PEEP对高分级动脉瘤性蛛网膜下腔出血合并重度呼吸功能障碍患者颅内压的影响

doi:10.3969/j.issn.10073205.2018.06.009

河北医科大学学报

PEEP对高分级动脉瘤性蛛网膜下腔出血合并重度呼吸功能障碍患者颅内压的影响

1.河北省石家庄市第一医院神经外三科，河北石家庄 050011；2.河北省石家庄市第一医院重症医学三科，
河北石家庄 050011；3.河北省石家庄市第一医院老年病三科，河北石家庄 050011

出版日期:2018-05-25 发布日期:2018-05-30
作者简介:杨磊（1980-），男，河北省定州人，河北省石家庄市第一医院主治医师，医学博士，从事神经外科疾病诊治研究。
基金资助:
河北省科技计划项目（162777208）

Effect of PEEP on intracranial pressure in patients with poorgrade aneurysmal subarachnoid hemorrhage and severe respiratory dysfunction#br#

1.The Third Department of Neurosurgery, the First Hospital of Shijiazhuang, Hebei Province,
Shijiazhuang 050011, China; 2.The Third Department of Intensive Medicine, the First Hospital
of Shijiazhuang, Hebei Province, Shijiazhuang 050011, China; 3.The Third Department of
Geriatrics, the First Hospital of Shijiazhuang, Hebei Province, Shijiazhuang 050011, China

Online:2018-05-25 Published:2018-05-30

摘要/Abstract

摘要： ［摘要］〓
〖HTH〗目的〖HTSS〗〖KG*2〗探讨呼气末正压通气(positive end expiratory pressure,PEEP)对高分级动脉瘤性蛛网膜下腔出血合并重度呼吸功能障碍患者颅内压的影响。
〖HTH〗方法〖HTSS〗〖KG*2〗选取高分级动脉瘤性蛛网膜下腔出血合并重度呼吸功能障碍患者30例，分为伴有神经源性肺水肿组19例，未发生神经源性肺水肿组11例，分别设置PEEP为0 cmH2O、6 cmH2O及12 cmH2O，观察患者生命体征及颅内压的变化。
〖HTH〗结果〖HTSS〗〖KG*2〗PEEP为12 cmH2O时颅内压、中心静脉压与PEEP为0 cmH2O、6 cmH2O时相比明显升高，PEEP为12 cmH2O时脑灌注压与PEEP为0 cmH2O时相比明显降低，差异均有统计学意义（P＜005）。2组不同PEEP下颅内压、脑灌注压及中心静脉压差异均无统计学意义（P＞0.05）。
〖HTH〗结论〖HTSS〗〖KG*2〗高分级动脉瘤性蛛网膜下腔出血合并重度呼吸功能障碍患者在机械通气状态下，PEEP>12 cmH2O后会显著升高颅内压降低脑灌注,可能与神经源性肺水肿的发生与否无关。

关键词: 蛛网膜下腔出血, 肺水肿, 呼吸功能不全

Abstract: ［Abstract］ Objective〖HTSS〗〓To investigate the effect of endexpiratory positive pressure on intracranial pressure in patients with poorgrade aneurysmal subarachnoid hemorrhage and severe respiratory dysfunction.
〖HTH〗〖WTHZ〗Methods〖HTSS〗〓Thrity cases of poorgrade aneurysmal subarachnoid hemorrhage combined with severe respiratory dysfunction were divided into 19 cases with neurogenic pulmonary edema and 11 cases without neurogenic pulmonary edema group. PEEP was set up to 0 cmH2O, 6 cmH2O and 12 cmH2O to observe the changes of vital signs and intracranial pressure.
〖HTH〗〖WTHZ〗Results〖HTSS〗〓When PEEP was 12 cmH2O, the intracranial pressure and central venous pressure were significantly higher than that of PEEP 0 cmH2O and PEEP 6 cmH2O. When PEEP was 12 cmH2O, the cerebral perfusion pressure was significantly lower than that of 0 cmH2O. There were statistically significant differences(P＜005). There was no significant difference in intracranial pressure, cerebral perfusion pressure and central venous pressure between the two groups at different end expiratory pressure(P＞005).
〖HTH〗〖WTHZ〗Conclusion〖HTSS〗〓Poorgrade aneurysmal subarachnoid hemorrhage combined with severe respiratory dysfunction in patients with severe respiratory dysfunction can significantly increase intracranial pressure and decrease cerebral perfusion after＞12 cmH2O, which is not related to the occurrence of neurogenic pulmonary edema.

Key words: subarachnoid hemorrhage, pulmonary edema, respiratory insufficiency

杨〓磊1，张栋梁1，韩永丰1，李聪慧1，宋〓贺2，张世阳3*. PEEP对高分级动脉瘤性蛛网膜下腔出血合并重度呼吸功能障碍患者颅内压的影响[J]. 河北医科大学学报, doi: 10.3969/j.issn.10073205.2018.06.009.

YANG Lei1, ZHANG Dongliang1, HAN Yongfeng1, LI Conghui1, SONG He2, ZHANG Shiyang3*. Effect of PEEP on intracranial pressure in patients with poorgrade aneurysmal subarachnoid hemorrhage and severe respiratory dysfunction#br#[J]. Journal of Hebei Medical University, doi: 10.3969/j.issn.10073205.2018.06.009.

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PEEP对高分级动脉瘤性蛛网膜下腔出血合并重度呼吸功能障碍患者颅内压的影响

Effect of PEEP on intracranial pressure in patients with poorgrade aneurysmal subarachnoid hemorrhage and severe respiratory dysfunction#br#

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