机械通气患者中心静脉压与上腔静脉横径相关性研究
|
摘要
目的:通过监测机械通气病人中心静脉压(central venous pressure CVP)与上腔静脉横径值(superior vena cava diameter SVCD)的动态变化,来评价呼气末正压(positive end-expiratory pressure PEEP)对机械通气病人CVP与SVCD的影响,以及SVCD与CVP相关性研究。为用无创手段测定机械通气病人SVCD值以来指导患者液体治疗提供理论依据。
方法:选取22例因急性呼吸衰竭行机械通气的病人作为研究组,男14例,女8例,应用彩色超声诊断仪监测受试者在不同水平PEEP(0-20cmH20)时的SVCD值与CVP值,同时记录患者心率、平均动脉压与血氧饱和度。统计学处理所有计量资料以及SVCD、CVP与PEEP相关性分析,P＜0.05为差别有统计学意义,P＜0.01为差别有显著性统计学意义。
结果:(1)机械通气病人SVCD值随PEEP值的增加而递减,SVCD与PEEP值呈显著负相关(r=-0.981,P＜0.01)。(2)CVP与PEEP呈显著正相关(r=0.997,P＜0.01)。(3)CVP与SVCD值呈显著负相关,(r=-0.961,P＜0.01)。(4)PEEP与MAP、HR无相关性。(5)PEEP与SaO_2值呈显著正相关,(r=0.971,P＜0.01)。
结论:机械通气时患者SVCD值随PEEP值增加而减少,CVP随PEEP值增加而增加,从而可用多普勒超声心动图检查来监测SVCD值以来间接评价病人液体治疗效果。
OBJECTIVE:To evaluate the effect of positive end-expiratory pressure(PEEP) on central venous pressure(CVP) and superior vena cava diameter(SVCD) of the patients undergoing mechanical ventilation in dynamic diversify,and to find the correlation between CVP and SVCD.To verify the theory of monitoring CVP with non-invasive method.
METHODS:22 patients(14 male and 8 female)undergoing mechanical ventilation for acute respiratory failure were enrolled in the study,and SVCD was measured by Doppler ultrasonography. SVCD,CVP,heart rate(HR),mean arterial pressure(MAP) and oxygen saturation of arterial blood (SaO_2) at various PEEP levels were recorded.Data were processed by F test and correlation analysis. There was statistical difference when P＜0.05 and significant statistical difference when P＜0.01.
RESULTS:(1) There were decreases of SVCD accompanied with PEEP increment,and there was a significant negative correlation between SVCD and PEEP(r=-0.981,P＜0.01).(2) There were increases of CVP accompanied with PEEP increment,and there was a significant positive correlation between CVP and PEEP(r=0.997,P＜0.01).(3) There was a significant negative correlation between CVP and SVCD(r=-0.961,P＜0.01).(4) No significant effects of PEEP on HR and MAP were found. (5)There was a significant positive correlation between SVCD and SaO_2(r=-0.971,P＜0.01).
CONCLUSION:Monitoring SVCD by Doppler ultrasonography was an effective method directing fluid theraphy in patients undergoing mechanical ventilation.
方法:选取22例因急性呼吸衰竭行机械通气的病人作为研究组,男14例,女8例,应用彩色超声诊断仪监测受试者在不同水平PEEP(0-20cmH20)时的SVCD值与CVP值,同时记录患者心率、平均动脉压与血氧饱和度。统计学处理所有计量资料以及SVCD、CVP与PEEP相关性分析,P＜0.05为差别有统计学意义,P＜0.01为差别有显著性统计学意义。
结果:(1)机械通气病人SVCD值随PEEP值的增加而递减,SVCD与PEEP值呈显著负相关(r=-0.981,P＜0.01)。(2)CVP与PEEP呈显著正相关(r=0.997,P＜0.01)。(3)CVP与SVCD值呈显著负相关,(r=-0.961,P＜0.01)。(4)PEEP与MAP、HR无相关性。(5)PEEP与SaO_2值呈显著正相关,(r=0.971,P＜0.01)。
结论:机械通气时患者SVCD值随PEEP值增加而减少,CVP随PEEP值增加而增加,从而可用多普勒超声心动图检查来监测SVCD值以来间接评价病人液体治疗效果。
OBJECTIVE:To evaluate the effect of positive end-expiratory pressure(PEEP) on central venous pressure(CVP) and superior vena cava diameter(SVCD) of the patients undergoing mechanical ventilation in dynamic diversify,and to find the correlation between CVP and SVCD.To verify the theory of monitoring CVP with non-invasive method.
