肺保护性通气策略对重型颅脑损伤并呼吸衰竭患者脑灌注压及脑氧代谢的影响

Impact of Lung Protective Ventilation Strategy on Cerebral Perfusion Pressure and Cerebral Oxygen Metabolism of Severe Craniocerebral Injury Patients Complicated With Respiratory Failure

目的探讨肺保护性通气策略对重型颅脑损伤并呼吸衰竭患者脑灌注压(CPP)及脑氧代谢的影响。方法选择枣庄矿业集团滕南医院2013—2014年收治的重型颅脑损伤并呼吸衰竭患者67例,根据通气策略分为观察组36例和对照组31例。观察组患者给予肺保护性通气策略,对照组患者给予常规通气策略。比较两组患者治疗后血氧指标〔动脉血二氧化碳分压(Pa CO2)、动脉血氧分压(Pa O2)、血氧饱和度(Sp O2)、氧合指数、颈静脉血二氧化碳分压(PjVCO2)、颈静脉血氧饱和度(SjVO2)〕、机械通气参数〔潮气量(VT)、呼气末正压(PEEP)及吸入氧浓度(Fi O2)〕及CPP、颅内压(ICP)、平均动脉压(MAP)。结果观察组患者Pa CO2、PjVCO2、PEEP、ICP高于对照组,VT、Fi O2低于对照组(P<0.05);两组患者Pa O2、Sp O2、氧合指数、SjVO2、CPP及MAP比较,差异均无统计学意义(P>0.05)。Pearson相关性分析结果显示,PEEP与ICP呈正相关(r=0.447,P=0.006);当PEEP>10 cm H2O时,PEEP与CPP呈负相关(r=-0.396,P=0.018);当PEEP≤10 cm H2O时,PEEP与CPP无直线相关性(r=-0.322,P=0.069)。Pa CO2与ICP无直线相关性(r=0.302,P=0.081),与CPP呈正相关(r=0.417,P=0.022);SjVO2与ICP(r=-0.512,P=0.367)、CPP(r=0.281,P=0.098)、MAP(r=-0.194,P=0.296)无直线相关性,与PjVCO2呈负相关(r=-0.512,P=0.002)。结论肺保护性通气策略对重型颅脑损伤并呼吸衰竭患者CPP及脑氧代谢无明显影响。

Objective To investigate the impact of lung protective ventilation strategy on cerebral perfusion pressure（ CPP） and cerebral oxygen metabolism of severe craniocerebral injury patients complicated with respiratory failure. Methods A total of 67 severe craniocerebral injury patients complicated with respiratory failure were selected in Tengnan Hospital of Zaozhuang Mining Group from 2013 to 2014,and they were divided into control group（ n = 31） and observation group（ n = 36）according to ventilation strategies. Patients of control group received conventional ventilation strategy,while patients of observation group received lung protective ventilation strategy. Pa CO2,Pa O2,Sp O2,oxygenation index,PjVCO2,SjVO2,VT,PEEP,Fi O2,CPP,ICP and MAP were compared between the two groups. Results Pa CO2,PjVCO2,PEEP and ICP of observation group were statistically significantly higher than those of control group, VT and Fi O2 of observation group were statistically significantly lower than those of control group（ P〈0. 05）, while no statistically significant differences of Pa O2,Sp O2,oxygenation index,SjVO2,CPP or MAP was found between the two groups（ P〉0. 05）. Pearson correlation analysis showed that,PEEP was positively correlated with ICP（ r = 0. 447,P = 0. 006）; PEEP was negatively correlated with CPP when it was over 10 cm H2O（ r =- 0. 396,P = 0. 018）,while PEEP was not linearly correlated with CPP when it was equal or less than 10 cm H2O（ r =- 0. 322,P = 0. 069）. Pa CO2 was not linearly correlated with ICP（ r = 0. 302,P = 0. 081）,while Pa CO2 was positively correlated with CPP（ r = 0. 417, P = 0. 022）; SjVO2 was not linearly correlated with ICP（ r =- 0. 512, P =0. 367）,CPP（ r = 0. 281, P = 0. 098） or MAP（ r =- 0. 194, P = 0. 296）, while SjVO2 was negatively correlated with PjVCO2（ r =- 0. 512,P = 0. 002）. Conclusion Lung protective ventilation strategy has no significant impact on CPP and cerebral oxygen metabolism of severe craniocerebral injury patients complicated with respiratory failure.