Department of Anesthesiology and Critical Care Medicine, CHU de Caen, Caen, France.
J Crit Care. 2012 Feb;27(1):33-6. doi: 10.1016/j.jcrc.2011.03.003. Epub 2011 Apr 21.
An increase in abdominal pressure induces an increase in left ventricular afterload under clinical conditions. We tested the hypothesis that positive end-expiratory pressure (PEEP) could reverse the hemodynamic consequences of abdominal hyperpression by opposing the increase in left ventricular afterload.
Eight healthy volunteers were investigated during 3 experimental conditions: (1) baseline, (2) increase in abdominal pressure by means of medical antishock trousers (MAST) inflation, and (3) addition of PEEP +10 cm H(2)O. Heart loading conditions and left ventricular systolic and diastolic function were assessed by transthoracic echocardiography.
The application of PEEP significantly reduced the prior increase in end-systolic wall stress: 45 ± 11 vs 55 ± 14 kdyn/cm(2), P < .05. Medical antishock trousers inflation significantly altered the deceleration time of mitral E wave: 199 ± 23 vs 156 ± 38 milliseconds, P < .05. Left ventricular preload and global systolic performance were unaffected by MAST and PEEP applications.
The increase in left ventricular afterload induced by MAST inflation can be efficiently reduced by the use of a moderate PEEP. Potential clinical applications in the abdominal compartment syndrome or in the setting of laparoscopic surgery should be developed.
在临床情况下，腹内压升高会增加左心室后负荷。我们假设呼气末正压（PEEP）可以通过对抗左心室后负荷的增加来逆转腹部高压引起的血流动力学后果，对此我们进行了验证。
在 3 种实验条件下，我们对 8 名健康志愿者进行了研究：（1）基础状态，（2）通过医用抗休克裤（MAST）充气增加腹内压，（3）外加 PEEP+10cmH2O。通过经胸超声心动图评估心脏负荷条件和左心室收缩和舒张功能。
PEEP 的应用显著降低了先前增加的收缩末期壁应力：45±11 与 55±14 kdyn/cm2，P<0.05。MAST 充气显著改变了二尖瓣 E 波的减速时间：199±23 与 156±38 毫秒，P<0.05。左心室前负荷和整体收缩功能不受 MAST 和 PEEP 应用的影响。
MAST 充气引起的左心室后负荷增加可以通过使用适度的 PEEP 有效降低。在腹腔间隔室综合征或腹腔镜手术的情况下，可能需要开发其临床应用。
