呼气末正压通气对Ⅱ型呼吸衰竭患者机械通气时血流动力学的影响

Effect of positive end expiratory pressure on the hemodynamic parameters of patients with type Ⅱ respiratory failure in the use of mechanical ventilation

目的观察Ⅱ型呼吸衰竭患者在不同水平时的呼气末正压通气(PEEP)对血流动力学的影响。方法记录23例实施机械通气的Ⅱ型呼吸衰竭患者在不同PEEP水平时的血流动力学,采用单因素方差分析和一元线性回归模型对数据进行分析。结果不同水平PEEP时中心静脉压(CVP)、心率(HR)、血氧饱和度(SaO2)差异有统计学意义(均P<0.05),平均动脉压(MAP)差异无统计学意义(P>0.05)。CVP与PEEP呈显著正相关(Pearson correlation=0.571,P>0.05),一元线性回归方程:CVP(cm H2O)=2.108+1.031×PEEP(cm H2O);SaO2与PEEP呈显著负相关(Pearson correlation=-0.499,P<0.05),一元线性回归方程:SaO2(%)=2.108-0.003×PEEP(cm H2O)。不同水平PEEP时HR与PEEP无线性相关性(拟合度=0.015,Pearson correlation=-0.124,P<0.05),不同水平PEEP时MAP的差异无统计学意义(P>0.05)。结论 PEEP可影响Ⅱ型呼吸衰竭患者的血流动力学,使实际测得CVP值偏高、SaO2值偏低,但对于MAP、HR则无显著影响。对于实施PEEP时检测CVP、SaO2的具体结果可提供客观量化的理论依据,进一步指导临床。

[ Objective] To observe the effect of different levels of positive end expiratory pressure （PEEP） on the hemodynamic pa- rameters of patients with type ]I respiratory failure. [ Methods ] The hemodynamic parameters of 23 patients with type 1I respiratory failure, who were treated with mechanical ventilation, were recorded at different PEEP levels. The data were analyzed with the one- way ANOVA and simple hnear regression model. [ Results] Under different PEEP levels, there were significant differences in CVP, HR and SaO2 （ P 〈 0.05 ） , but the difference in MAP was not significant （ P 〉 0.05 ）. There was a significant positive correlation between CVP and PEEP （ Pearson correlation = 0. 571, P 〉 O. 05 ）, and the linear regression equation was as fallows： CVP （ cm H20 ） = 2. 108 ＋ 1.031 x PEEP （ cm H20 ）. There was a significant negative correlation between SaO2 and PEEP （ Pearson correlation = - O. 499, P 〈 0.05 ）, and the linear regression equation was as follows ： SaO2 （ % ） = 2.108-0.003 x PEEP （ cm H2 O）. There was no a linear correlation between HR and PEEP （fitting degree =0.015, Pearson correlation =- 0. 124, P 〈 0.05）. The difference in MAP was not significant among different PEEP levels I P 〉 0. 05）. [ Conclusion] PEEP may influence the hemody- namic parameters of patients with type 1I respiratory failure, which the CVP value increases relatively and SaO2 value decrease rel- atively. However, the effect of PEEP on MAP and HR values are not significant. The study provides the objective and quantitative basis for the actual results of CVP and SaO2 in the use of PEEP, which can further guide the clinical practice.