ARDS 患者机械通气时不同呼气末正压对腹腔内压力的影响

摘要

目的：探讨仰卧位机械通气状态下ARDS患者机械通气时不同的PEEP值对腹腔内压力（IAP）的影响。方法采用前瞻性、自身对照的方法，对 ICU 中12例因急性呼吸衰竭接受机械通气并最终确诊 ARDS 的患者，观察在上呼吸机前和 PEEP 0、3、6、9、12、15 cm H2 O 时 IAP 的变化，同时测定心率、平均动脉压（MAP）、经皮脉搏血氧饱和度（SpO2）及每小时尿量。结果当PEEP 由0逐步增加至9 cm H2 O 时，不同 PEEP 间的 IAP 比较差异无统计学意义（P ＞0.05）；PEEP增加至12、15 cm H2 O 时，其 IAP 高于0～9 cm H2 O 时的 IAP （P 均＜0.05），部分数值达到腹腔内高压分级Ⅱ级标准。不同 PEEP 间的心率、MAP、SpO2及尿量比较差异均无统计学意义（P 均＞0.05）。结论仰卧位机械通气状态下，短期内不影响心率、MAP、SpO2及每小时尿量，但较高的 PEEP 值（≥12 cm H2 O）可增加 ARDS 患者 IAP 水平，应动态监测 IAP 变化，避免持续上升。%Objective To observe the effect of different positive end-expiratory pressure (PEEP)on intra-abdominal pressure (IAP)in patients diagnosed with acute respiratory distress syndrome (ARDS)on me-chanical ventilation in a supine position.Methods A prospective self-control study consisting of 12 patients undergoing mechanical ventilation in intensive care unit (ICU)due to acute respiratory failure and subsequent-ly diagnosed with ARDS was performed.The variation of abdominal pressure was measured before mechanical ventilation and on mechanical ventilation with different PEEP (0,3,6,9,12 and 15 cm H2 O).Heart rate (HR),mean arterial pressure (MAP),oxygen saturation of pulse (SpO2 )and hourly urine volume were measured.Results IAP did not significantly differ over the sequential increase in PEEP from 0 to 9 cmH2 O (P >0.05).When PEEP was increased up to 12 and 15 cm H2 O,the IAP was significantly higher compared with those at 0 ~9 cm H2 O PEEP (all P <0.01 )and even reached grade II intra-abdominal hypertension.HR,MAP,SpO2 and hourly urine volume did not significantly differ under different PEEP conditions(all P >0.05).Conclusions During mechanical ventilation in a supine position,HR,MAP,SpO2 and hourly urine volume were not affected in a short period of time,whereas relatively high PEEP values (≥12 cm H2 O)could elevate IAP in ARDS patients on mechanical ventilation.IAP should be dynamically monitored to avoid a con-stant rise.