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| 不同呼气末正压对感染性休克患者容量反应性的影响 |
| Influence of different positive end expiratory pressure on volume responsiveness of patients with septic shock |
| 投稿时间：2015-04-16 修订日期：2015-06-25 |
| DOI：10.3969/j.issn.1000-0399.2015.08.017 |
| 中文关键词: 感染性休克 呼气末正压 容量反应性 |
| 英文关键词: Septic shock positive end expiratory pressure Volume responsiveness |
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| 中文摘要: |
| 目的 探讨不同水平的呼气末正压(PEEP)对进行机械通气感染性休克患者容量反应性的影响。 方法 选择2012年1月至2014年8月淮北市人民医院重症医学科收治的28例进行机械通气的感染性休克患者为研究对象,所有患者采用容量控制通气,血流动力学稳定后每隔1 h递增PEEP,PEEP从0 cmH2O增加到15 cmH2O(能承受者),根据不同的PEEP水平分为4组(PEEP 0 cmH2O组,PEEP 5 cmH2O组,PEEP 10 cmH2O组,PEEP 15 cmH2O组),在不同的PEEP水平下进行被动抬腿试验(PLRT),记录PLRT前后中心静脉压(CVP)及心脏指数(CI)。观察不同水平的PEEP对进行机械通气的感染性休克患者容量反应性的影响。 结果 28例感染性休克患者,基础PEEP水平为(8.3±2.8)cmH2O。随PEEP升高,PLRT前后中心静脉压(CVP)均逐渐升高,但不同PEEP组间CVP变化值(ΔCVP)差异无统计学意义(P >0.05);随PEEP升高,CI逐渐下降,但不同PEEP组间CI变化值(ΔCI)逐渐升高,差异有统计学意义(P <0.05)。结论 机械通气使用外源性PEEP的感染性休克患者,CVP作为评估其容量反应性的指标不可靠,CI作为容量反应性评估的指标相对可靠,且随PEEP增高,其容量反应性逐渐增加。 |
| 英文摘要: |
| Objective To evaluate the influence of different positive end expiratory pressure (PEEP) levels on volume responsiveness of mechanical ventilation patients with septic shock. Methods Twenty-eight patients with septic shock ever treated in our hospital from Jan 2012 to Aug 2014 were enrolled in the study. The patients were all mechanically ventilated with volume controlled mode till hemodynamic stability, then the PEEP levels were increased every one hour gradually from 0 cm H2O to 15 cm H2O (if tolerated). Depending on the tolerated PEEP level, all patients were divided into four groups: PEEP 0 cm H2O group, PEEP 5 cm H2O group, PEEP 10 cm H2O group and PEEP 15 cm H2O group, and the volume responsiveness of all patients were assessed by passive leg raising test (PLRT). The influence of different PEEP levels on volume responsiveness of all patients with septic shock was evaluated. Results Of the 28 patients with septic shock, the basal PEEP level was (8.3±2.8) cm H2O. With increased PEEP, CVP around PLRT was gradually increased, but the ΔCVP differences between different PEEP groups were not statistically significant (P >0.05); the cardiac index (CI) was gradually decreased with increased PEEP, but ΔCI between different PEEP groups were gradually increased, with significant difference (P <0.05). Conclusion For patients with septic shock using exogenous PEEP in mechanical ventilation, CVP is not a reliable indicator to assess the volume responsiveness, but CI is relatively reliable as a indicator, and the volume responsiveness would increase with the increasing PEEP. |
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