半卧位对危重患者中心静脉压检测值的影响

Changes of central venous pressure effect by semisupine position in critically ill adult patients

目的研究半卧位对危重患者中心静脉压(CVP)检测值的影响及其临床意义。方法选择2010年1月～2011年6月期间收住加强监护病房(ICU)的30例成年危重患者为监测对象,采用前瞻性自身对照方法,分别检测平卧位、30°半卧及45°半卧时CVP、平均动脉压(MAP)及脉搏血氧饱和度(SpO2),采用单因素方差分析和一元线性回归分析法,分析半卧位对CVP、MAP和SpO2值的影响。结果 CVP值随着体位抬高而逐渐升高(F=116.699,P<0.01),但MAP和SpO2无显著变化。平卧位CVP与30°半卧和45°半卧CVP值均呈直线正相关(r=0.949,0.847,P<0.01),线性回归方程分别为:CVP平卧=-1.242+1.022×CVP30半°卧,CVP平卧=-1.527+0.902×CVP45°半卧。结论半卧位可使CVP检测值偏高,平卧位CVP值与30°半卧和45°半卧CVP值均呈直线正相关。该结果可为需半卧位的重症患者准确评估CVP检测值提供量化参考。

[ Objective ] To explore the changes of central venous pressure （CVP） effected by semisupine position in critically ill aduh patients and related clinical significance. [Methods] 30 critically ill adult patients with steady circulatory status and no cardiopulmonary ailment, no coagulopathy and no abdominal distention were enrolled in this prospective self-control study from January 2010 to June 2011. The levels of CVP, mean arterial pressure （MAP）, pulse oxygen saturation （SpO2） that were sequentially measured during supine flat position, 30~ semi-supine and 45~ semi-supine position, were analyzed with one-way analysis of variance （one-way ANOVA） and linear re- gression mode, to explore the impact of semisupine positions on the levels of CVP, MAP and SpOz. [ Results ] The levels of CVP gradually increased with the increased body position （F =116.699, P =0.000）, but without statistically significant difference for the levels of MAP and SpO2. The levels of CVP at supine fiat position were significantly positively correlated with those at 30~ semi-supine and 45~ semi-supine position, with Pearson relation coefficients being 0.949 and 0.847, respectively, P values both 0.000. Their linear regression equations are CVP=-1.242＋ 1.022 CVP and CVP~=-l.527＋0.902CVP45 , respectively. [Conclusion] The CVP levels gradually increase with the elevation of body position, the levels of CVP at supine fiat position are significantly positively cor- related with those at 30 semi-supine and 45 semi-supine position. This result could supply a quantitative refer-ence for correct evaluation of CVP values for severe patients who are subject to semi-supine position and need CVP monitoring.