机械通气中不同PEEP水平对老年腹腔高压患者腹内压及肾脏血流的影响

目的探讨机械通气时不同呼气末正压(PEEP)水平对老年腹腔高压(IAH)患者腹内压(IAP)及肾脏血流的影响方法选取2018年10月至2021年5月符合入组标准的老年机械通气合并IAH患者30例,所有患者均予常规治疗方案,实施机械通气治疗,PEEP值自0开始,增加2cmH_(2)O/d,共观察8d,调节PEEP值后次日实施相关检查,统计不同PEEP值状态下IAP、经皮血氧饱和度(SpO_(2))、心率(HR)、平均动脉压(MAP)、肾脏血流阻力指数(RI)、搏动指数(PI)、肾动脉收缩期峰值流速(Vmax)、肾动脉舒张末期流速(Vmin)。结果PEEP值≥12cmH_(2)O时IAP、RI、PI、肾动脉收缩期峰值流速(Vmax)、肾动脉舒张末期流速(Vmin)比PEEP<12cmH_(2)O增高,差异有统计学意义(P<0.05),PEEP值≥6cmH_(2)O时SpO_(2)高于PEEP值<6cmH_(2)O,差异有统计学意义(P<0.05)。不同PEEP值对HR、MAP的影响差异无统计学意义。结论机械通气中PEEP水平过高可影响IAP及肾脏血流,过低的PEEP则对患者的氧合不利,将PEEP值设定为6~10cmH_(2)O既可满足氧合需求,也不会增加IAP,并能减少对肾脏血流的影响。

ObjectiveTo investigate the effects of different positive end expiratory pressure(PEEP)levels on intra-abdominal pressure(IAP)and renal blood flow in elderly patients with intra-abdominal hypertension(IAH).Methods A total of 30 elderly patients were enrolled in the study who suffered from IAH while receiving mechanical ventilation during October 2018 to May 2021.All patients received conventional therapy and mechanical ventilation.The PEEP values started from O to 16 cmH_(2)O,and added 2 cmH_(2)O per day.The data the next day after adjusting PEEP value including IAP.percutaneous oxygen saturation(SpO_(2)),heart rate(HR),mean arterial pressure(MAP),renal flow resistance index(RI),beat index(PI),renal artery systolic peak flow rate(Vmax),renal artery end diastolic flow rate(Vmin)were recorded.Results IAP,RI,PI,renal artery systolic peak flow rate(Vmax),renal artery end-diastolic velocity(Vmin)increased significantly when PEEP>12 cmH_(2)O(P<0.05),the SpO_(2)was higher when PEEP>12 cmH_(2)O(P<0.05).The SpO_(2)was higher when the PEEP>6 cmH_(2)O compared with that when PEEP value<6 cmH_(2)O,with statistical significance(P<0.05).There was no statistical difference in the effect of the different PEEP values on HR or MAP.Conclusion Excessive PEEP levels in mechanical ventilation can affect IAP and renal blood flow,while low PEEP affects patient oxygenation adversely.Setting the PEEP value from 6 to 1O cmH_(2)O can meet the need of oxygen but not increase IAP and reducetherenal blood flow.