利用动脉脉压的呼吸变化进行临床应用，以监测呼气末正压通气（PEEP）的血流动力学效应。

Clinical use of respiratory changes in arterial pulse pressure to monitor the hemodynamic effects of PEEP.

作者信息

Michard F, Chemla D, Richard C, Wysocki M, Pinsky M R, Lecarpentier Y, Teboul J L

机构信息

Service de Réanimation Médicale et Service de Physiologie Cardio-Respiratoire, Hopital de Bicêtre, AP-HP, Université Paris-Sud, Le Kremlin-Bicetre, INSERM U451-LOA-ENSTA-Ecole Polytechnique, Palaiseau, France.

出版信息

Am J Respir Crit Care Med. 1999 Mar;159(3):935-9. doi: 10.1164/ajrccm.159.3.9805077.

DOI:10.1164/ajrccm.159.3.9805077

PMID:10051276

Abstract

In ventilated patients with acute lung injury (ALI) we investigated whether respiratory changes in arterial pulse pressure (DeltaPP) could be related to the effects of PEEP and fluid loading (FL) on cardiac index (CI). Measurements were performed before and after application of a PEEP (10 cm H2O) in 14 patients. When the PEEP-induced decrease in CI was > 10% (six patients), measurements were also performed after FL. Maximal (PPmax) and minimal (PPmin) values of pulse pressure were determined over one respiratory cycle and DeltaPP was calculated: DeltaPP (%) = 100 x ((PPmax - PPmin)/ ([PPmax + PPmin]/2)). PEEP decreased CI from 4.2 +/- 1.1 to 3.8 +/- 1.3 L/min/m2 (p < 0.01) and increased DeltaPP from 9 +/- 7 to 16 +/- 13% (p < 0.01). The PEEP-induced changes in CI correlated with DeltaPP on ZEEP (r = -0.91, p < 0.001) and with the PEEP-induced increase in DeltaPP (r = -0.79, p < 0.001). FL increased CI from 3.5 +/- 1.1 to 4.2 +/- 0.9 L/min/m2 (p < 0.05) and decreased DeltaPP from 27 +/- 13 to 14 +/- 9% (p < 0.05). The FL-induced changes in CI correlated with DeltaPP before FL (r = 0.97, p < 0.01) and with the FL-induced decrease in DeltaPP (r = -0.85, p < 0.05). In ventilated patients with ALI, DeltaPP may be useful in predicting and assessing the hemodynamic effects of PEEP and FL.

摘要

在急性肺损伤（ALI）的机械通气患者中，我们研究了动脉脉压（ΔPP）的呼吸变化是否与呼气末正压（PEEP）和液体负荷（FL）对心脏指数（CI）的影响有关。对14例患者在应用PEEP（10 cm H₂O）前后进行了测量。当PEEP导致CI下降>10%时（6例患者），在液体负荷后也进行了测量。在一个呼吸周期内测定脉压的最大值（PPmax）和最小值（PPmin），并计算ΔPP：ΔPP（%）=100×[（PPmax - PPmin）/（[PPmax + PPmin]/2）]。PEEP使CI从4.2±1.1降至3.8±1.3 L/min/m²（p<0.01），并使ΔPP从9±7增加至16±13%（p<0.01）。PEEP引起的CI变化与零呼气末正压（ZEEP）时的ΔPP相关（r=-0.91，p<0.001），并与PEEP引起的ΔPP增加相关（r=-0.79，p<0.001）。液体负荷使CI从3.5±1.1增加至4.2±0.9 L/min/m²（p<0.05），并使ΔPP从27±13降至14±9%（p<0.05）。液体负荷引起的CI变化与液体负荷前的ΔPP相关（r=0.97，p<0.01），并与液体负荷引起的ΔPP降低相关（r=-0.85，p<0.05）。在ALI的机械通气患者中，ΔPP可能有助于预测和评估PEEP和液体负荷的血流动力学效应。