四种不同体位对机械通气危重症患者中心静脉压的影响

Effects of four body positions on the central venous pressure of critical patients with mechanical ventilation

目的 分析4种不同体位对机械通气危重症患者中心静脉压（CVP）测量的影响,探讨平卧位与其他3种体位CVP间的定量关系.方法 采用前瞻性自身对照研究,选取45例机械通气危重症患者作为研究对象,分别测量研究对象平卧位（0°）、30°卧位、45°卧位和60°卧位时的CVP,平均动脉压（MAP）,血氧饱和度（SpO2）,心率（HR）和呼吸频率（RR）.采用重复测量方差分析和配对t检验比较不同体位CVP间的差异,采用简单回归分析方法探讨平卧位与其他卧位CVP间的定量关系.结果 ①平卧位、30°卧位、45°卧位和60°卧位CVP测量值分别为（10.71±4.85）cm H2O、（9.64±4.93）cm H2O、（9.11±4.97）cm H2O和（8.58±5.06） cm H2O,两两比较差异均有统计学意义（P＜0.05）.②平卧位与30°卧位CVP间相关系数为0.99（P＜0.01）,线性回归方程为CVP平卧=0.98×CVP30°卧位＋1.31;平卧位与45°卧位CVP间相关系数为0.99（P＜0.01）,线性回归方程为CVP平卧=0.96×CVP45°卧位＋1.94;平卧位与60°卧位CVP间相关系数为0.98（P＜0.01）,线性回归方程为CVP平卧=0.94×CVP60°卧位＋2.63.结论 机械通气危重症患者测量体位角度越高,CVP值越低.平卧位与其他卧位间的CVP存在线性定量关系.

Objective To analyze the effects of four different body positions on the central venous pres- sure （CVP） among ICU critical patients with mechanical ventilation, to explore the relationships of CPV measured at supine position with those measured at other three body position. Methods Prospective self-controlled designed study was used. 45 cases of ICU critical patients with mechanical ventilation were selected. The value of CPV, mean arterial -pressure （MAP）, oxygen saturation （SpO2）, heart rate （ HR ） and respiratory rate （ RR ） were respec- tively measured at 0°, 30°, 45° and 60°body positions. Analysis of variance and paired t-test were performed to assess the differences of CVP by body positions. Correlation analysis and linear regression methods were used for exploring the quantitative relationship of CVPs. Results The CVPs were （10.71±4.85）cm H20, （9.64±4.93）cm H20, （9.11±4.97）cm H20 and （8.58±5.06）cm H20 at position of 0°, 30°, 45° and 60° respectively. There are signifi- cant differences between any two positions （P〈0.05）. The values of CVP measured at 0° were highly correlated with those at 30°, 45° and 60°（r=0.99, P〈0.01, r=0.99, P〈0.01, r=0.98, P〈0.01）, and the linear regression equations were CVP_supine position =0.98×CVP30°＋1.31, CVP_supine position =0.96 ×CVP45° ＋1.94 and CVP_supine position =0.94 × CVP60°＋2.63, respectively. Conclusion The higher the angle of body position among critical patients with me- chanical ventilation is, the lower the value of CPV. There is linear regression relationships between CVP measured at supine and those measured at other body position.