METHODS:22 patients(14 male and 8 female)undergoing mechanical ventilation for acute respiratory failure were enrolled in the study,and SVCD was measured by Doppler ultrasonography. SVCD,CVP,heart rate(HR),mean arterial pressure(MAP) and oxygen saturation of arterial blood (SaO_2) at various PEEP levels were recorded.Data were processed by F test and correlation analysis. There was statistical difference when P＜0.05 and significant statistical difference when P＜0.01.
RESULTS:(1) There were decreases of SVCD accompanied with PEEP increment,and there was a significant negative correlation between SVCD and PEEP(r=-0.981,P＜0.01).(2) There were increases of CVP accompanied with PEEP increment,and there was a significant positive correlation between CVP and PEEP(r=0.997,P＜0.01).(3) There was a significant negative correlation between CVP and SVCD(r=-0.961,P＜0.01).(4) No significant effects of PEEP on HR and MAP were found. (5)There was a significant positive correlation between SVCD and SaO_2(r=-0.971,P＜0.01).
CONCLUSION:Monitoring SVCD by Doppler ultrasonography was an effective method directing fluid theraphy in patients undergoing mechanical ventilation.
引文
1 Vieillard-Baron A,Chergui K,Rabiller A,et al.Superior vena caval collapsibility as a gauge of volume status in ventilated septic patients[J].Intensive Care Med,2004,30(9):1734-1739.
2 Charron C,Caille V,Jardin F,et al.Echocardiographic measurement of fluid responsiveness[J].Curr Opin Crit Care,2006,12(3):249-254.
3 Wilson RF.Cardiovascular physiology[M].In:Wilson,RF,eds.Critical Care Manual:Applied Physiology and Principles of Therapy.ed2.Philadelphia F.A DAVIS COMPANY,1992.17-19.
4 田卓民.呼气末正压对机械通气病人中心静脉压的影响[J].中国急救医学,2003,23(4):227-228.
5 朱波,骆辛.不同水平呼气末正压对机械通气患者中心静脉压的影响[J].医学信息,2007,20(3):445-447.
6 解建,李志强.急危重病抢救技术.第1版.海南:南海出版公司,2004.
7 吕发勤,段云友,王文,等.上腔静脉综合征患者上腔静脉频谱多普勒变化规律研究[J].中华超声影像学杂志,2004,13(6):429-432.
8 贾化平,段云友,曹铁生,等.右心房压力升高对上腔静脉血流参数影响的实验研究[J].中国医学影像技术,2006,22(3):344-346.
9 Cohen ML,Cohen BS,Kronzon I,etal.Superior vena caval blood flow velocities in adults:a Doppler echocardiographic study.J Appl Physiol,1986,61(1):215-219.
10 Klein AL,Leung DY,Murray RD,etal.Effects of age and physiologic variables on right ventricular filling dynamics in normal subjects.Am J Cardiol,1999,84(4):440-448.
11 Appleton CP,Hatle LK,Popp RL.Superior vena cava and hepatic vein Doppler echocardiography in healthy adults.J Am Coll Cardiol,1987,10(5):1032-1039.
12 Gindea AJ,Slater J,Kronzon I.Doppler echocardiographic flow velocity measurements in the superior vena cava during the Valsalva maneuver in normal subjects.Am J Cardiol,1990,65(20):1387-1391.
