不同呼气末正压水平对重型颅脑损伤合并急性呼吸窘迫综合征患者的影响及护理

Effect of different levels positive end-expiratory pressure on patients with severe craniocerebral injury complicated with acute respiratory distress syndrome and nursing measures

目的 探讨不同呼气末正压（PEEP）水平对重型颅脑损伤合并急性呼吸窘迫综合征患者的影响及护理措施.方法 选取2015 年8 月—2016 年8 月徐州市中心医院收治的46例重型颅脑损伤合并急性呼吸窘迫综合征患者,测定不同PEEP（3-15 cmH2O）时动脉血氧分压（PaO2）、动脉血二氧化碳分压（PaCO2）、氧合指数（PaO2/FiO2）、脑灌注压（CPP）、平均动脉压（MAP）及颅内压（ICP）的变化情况.PEEP治疗过程中采取适当的护理措施.结果 本组患者PEEP 为3、7、11、15 cmH2O 时PaO2分别为（73.4±9.8）、（92.5±14.3）、（105.0±16.9）、（114.6±16.4） mmHg,差异有统计学意义（F=36.875,P〈0.01）;PaO2、 PaCO2、PaO2/FiO2随PEEP值的增加而呈上升趋势. MAP、CPP 随PEEP 的增长而呈降低趋势. PEEP在3-11 cmH2O时,ICP随PEEP的增长而增加,当PEEP≥11 cmH2O 时,ICP值较为稳定.结论 PEEP的安全范围为3~15 cmH2O,并根据患者病情及个人具体情况,对PEEP做相应调整,并辅以适当的护理措施,提高治疗效果,减少并发症的出现.

Objective To explore the effects of different levels positive end-expiratory pressure （PEEP） on patients with severe craniocerebral injury complicated with acute respiratory distress syndrome and its nursing measures. Methods A total of 46 cases of severe craniocerebral injury combined with acute respiratory distress syndrome patients in Xuzhou Central Hospital from August 2015 to August 2016 were selected. Changes of their arterial partial pressure of oxygen （PaO2）, partial pressure of carbon dioxide in artery （PaCO2）, oxygenation index （PaO2/FiO2）, cerebral perfusion pressure （CPP）, mean artery pressure （MAP） and intracranial pressure （ICP） were analyzed when PEEP changes from 3 cmH2O to 15 cmH2O. Appropriate nursing measures were taken during PEEP treatment. Results The value of PaO2was （73.4±9.8）, （92.5±14.3）, （105.0±16.9） and （114.6±16.4） mmHg when PEEP was 3, 7, 11 and 15 cmH2O respectively, and the difference was statistically significant （F=36.875,P〈0.01）. With the increase of PEEP, the value of PaO2, PaCO2and PaO2/FiO2showed tendency to ascend. There was a downward trend of MAP and CPP when PEEP was increased. With the increase of PEEP （3-11 cmH2O） ICP increased, and ICP was stable when PEEP was more than 11 cmH2O. Conclusions The safe range of PEEP is 3 to 15 cmH2O. Corresponding adjustment of PEEP according to patient individual condition, with proper nursing measures can improve therapeutic effects and reduce complications.