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目的观察Ⅱ型呼吸衰竭患者在不同水平时的呼气末正压通气(PEEP)对血流动力学的影响。方法记录23例实施机械通气的Ⅱ型呼吸衰竭患者在不同PEEP水平时的血流动力学,采用单因素方差分析和一元线性回归模型对数据进行分析。结果不同水平PEEP时中心静脉压(CVP)、心率(HR)、血氧饱和度(SaO2)差异有统计学意义(均P<0.05),平均动脉压(MAP)差异无统计学意义(P>0.05)。CVP与PEEP呈显著正相关(Pearson correlation=0.571,P>0.05),一元线性回归方程:CVP(cm H2O)=2.108+1.031×PEEP(cm H2O);SaO2与PEEP呈显著负相关(Pearson correlation=-0.499,P<0.05),一元线性回归方程:SaO2(%)=2.108-0.003×PEEP(cm H2O)。不同水平PEEP时HR与PEEP无线性相关性(拟合度=0.015,Pearson correlation=-0.124,P<0.05),不同水平PEEP时MAP的差异无统计学意义(P>0.05)。结论 PEEP可影响Ⅱ型呼吸衰竭患者的血流动力学,使实际测得CVP值偏高、SaO2值偏低,但对于MAP、HR则无显著影响。对于实施PEEP时检测CVP、SaO2的具体结果可提供客观量化的理论依据,进一步指导临床。
Objective To investigate the effect of positive end-expiratory pressure (PEEP) on hemodynamics in patients with type Ⅱ respiratory failure at different levels. Methods The hemodynamics of 23 patients with type Ⅱ respiratory failure who underwent mechanical ventilation at different levels of PEEP were recorded. Data were analyzed by one-way ANOVA and univariate linear regression analysis. Results There were significant differences in CVP, HR and SaO2 at different levels of PEEP (all P <0.05) and no significant differences in mean arterial pressure (MAP) (P> 0.05). There was a significant positive correlation between CVP and PEEP (Pearson correlation = 0.571, P> 0.05). The linear regression equation was CVP (cm H2O) = 2.108 + 1.031 × PEEP -0.499, P <0.05). The linear regression equation of the unit: SaO2 (%) = 2.108-0.003 × PEEP (cm H2O). There was no linear correlation between HR and PEEP at different levels of PEEP (F = 0.015, Pearson correlation = -0.124, P <0.05). There was no significant difference in MAP between different levels of PEEP (P> 0.05). Conclusions PEEP can affect the hemodynamics of patients with type Ⅱ respiratory failure. The measured CVP value is actually high and the value of SaO2 is low, but there is no significant effect on MAP and HR. For the detection of CVP when implementing PEEP, the specific results of SaO2 can provide the objective basis for quantitative analysis to further guide the clinical practice.