13 Ueki J,Dambara T.Dynamic changes in superior vena cavalconfiguration based on posture.Nihon Kyobu Shikkan Gakkai Zasshi,1991,29(8):971-977.
14 Ayabakan C,Ozkutlu S.Normal patterns of flow in the superior caval,hepatic and pulmonary veins as measured using Doppler echocardiography during childhood.Cardiol Young,2003,13(2):143-151.
15 吕发勤,段云友,曹铁生,等.正常成人上腔静脉多普勒血液频谱分析[J].中华超声影像学杂志,2001,10(8):470-472.
16 Jellinek H,Krenn H,Oczenski W,et al.Influence of positive airway pressure on the pressure gradient for venous return in humans[J].J Appl Physiol,2000,88:926-932.
17 Vieillard-Baron A,Augarde R,Prin S,et al.Influence of superior vena caval zone condition on cyclic changes in right ventricular outflow during respiratory support[J].Anesthesiology,2001,95:1083-1088.
18 贾化平,段云友,曹铁生,等.呼吸运动对健康成年人上腔静脉多普勒频谱影响研究[J].临床超声医学杂志,2006,8(6):343-345.
19 Dambrosio M,Fiore G,Brienza N,etal.Right ventricular myocardial function in ARF patients:PEEP as a challenge for the right heart[J].Intensive Care Med,1996,22(8):772.
20 余守章。临床监测学[M].广州:广东科技出版社,1997,15.
21 吴雅峰,吴安石,李一丹,等.术中经食管超声检测肝静脉血流与中心静脉压相关性研究[J].中国超声医学杂志,2006,22(7):526-528.
22 arcelino P,Borba A,Fernandes AP,et al.Non Invasive evaluation of central venous pressure using echocardiography in the intensive care-Specific features of patients with right ventricular enlargement and chronic exacerbated pulmonary disease[J].Rev Port Pneumol,2006,12(6):637-658.
1 Cohen ML,Cohen BS,Kronzon I,etal.Superior vena caval blood flow velocities in adults:a Doppler echocardiographic study.J Appl Physiol,1986,61(1):215-219.
2 Klein AL,Leung DY,Murray RD,etal.Effects of age and physiologic variables on right ventricular filling dynamics in normal subjects.Am J Cardiol,1999,84(4):440-448.
3 吕发勤,段云友,王文,等.上腔静脉综合征患者上腔静脉频谱多普勒变化规律研究[J].中华超声影像学杂志,2004,13(6):429-432.
4 贾化平,段云友,曹铁生,等.右心房压力升高对上腔静脉血流参数影响的实验研究[J].中国医学影像技术,2006,22(3):344-346.
5 Braunwald E.Heart disease-a text book of cardiovascular medicine.Philadelphia,PA:Saunders WB,2001,1825-1845.
6 Marangoni S,Yitacca M,Quadri A,et al.Non-invasive haemodynamic effects of two nasal positive pressure ventilation modalities in stable chronic obstructive lung disease patients.Respiration,1997,64:138-144.
7 王泓,曹铁生,丁康,等.超声心动图研究正压通气对犬心功能的影响及其机制[J].中华超声影像学杂志,2005,14:63-66.
8 William PL,Warwick R,Gray's Anatomy[M].36~(th) ed.Churchill Livingston,1980:753-754.
9 河北医学院.人体解剖学(一册)[M].北京:人民卫生出版社,1978.1045-1046.
10 Appleton CP,Hatle LK,Popp RL.Superior vena cava and hepatic vein Doppler了解到echocardiography in healthy adults.J Am Coll Cardiol,1987,10(5):1032-1039.
11 Gindea AJ,Slater J,Kronzon I.Doppler echocardiographic flow velocity measurements in the superior vena cava during the Valsalva maneuver in normal subjects.Am J Cardiol,1990,65(20):1387-1391.
