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目的观察肺功能正常的患者术后使用不同水平呼气末正压(PEEP)小潮气量通气对血流动力学的影响。方法102例ASAⅠ或Ⅱ级,择期全麻下耳鼻喉科术后患者,随机均分为六组。研究组使用保护性肺通气模式,潮气量5ml/kg,根据PEEP0、5、10、15和20cmH2O分为P0、P5、P10、P15和P20五组。对照组(C组)使用常规机械通气模式,潮气量10ml/kg。观察保护性肺通气前(T1)及保护性肺通气30min后(T2)的血流动力学的改变。结果与C组及T1时比较,T2时加速度指数(ACI)在P0、P5、P10和P15组升高,P20组降低;心脏指数(CI)、左室做功指数(LCWI)、平均动脉压(MAP)在P20组降低(P<0.05);胸腔液体水平(TFC)P10、P15和P20组T2时明显低于T1时(P<0.05)。结论对肺功能正常患者实施小潮气量的保护性肺通气,PEEP在0和5cmH2O水平,对血流动力学无明显影响;当PEEP在10和15cmH2O水平时ACI增强和TFC减少,有潜在血流动力学危害;当PEEP在20cmH2O时CI和MAP均降低,有明显血流动力学波动。
Objective To observe the effects of different levels of positive end expiratory pressure (PEEP) on the hemodynamics in patients with normal pulmonary function. Methods One hundred and two ASA Ⅰ or Ⅱ patients undergoing elective postoperative ENT surgery were randomly divided into six groups. The study group used protective pulmonary ventilation mode, tidal volume 5ml / kg, according to PEEP0,5,10,15 and 20cmH2O divided into P0, P5, P10, P15 and P20 five groups. Control group (C group) using conventional mechanical ventilation mode, tidal volume 10ml / kg. Hemodynamic changes were observed before protective lung ventilation (T1) and after protective lung ventilation (T2) for 30 min. Results Compared with group C and T1, the acceleration index (ACI) increased at T2, and increased at P20, P10 and P15, and decreased at P20. The indexes of cardiac index (CI), left ventricular function index (LCWI), mean arterial pressure MAP decreased in P20 group (P <0.05); while in T2 group of P10, P15 and P20 group in thorax fluid level (TFC) was significantly lower than that in T1 group (P <0.05). Conclusions Protective pulmonary ventilation with low tidal volume is performed in patients with normal pulmonary function. PEEP at 0 and 5cmH2O levels has no significant effect on hemodynamics. When PEEP is at 10 and 15cmH2O levels, ACI increases and TFC decreases. There is potential hemodynamic Learning hazards; when the PEEP at 20cmH2O CI and MAP were reduced, significant hemodynamic fluctuations.