呼气末正压对右心室Tei指数的影响

Effect of positive end-expiratory pressure on the Tei index of right ventricle

目的 探讨呼气末正压(PEEP)对右心室Tei指数的影响。方法 选择2021年6月至2022年1月收治的52例机械通气的危重症患者,使用容量控制的通气模式,分别设置PEEP为4、8和12 cm H_(2)O,比较改变PEEP后血氧饱和度、心率(HR)、平均动脉压(MAP)、血乳酸及肺静态顺应性(Clst)的变化。对患者进行超声心动图检查,测量右心室心肌做功指数(Tei指数)、心输出量,进行前后对比。结果 纳入52例患者,PEEP为4、8和12 cm H_(2)O时,血氧饱和度、心率、平均动脉压及乳酸无明显变化;Clst分别为50.72(43.61,57.85)、45.60(42.21,51.22)及37.39(31.64,41.20),各组之间差异有统计学意义(P<0.05);Tei指数分别为0.41(0.31,0.46)、0.44(0.36,0.52)和0.57(0.49,0.72),各组之间差异有统计学意义(P<0.05)。然而,左心室心输出量未出现明显变化,分别为4.72(4.37,5.21)L/min,4.72(4.23,5.24)L/min和4.73(4.22,5.30)L/min,差异无统计学意义(P>0.05)。结论 适当增加PEEP可能导致肺部静态顺应性减小,同时右心室Tei指数升高,提示右心室负荷增大,但心输出量没有明显改变。

Objective To investigate the effect of positive end-expiratory pressure(PEEP) on the Tei index of right ventricle. Methods 52 critical patients with mechanical ventilation were included. The ventilation mode was set as volume control, PEEP was set as 4, 8 and 12 cm H_(2)O in turn. Heart rate(HR), blood oxygen saturation, mean arterial pressure(MAP), lactic acid and static lung compliance was compared. The patients were examined by echocardiography, Tei index of right ventricle and cardiac output were measured. Results When PEEP was set as 4, 8 and 12 cm H_(2)O respectively, there were no significant differences in HR, blood oxygen saturation, MAP and lactic acid. There were significant differences in static lung compliance[50.72(43.61,57.85), 45.60(42.21,51.22), 37.39(31.64,41.20)] and the Tei index [0.41(0.31, 0.46), 0.44(0.36, 0.52) and 0.57(0.49, 0.72)]among different groups(P<0.05). However, there was no significant change in the left ventricular output [4.72(4.37,5.21)L/min, 4.72(4.23,5.24)L/min, 4.73(4.22,5.30)L/min, P>0.05]. Conclusions An increase of PEEP may lead to a decrease in static lung compliance, and an increase in right ventricular Tei index, which indicates an increase in right ventricular load. However, cardiac output is not impacted significantly.