12 Ueki J,Oambara Z.Dynamic changes in superior vena cavalconfiguration based on posture.Nihon Kyobu Shikkan Gakkai Zasshi,1991,29(8):971-977.
13 Ayabakan C,Ozkutlu S.Normal patterns of flow in the superior caval,hepatic and pulmonary veins as measured using Doppler echocardiography during childhood.Cardiol Young,2003,13(2):143-151.
14 解建,李志强.急危重病抢救技术.第1版.海南:南海出版公司,2004.
15 Vieillard-Baron A,Chergui K,Rabiller A,et al.Superior vena caval collapsibility as a gauge of volume status in ventilated septic patients[J].Intensive Care Med,2004,30(9):1734-1739.
16 Charron C,Caille V,Jardin F,et al.Echocardiographic measurement of fluid responsiveness[J].Curr Opin Crit Care,2006,12(3):249-254.
17 吕发勤,段云友,曹铁生,等.正常成人上腔静脉多普勒血液频谱分析[J].中华超声影像学杂志,2001,10(8):470-472.
18 Jellinek H,Krenn H,Oczenski W,et al.Influence of positive airway pressure on the pressure gradient for venous return in humans[J].J Appl Physiol,2000,88:926-932.
19 Vieillard-Baron A,Augarde R,Prin S,et al.Influence of superior vena caval zone condition on cyclic changes in right ventricular outflow during respiratory support[J].Anesthesiology,2001,95:1083-1088.
20 贾化平,段云友,曹铁生,等.呼吸运动对健康成年人上腔静脉多普勒频谱影响研究[J].临床超声医学杂志,2006,8(6):343-345.
21 Dambrosio M,Fiore G,Brienza N,etal.Right ventricular myocardial function in ARF patients:PEEP as a challenge for the right heart[J].Intensive Care Med,1996,22(8):772.
22 Wilson RF.Cardiovascular physiology[M].In:Wilson,RF,eds.Critical Care Manual:Applied Physiology and Principles of Therapy.ed2.Philadelphia F.A DAVIS COMPANY,1992.17-19.
23 Pizov R,Conen M,Segal E,etal.PEEP induced hemodynamic changes are reflected in the arterial pressure ware from[J].Anesthesiology,1992,77:A64.
24 田卓民.呼气末正压对机械通气病人中心静脉压的影响[J].中国急救医学,2003,23(4):227-228.
25 朱波,骆辛.不同水平呼气末正压对机械通气患者中心静脉压的影响[J].医学信息,2007,20(3):445-447.
26 吴雅峰,吴安石,李一丹,等.术中经食管超声检测肝静脉血流与中心静脉压相关性研究[J].中国超声医学杂志,2006,22(7):526-528.
27 Marcelino P,Borba A,Fernandes AP,et al.Non Invasive evaluation of central venous pressure using echocardiography in the intensive care-Specific features of patients with right ventricular enlargement and chronic exacerbated pulmonary disease[J].Rev Port Pneumol, 2006,12(6):637-658.
2 Charron C,Caille V,Jardin F,et al.Echocardiographic measurement of fluid responsiveness[J].Curr Opin Crit Care,2006,12(3):249-254.
3 Wilson RF.Cardiovascular physiology[M].In:Wilson,RF,eds.Critical Care Manual:Applied Physiology and Principles of Therapy.ed2.Philadelphia F.A DAVIS COMPANY,1992.17-19.
4 田卓民.呼气末正压对机械通气病人中心静脉压的影响[J].中国急救医学,2003,23(4):227-228.
5 朱波,骆辛.不同水平呼气末正压对机械通气患者中心静脉压的影响[J].医学信息,2007,20(3):445-447.
6 解建,李志强.急危重病抢救技术.第1版.海南:南海出版公司,2004.
7 吕发勤,段云友,王文,等.上腔静脉综合征患者上腔静脉频谱多普勒变化规律研究[J].中华超声影像学杂志,2004,13(6):429-432.
