目的探讨呼气末正压(PEEP)对不同呼吸系统顺应性患者中心静脉压(CVP)的影响。方法将2017年11月至2018年2月入住东南大学附属中大医院重症医学科需要监测CVP的55例机械通气患者依据呼吸系统静态顺应性(Crs)分为高顺应性组[Crs≥0.63 ml/(...目的探讨呼气末正压(PEEP)对不同呼吸系统顺应性患者中心静脉压(CVP)的影响。方法将2017年11月至2018年2月入住东南大学附属中大医院重症医学科需要监测CVP的55例机械通气患者依据呼吸系统静态顺应性(Crs)分为高顺应性组[Crs≥0.63 ml/(cm H_2O·kg),1 cm H_2O=0.098 k Pa]和低顺应性组[Crs<0.63 ml/(cm H_2O·kg)],分别观察2组患者PEEP在5、10、15 cm H_2O下的CVP、心率、血压及呼吸力学的变化。结果高顺应性组和低顺应性组患者CVP均随着PEEP增加而升高,差异具有统计学意义(P<0.05)。高顺应性组患者PEEP分别在5、10、15 cm H_2O时,CVP分别为(8.4±2.7)、(10.3±2.5)、(12.2±2.5)cm H_2O,差异具有统计学意义(P<0.05)。低顺应性组PEEP分别在5、10、15 cm H_2O时,CVP分别为(9.6±2.9)、(11.0±2.8)、(12.2±2.7)cm H_2O,差异具有统计学意义(P<0.05)。与低顺应性组患者相比,高顺应性组患者CVP随着PEEP增加而升高更为显著,差异具有统计学意义(P<0.05)。结论对于机械通气患者,PEEP的增加会引起CVP的增加,呼吸系统顺应性高的患者CVP增加更为显著。展开更多
In mechanically ventilated anesthetized dogs (pentobarbital sodium,30mg/kg) with acute lung injury induced by intravenous infusion of oleic acid(OA),changes in airflow,lung volume,and tracheal (Pao),transpulmonary (Pt...In mechanically ventilated anesthetized dogs (pentobarbital sodium,30mg/kg) with acute lung injury induced by intravenous infusion of oleic acid(OA),changes in airflow,lung volume,and tracheal (Pao),transpulmonary (Ptp)and esophageal (Pes) pressures were measured.Changes in lung mechanics werestudied before and after OA infusion at intervals,during an observation periodlasting 4h,using curve-fitting method,interrupter technique and pressure-volume(PV) loops measurement.The main findings are listed as follows:(1)Complianceand functional residual capacity (FRC) showed a marked decrease,while Pao andPtp showed a marked increase within 2h after OA.(2) Airflow resistance atexpiratory phase estimated by the curve-fitting method showed a marked increaseafter OA.(3)PV loops of the lungs or total respiratory system showed similarchanges 4h after OA,characterized by the presence of an inflexion point at theinflation limb,increased hysteresis and rightward and downward shift of the loop.It is suggested that use of the curve-fitting method in combination with the PVloop for the total respiratory system would be more appropriate for monitoringlung mechanics during mechanical ventilatory support of ARDS patients.展开更多
文摘目的探讨呼气末正压(PEEP)对不同呼吸系统顺应性患者中心静脉压(CVP)的影响。方法将2017年11月至2018年2月入住东南大学附属中大医院重症医学科需要监测CVP的55例机械通气患者依据呼吸系统静态顺应性(Crs)分为高顺应性组[Crs≥0.63 ml/(cm H_2O·kg),1 cm H_2O=0.098 k Pa]和低顺应性组[Crs<0.63 ml/(cm H_2O·kg)],分别观察2组患者PEEP在5、10、15 cm H_2O下的CVP、心率、血压及呼吸力学的变化。结果高顺应性组和低顺应性组患者CVP均随着PEEP增加而升高,差异具有统计学意义(P<0.05)。高顺应性组患者PEEP分别在5、10、15 cm H_2O时,CVP分别为(8.4±2.7)、(10.3±2.5)、(12.2±2.5)cm H_2O,差异具有统计学意义(P<0.05)。低顺应性组PEEP分别在5、10、15 cm H_2O时,CVP分别为(9.6±2.9)、(11.0±2.8)、(12.2±2.7)cm H_2O,差异具有统计学意义(P<0.05)。与低顺应性组患者相比,高顺应性组患者CVP随着PEEP增加而升高更为显著,差异具有统计学意义(P<0.05)。结论对于机械通气患者,PEEP的增加会引起CVP的增加,呼吸系统顺应性高的患者CVP增加更为显著。
文摘In mechanically ventilated anesthetized dogs (pentobarbital sodium,30mg/kg) with acute lung injury induced by intravenous infusion of oleic acid(OA),changes in airflow,lung volume,and tracheal (Pao),transpulmonary (Ptp)and esophageal (Pes) pressures were measured.Changes in lung mechanics werestudied before and after OA infusion at intervals,during an observation periodlasting 4h,using curve-fitting method,interrupter technique and pressure-volume(PV) loops measurement.The main findings are listed as follows:(1)Complianceand functional residual capacity (FRC) showed a marked decrease,while Pao andPtp showed a marked increase within 2h after OA.(2) Airflow resistance atexpiratory phase estimated by the curve-fitting method showed a marked increaseafter OA.(3)PV loops of the lungs or total respiratory system showed similarchanges 4h after OA,characterized by the presence of an inflexion point at theinflation limb,increased hysteresis and rightward and downward shift of the loop.It is suggested that use of the curve-fitting method in combination with the PVloop for the total respiratory system would be more appropriate for monitoringlung mechanics during mechanical ventilatory support of ARDS patients.
