不同PEEP时PiCCO监测左心衰竭患者血流动力学的变化

Changes in hemodynamics monitored by PiCCO in patients with acute left heart failure under different PEEP mechanical ventilation

目的:研究左心衰竭患者在不同呼气末正压通气(PEEP)时的血流动力学指标变化情况,选择合适的PEEP范围。方法:选择急性左心衰竭行机械通气并脉搏指示剂连续心排血量监测(PiCCO)患者60例,基础PEEP在3cmH_2O时前3天PiCCO校准后取得177个初始数据,然后调整PEEP在5、7、9cmH_2O时分别记录患者在4种PEEP水平下PiCCO数据中的心输出量指数(CI)、心脏每搏量指数(SVI)、全心舒张末期指数(GEDI)、中心静脉压(CVP)、有创平均动脉血压(MAP)、血管外肺水指数(EVLWI)变化情况,直至心衰症状缓解或治疗终止。结果:GEDI、SVI在PEEP=7、9cmH_2O时较前两组PEEP水平有显著性差异(P<0.05)。CI在PEEP=9cmH_2O时与前3组有显著性差异(P<0.05)。CVP、MAP在4中PEEP水平下比较无显著性差异。结论:临床治疗正压通气的左心衰竭患者时,PEEP控制在7、9cmH_2O以下,对血流动力学指标变化影响不显著。

Objective：To observe the changes in hemodynamic parameters under different positive end expiratory pressure（PEEP）in patients with left ventricular cardiac failure,and select optimal PEEP for patients.Methods：Sixty patients in mechanical ventilation and pulseinduced contour cardiac output（PiCCO）monitoring suffered from acute left ventricular cardiac failure were selected,the data of PiCCO when PEEP=3cmH2O to obtained 177 initial data was recorded in the first three days,then adjusted PEEP at 5,7,9cmH2O,and recorded the data of PiCCO：cardiac output index（CI）,stroke volume index（SVI）,global end diastolic index（GEDI）,central venous pressure（CVP）,mean arterial blood pressure（MAP）,extravascular lung water index（EVLWI）in the condition of four kinds of PEEP until remission or terminate treatment.Results：GEDI,SVI in the condition of PEEP=7and 9cmH2O have significant difference with those in the condition of PEEP=3and 5cmH2O.CI in the condition of PEEP=9cmH2O have significant difference with CI in the condition of PEEP=3,5,7cmH2O.CVP,MAP in the condition of four kinds of PEEP have no significant difference.Conclusion：When patients with left ventricular cardiac failure are treated with mechanical ventilation,control PEEP in the range of 7,9cmH2O has no significanct influence in hemodynamics.