叶永顺+李文丰+刘华

[摘要]目的 探讨不同水平呼气末正压（PEEP）对急性呼吸窘迫综合征（ARDS）患者血流动力学的影响。方法 选取2014年7月～2015年7月我院ICU科入住的ARDS患者36例，所有患者均使用有创机械通气治疗，根据有创机械通气使用PEEP水平不同分为低PEEP组（5～8 cmH2O）、中PEEP组（>8～12 cmH2O）和高PEEP组（>12～16 cmH2O）三组，各12例，并比较各组中心静脉压（CVP）、平均动脉压（MAP）和心率（HR）治疗前后24 h差异及各组治疗前后ΔCVP、ΔMAP、ΔHR的组间差异。结果 各组治疗前后CVP、MAP、HR比较，施加PEEP治疗后CVP水平高于治疗前的水平，差异有统计学意义（P<0.01），而施加PEEP治疗后的MAP、HR水平低于治疗前，差异有统计学意义（P<0.01）。各组ΔCVP、ΔMAP比较，高PEEP组明显大于低PEEP组，差异有统计学意义（P<0.05），而各组间ΔHR比较，差异均无统计学意义（P>0.05）。结论 随着PEEP水平增加，有创机械通气对ARDS患者的血流动力学的影响也相应增加。

[关键词]呼气末正压；急性呼吸窘迫综合征；血流动力学

[中图分类号] R714.253 [文献标识码] A [文章编号] 1674-4721（2017）01（c）-0048-03

[Abstract]Objective To explore the effect of positive end-expiratory pressure （PEEP）in different levels on hemodynamics in patients with acute respiratory distress syndrome（ARDS）.Methods 36 ARDS patients from July 2014 to July 2015 were admitted into our intensive care unit in our hospital and were selected.All patients were treated with invasive mechanical ventilation.According to different levels of PEEP in the process of invasive mechanical ventilation，they were evenly divided into low PEEP group （>5-8 cmH2O），medium PEEP group （>8-12 cmH2O），and high PEEP group （>12-16 cmH2O）respectively.Centralvenous pressure （CVP），mean arterial pressure （MAP），and heart rate 24 hours before and after treatment were compared between three groups.Additionally，inter-group difference of ΔCVP，ΔMAP，andΔHR before and after therapy was compared.Results Among comparisons of CVP，MAP and HR were compared before and after therapy，when application of PEEP，the CVP level were higher than these before treatment with statistical difference （P<0.01）.The levels of MAP and HR were lower than those before treatment after using PEEP，which were displayed statistical difference （P<0.01）.In comparison of ΔCVP and ΔMAP，the index in the high PEEP group was greatly larger than that of low PEEP group with statisticant difference （P<0.05）.There was no great obvious difference in ΔHR among the groups （P>0.05）.Conclusion With the increase of PEEP levels，the effect of invasive mechanical ventilation on hemodynamics in ARDS patients also increases accordingly.

[Key words]Positive end-expiratory pressure；Acute respiratory distress syndrome；Hemodynamics

急性呼吸窘迫综合征（acute respiratory distress syndrome，ARDS）是呼吸系统的急重症，可由肺内原因或肺外原因而引起，呈急性呼吸窘迫、常规氧疗难以纠正的低氧血症为表现。该疾病的病死率常年居高不下，在治疗上仍然没有非常有效的手段。目前该疾病的治疗手段为原发病治疗、呼吸支持及药物治疗等。而有创机械通气是ARDS患者呼吸支持的重要一环[1]，其中呼气末正压（positive end-expiratory pressure，PEEP）对ARDS患者的影响是一个值得争议的话题。本研究通过探讨ARDS患者在一定時间内应用不同水平PEEP，并监测中心静脉压（central venous pressure，CVP）、平均动脉压（mean arterial pressure，MAP）及心率（heart rate，HR）等指标，从而研究其对血流动力学的影响。

1.资料与方法

1.1一般资料

选取2014年7月～2015年7月广东药学院附属第一医院ICU患者36例。纳入标准：①符合2012年Berlin诊断ARDS标准；②需要有创机械通气治疗。排除标准：①年龄<18岁；②血……