Evaluation Of The Hemodynamic Status In Elders With Different Positive End-expiratory Pressure Ventilations By Pulse-induced Contour Cardiac Output(PiCCO)

ObjectTo evaluated the effects of different PEEP on haemodynamic parameters in elders during general anesthesia with PiCCO. MethodsTwenty patients（ASA I^II, age from 65 to 85 years old）undergoing elective no laparoscopic surgery were included in the study.The patients were divided into 2 groups（Group I, included 10 patients with normal pulmonary function;Group â…¡, included 10 patients with decreasing pulmonary function）. All the patients were instrumented with deep venous catheters, PiCCO, and arterial catheters before regular induction. Three ventilatory settings were randomly assigned for 10 min each: tidal volume（Vt） 8ml?kg-1 and PEEP 0、5、10、15 cmH₂O. Adjusted the respiratory frequencies in order to keep the PETCO2 in the level of 30⁴0mm Hg. Data were collected at each setting. Measurements include haemodynamic parameters MAP、HR、CVP、CI、SVV、SVRI、ITBI、GEDVI、and GEF; respiratory parameters VT、SpO2、RR、Ppeak and PETCO2. Results1There were no significant difference in cardiac preload related indicators GEDI、ITBI and SVV in both groups with every PEEP level.2Compared with the levels of PEEP0,5cmH₂O,there was significant increasing in cardiac afterload related indicator SVR in level of PEEP10cmH₂O in pulmonary function decreasing group（P<0.05 and P<0.01 respectively）.3Compared with the levels of PEEP0, 5cmH₂O,there was significant decreasing in CI in pulmonary function decreasing group inlevel of PEEP15cmH2O（P<0.05 and P<0.01 respectively）.In normal pulmonary function group GEF was lower significant at the level of PEEP10 cmH₂O than at the level of PEEP0 cmH2O（P<0.01）,and was lower significant at the level of PEEP15 cmH₂O than at the levels of PEEP0,5,10cmH2O（P<0.01,P<0.01 and P<0.05 respectively）.In pulmonary function decreasing group GEF was lower significant at the level of PEEP15 cm H₂O than at the level of PEEP0 cmH2O（P<0.01）. There were no significant difference in indicators MAP、HR and ELWI in both groups with every PEEP level.4The Ppeak of all patients increased along with the levels of PEEP.There was significant increasing at the level of PEEP compared with the others（P<0.01）. Compared with the levels of PEEP0cmH₂O,there was significant increased in SPO2 in pulmonary function decreasing group at the level of PEEP10,15cmH2O（P<0.05 and P<0.01 respectively）.There were no significant difference inindicators ETCO2 and RR in both groups with every PEEP level. Conclusion 1In elderly patients with normal pulmonary function undergoing general anesthesia, the hemodynamic status and cardiac functions were not changed significantly when PEEP was set at 5 cmH₂O or lower. 2 In elderly patients with decreasing pulmonary function undergoing general anesthesia, the hemodynamic status and cardiac functions were not changed significantly when PEEP was set at 10 cmH₂O or lower.