正压呼气末对手术减压治疗外伤性脑肿胀患儿脑血流动力学的影响。
Impact of positive end expiratory pressure on cerebral hemodynamic in paediatric patients with post-traumatic brain swelling treated by surgical decompression.
机构信息
Department of Anaesthesia and Intensive Care, Catholic University, Rome, Italy.
Department of Anaesthesia and Intensive Care, San Bortolo Hospital, Vicenza, Italy.
出版信息
PLoS One. 2018 May 10;13(5):e0196980. doi: 10.1371/journal.pone.0196980. eCollection 2018.
INTRODUCTION
The objective of our present study is to evaluate the impact of different PEEP levels on cerebral hemodynamic, gas exchanges and respiratory system mechanics in paediatric patients with post-traumatic brain swelling treated with decompressive craniectomy (DC).
MATERIALS AND METHODS
A prospective physiologic study was carried out on 14 paediatric patients presenting with severe traumatic brain swelling treated with DC. Transcranial Doppler ultrasonography was performed on the middle cerebral artery bilaterally after DC. After assessment at ZEEP, intracranial pressure (ICP), cerebral perfusion pressure (CPP), mean arterial pressure (MAP), central venous pressure (CVP) and gas exchanges were recorded at PEEP 4 and PEEP 8.
RESULTS
From ZEEP to PEEP 8, the compliance of respiratory system indexed to the weight of the patient significantly increased (P = 0.02) without ICP modifications. No significant variation of the MAP, CPP, Vmed, the total resistance of respiratory system and ohmic resistance of the respiratory system indexed to the weight of the patients was observed. CVP significantly increased between ZEEP and PEEP 8 (P = 0.005), and between PEEP 4 and PEEP 8 (P = 0.05).
CONCLUSIONS
PEEP values up to 8 cmH20 seem to be safe in paediatric patients with a severe post-traumatic brain swelling treated with DC.
简介
本研究的目的在于评估不同呼气末正压（PEEP）水平对行去骨瓣减压术（DC）治疗的外伤性脑肿胀患儿脑血流动力学、气体交换和呼吸系统力学的影响。
材料与方法
对 14 例行 DC 治疗的严重外伤性脑肿胀患儿进行前瞻性生理研究。DC 后对双侧大脑中动脉行经颅多普勒超声检查。在 ZEEP 评估后，记录 PEEP 4 和 PEEP 8 时的颅内压（ICP）、脑灌注压（CPP）、平均动脉压（MAP）、中心静脉压（CVP）和气体交换。
结果
从 ZEEP 到 PEEP 8，患者体重指数的呼吸系统顺应性显著增加（P = 0.02），而 ICP 无变化。MAP、CPP、Vmed、呼吸系统总阻力和患者体重指数的呼吸系统欧姆电阻无显著变化。CVP 在 ZEEP 与 PEEP 8 之间（P = 0.005）和 PEEP 4 与 PEEP 8 之间（P = 0.05）显著增加。
结论
对于行 DC 治疗的严重外伤性脑肿胀患儿，PEEP 值高达 8 cmH20 似乎是安全的。
Zotero 插件