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目的:研究呼气末正压通气(PEEP)对去骨瓣减压术后患者颅内压及脑灌注压的影响。方法:选取17例去骨瓣减压术后并发急性肺损伤/呼吸窘迫综合症,并行呼吸机辅助呼吸的患者,记录和计算不同PEEP下的中心静脉压(CVP)、平均动脉压(MAP)、颅内压(ICP)、脑灌注压(CPP)数值。结果:随着PEEP的升高,CVP也相应升高,二者呈显著正相关(r=0.703,P=0.000);MAP降低,MAP与PEEP呈显著负相关(r=-0.340,P=0.000);ICP未被显著影响,ICP与PEEP水平无相关性(r=0.018,P>0.05);CPP降低,CPP与PEEP呈显著负相关(r=-0.468,P=0.000)。CPP随着MAP的降低而降低,二者呈正相关(r=0.305,P=0.04)。结论:呼气末正压通气对去骨瓣减压术后患者颅内压影响不大,但会显著降低脑灌注压。
Objective: To study the effect of end-expiratory pressure ventilation (PEEP) on intracranial pressure and cerebral perfusion pressure in patients with decompressive craniectomy. Methods: Seventeen patients with acute lung injury / respiratory distress syndrome complicated with restenosis after decompressive craniectomy and ventilator assisted breathing were enrolled. The central venous pressure (CVP) and mean arterial pressure (MAP) under different PEEP were recorded and calculated. , Intracranial pressure (ICP), cerebral perfusion pressure (CPP) values. Results: With the increase of PEEP, the CVP also increased accordingly. There was a significant positive correlation between them (r = 0.703, P = 0.000); MAP decreased, MAP and PEEP had a significant negative correlation (r = -0.340, P = 0.000 ); ICP was not significantly affected, ICP and PEEP no correlation (r = 0.018, P> 0.05); CPP decreased, CPP and PEEP showed a significant negative correlation (r = -0.468, P = 0.000). CPP decreased with the decrease of MAP, the two were positively correlated (r = 0.305, P = 0.04). Conclusion: Positive end-expiratory ventilation has little effect on intracranial pressure in patients with decompressive craniectomy, but decreases cerebral perfusion pressure significantly.