持续气道正压对机械通气患者锁骨下静脉横截面积和锁骨下静脉/胸膜间距的影响

目的通过对机械通气患者实施持续气道正压以实现胸内正压,拟观察其对锁骨下静脉(SCV)横截面积(CSA)和锁骨下静脉/胸膜间距(Dscv-pleura)的影响。方法2018年10~12月于宁波大学附属人民医院行择期手术患者35例。年龄20~60岁,ASA Ⅰ或Ⅱ级。于正常机械通气的呼气末(N组)和20cm H2O持续气道正压(Ⅰ组)时分别采集患者右侧SCV图像,测量并记录SCV的CSA和Dscv-pleura。定义CSA和Dscv-pleura改变>15%为有临床意义。结果与N组比较,Ⅰ组患者SCV的CSA显著增加(t=3.636,P<0.001),增加幅度为16.1%,有临床意义。与N组相比,I组患者Dscv-pleura显著减小(t=2.506,P<0.05),减少幅度为11.2%,无临床意义。结论20cm H2O的持续气道正压增加锁骨下静脉CSA,同时对锁骨下静脉和胸膜间距无显著影响。

Objective To achieve positive intrathoracic pressure by continuous positive airway pressure in patients with mechanical ventilation.It is planned to investigate the subclavian vein(SCV)cross-sectional area(CSA)and distance between the subclavian vein and pleura(Dscv-pleura).Methods From October to December 2018,35 patients with age 20 to 60 years old,ASAI or Ⅱ,underwent elective surgery at Affiliated People's Hospital of Ningbo University were included.The right SCV images were taken at the end of expiratory(N group)or 20cm H2O positive airway pressure(group Ⅰ),and the CSA of SCV and Dscv-pleura were measured and recorded.Defining CSA and Dscv-pleura changes>15%was clinically signifcant.Results Compared with group N,the CSA of SCV in group Ⅰ was signifcantly increased(t=3.636,P<0.001),with an increase of 16.1%,which was clinically significant.Compared with group N,Dscv-pleura in group Ⅰ was signifcantly reduced(t=2.506,P<0.05),with a decrease of 11.2%,which was of no clinical significance.Conclusion The continuous positive airway pressure of 20cm H2O increases the CSA of the subclavian vein,and has no significant effect on the Dscv-pleura.