急性呼吸窘迫综合征肺保护通气策略中PEEP对SVV的影响

Effect of Positive End-expiratory Pressure on Stroke Volume Variations in Acute Respiratory Distress Syndrome Patients with Lung Protective Ventilation

目前治疗急性呼吸窘迫综合征患者常采用最佳呼气末正压(PEEP)、低潮气量的肺保护通气策略。PEEP过低无法有效纠正缺氧,PEEP设置过高会导致血流动力学变化,以心前负荷减少为主要表现。每搏输出量变异度(SVV)是近年来常用的血流动力学动态指标,可评估患者心脏前负荷情况。使用不同水平正压通气的患者PEEP与SVV的变化有相关性。该文旨在讨论PEEP对SVV的影响,以期为临床治疗提供理论依据。

The treatment of acute respiratory distress syndrome commonly adopts lung protective ventila- tion with the optimal positive end-expiratory pressure（PEEP） and low tidal volume. Too low PEEP cannot effectively correct the hypoxia, however too high PEEP setting would result in changes of hemodynamic, with cardiac preload as the major manifestation. In recent years, stroke volume variation （SVV） as a dynamic index of hemodyuamic is commonly used to evaluate the cardiac preload of the patients. And there is a correlation between the changes of SVV and different levels of PEEP. Here is to discuss the changes of SVV induced by the changes of PEEP in order to provide theoretical basis for the clinical treatment.