHg at PEEP 15.The intra-abdominal pressure was closely correlated with intrapleural pressure at different PEEP with a Pearson correlation coefficient R^2 = 0.789（p 0.01）.Conclusion Intra-abdominal pressure has close correlation with intra-pleural pressure in patients under anesthesia and muscle relaxation condition with different PEEP.