8 贾化平,段云友,曹铁生,等.右心房压力升高对上腔静脉血流参数影响的实验研究[J].中国医学影像技术,2006,22(3):344-346.
9 Cohen ML,Cohen BS,Kronzon I,etal.Superior vena caval blood flow velocities in adults:a Doppler echocardiographic study.J Appl Physiol,1986,61(1):215-219.
10 Klein AL,Leung DY,Murray RD,etal.Effects of age and physiologic variables on right ventricular filling dynamics in normal subjects.Am J Cardiol,1999,84(4):440-448.
11 Appleton CP,Hatle LK,Popp RL.Superior vena cava and hepatic vein Doppler echocardiography in healthy adults.J Am Coll Cardiol,1987,10(5):1032-1039.
12 Gindea AJ,Slater J,Kronzon I.Doppler echocardiographic flow velocity measurements in the superior vena cava during the Valsalva maneuver in normal subjects.Am J Cardiol,1990,65(20):1387-1391.
13 Ueki J,Dambara T.Dynamic changes in superior vena cavalconfiguration based on posture.Nihon Kyobu Shikkan Gakkai Zasshi,1991,29(8):971-977.
14 Ayabakan C,Ozkutlu S.Normal patterns of flow in the superior caval,hepatic and pulmonary veins as measured using Doppler echocardiography during childhood.Cardiol Young,2003,13(2):143-151.
15 吕发勤,段云友,曹铁生,等.正常成人上腔静脉多普勒血液频谱分析[J].中华超声影像学杂志,2001,10(8):470-472.
16 Jellinek H,Krenn H,Oczenski W,et al.Influence of positive airway pressure on the pressure gradient for venous return in humans[J].J Appl Physiol,2000,88:926-932.
17 Vieillard-Baron A,Augarde R,Prin S,et al.Influence of superior vena caval zone condition on cyclic changes in right ventricular outflow during respiratory support[J].Anesthesiology,2001,95:1083-1088.
18 贾化平,段云友,曹铁生,等.呼吸运动对健康成年人上腔静脉多普勒频谱影响研究[J].临床超声医学杂志,2006,8(6):343-345.
19 Dambrosio M,Fiore G,Brienza N,etal.Right ventricular myocardial function in ARF patients:PEEP as a challenge for the right heart[J].Intensive Care Med,1996,22(8):772.
20 余守章。临床监测学[M].广州:广东科技出版社,1997,15.
21 吴雅峰,吴安石,李一丹,等.术中经食管超声检测肝静脉血流与中心静脉压相关性研究[J].中国超声医学杂志,2006,22(7):526-528.
22 arcelino P,Borba A,Fernandes AP,et al.Non Invasive evaluation of central venous pressure using echocardiography in the intensive care-Specific features of patients with right ventricular enlargement and chronic exacerbated pulmonary disease[J].Rev Port Pneumol,2006,12(6):637-658.
1 Cohen ML,Cohen BS,Kronzon I,etal.Superior vena caval blood flow velocities in adults:a Doppler echocardiographic study.J Appl Physiol,1986,61(1):215-219.
2 Klein AL,Leung DY,Murray RD,etal.Effects of age and physiologic variables on right ventricular filling dynamics in normal subjects.Am J Cardiol,1999,84(4):440-448.
3 吕发勤,段云友,王文,等.上腔静脉综合征患者上腔静脉频谱多普勒变化规律研究[J].中华超声影像学杂志,2004,13(6):429-432.
4 贾化平,段云友,曹铁生,等.右心房压力升高对上腔静脉血流参数影响的实验研究[J].中国医学影像技术,2006,22(3):344-346.
5 Braunwald E.Heart disease-a text book of cardiovascular medicine.Philadelphia,PA:Saunders WB,2001,1825-1845.
6 Marangoni S,Yitacca M,Quadri A,et al.Non-invasive haemodynamic effects of two nasal positive pressure ventilation modalities in stable chronic obstructive lung disease patients.Respiration,1997,64:138-144.
7 王泓,曹铁生,丁康,等.超声心动图研究正压通气对犬心功能的影响及其机制[J].中华超声影像学杂志,2005,14:63-66.
8 William PL,Warwick R,Gray's Anatomy[M].36~(th) ed.Churchill Livingston,1980:753-754.
9 河北医学院.人体解剖学(一册)[M].北京:人民卫生出版社,1978.1045-1046.
10 Appleton CP,Hatle LK,Popp RL.Superior vena cava and hepatic vein Doppler了解到echocardiography in healthy adults.J Am Coll Cardiol,1987,10(5):1032-1039.
11 Gindea AJ,Slater J,Kronzon I.Doppler echocardiographic flow velocity measurements in the superior vena cava during the Valsalva maneuver in normal subjects.Am J Cardiol,1990,65(20):1387-1391.
12 Ueki J,Oambara Z.Dynamic changes in superior vena cavalconfiguration based on posture.Nihon Kyobu Shikkan Gakkai Zasshi,1991,29(8):971-977.
13 Ayabakan C,Ozkutlu S.Normal patterns of flow in the superior caval,hepatic and pulmonary veins as measured using Doppler echocardiography during childhood.Cardiol Young,2003,13(2):143-151.
14 解建,李志强.急危重病抢救技术.第1版.海南:南海出版公司,2004.
15 Vieillard-Baron A,Chergui K,Rabiller A,et al.Superior vena caval collapsibility as a gauge of volume status in ventilated septic patients[J].Intensive Care Med,2004,30(9):1734-1739.
16 Charron C,Caille V,Jardin F,et al.Echocardiographic measurement of fluid responsiveness[J].Curr Opin Crit Care,2006,12(3):249-254.
17 吕发勤,段云友,曹铁生,等.正常成人上腔静脉多普勒血液频谱分析[J].中华超声影像学杂志,2001,10(8):470-472.
18 Jellinek H,Krenn H,Oczenski W,et al.Influence of positive airway pressure on the pressure gradient for venous return in humans[J].J Appl Physiol,2000,88:926-932.
19 Vieillard-Baron A,Augarde R,Prin S,et al.Influence of superior vena caval zone condition on cyclic changes in right ventricular outflow during respiratory support[J].Anesthesiology,2001,95:1083-1088.
20 贾化平,段云友,曹铁生,等.呼吸运动对健康成年人上腔静脉多普勒频谱影响研究[J].临床超声医学杂志,2006,8(6):343-345.
21 Dambrosio M,Fiore G,Brienza N,etal.Right ventricular myocardial function in ARF patients:PEEP as a challenge for the right heart[J].Intensive Care Med,1996,22(8):772.
22 Wilson RF.Cardiovascular physiology[M].In:Wilson,RF,eds.Critical Care Manual:Applied Physiology and Principles of Therapy.ed2.Philadelphia F.A DAVIS COMPANY,1992.17-19.
23 Pizov R,Conen M,Segal E,etal.PEEP induced hemodynamic changes are reflected in the arterial pressure ware from[J].Anesthesiology,1992,77:A64.
24 田卓民.呼气末正压对机械通气病人中心静脉压的影响[J].中国急救医学,2003,23(4):227-228.
25 朱波,骆辛.不同水平呼气末正压对机械通气患者中心静脉压的影响[J].医学信息,2007,20(3):445-447.
26 吴雅峰,吴安石,李一丹,等.术中经食管超声检测肝静脉血流与中心静脉压相关性研究[J].中国超声医学杂志,2006,22(7):526-528.
27 Marcelino P,Borba A,Fernandes AP,et al.Non Invasive evaluation of central venous pressure using echocardiography in the intensive care-Specific features of patients with right ventricular enlargement and chronic exacerbated pulmonary disease[J].Rev Port Pneumol, 2006,12(6):637-658.