INTERACTIONS BETWEEN HEMODYNAMIC AND HORMONAL MODIFICATIONS DURING PEEP-INDUCED ANTIDIURESIS AND ANTINATRIURESIS
INTERACTIONS BETWEEN HEMODYNAMIC AND HORMONAL MODIFICATIONS DURING PEEP-INDUCED ANTIDIURESIS AND ANTINATRIURESIS
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DOI：
10.1378/chest.107.4.1095
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发表时间：
1995-04-01
期刊：
影响因子：
9.6
通讯作者：
PAYEN, DM
中科院分区：
文献类型：
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作者：
FARGE, D;DELACOUSSAYE, JE;PAYEN, DM
本文研究了6例呼气末正压（PEEP）前和下体正压（LBPP）加PEEP （PEEP+LBPP）后15 cm H2O PEEP患者抗利尿和抗尿过程中血流动力学和激素变化的相互作用。我们测量或计算了以下指标：心脏指数、全身动脉、右心房、肺动脉和肺动脉闭塞压；现肾血指标（碘酸131钠清除率）；总血容量（铬51放射性标记红细胞）；肾小球滤过率；尿输出;钠（FE Na+）的部分排泄；血浆抗利尿激素（ADH）浓度、血浆肾素活性（PRA）、去甲肾上腺素和肾上腺素；尿PGE浓度(2)（PGE(2)u）。虽然LBPP应用纠正了PEEP对全身和肾脏血流动力学的有害影响，但观察到Vu和FE Na+持续下降。抗利尿不是由于ADH的释放。交感神经激活和高PRA是PEEP通气时肾功能改变的主要决定因素。
The interactions between hemodynamic and hormonal modifications during antidiuresis and antinatriuresis induced by positive end-expiratory pressure (PEEP) were studied in six patients under 15 cm H2O PEEP before PEEP and after the addition of lower body positive pressure (LBPP) to PEEP (PEEP+LBPP). We measured or calculated the following: cardiac index, systemic arterial, right atrial, pulmonary arterial, and pulmonary artery occlusive pressures; indexed renal blood now (iodohippurate 131 sodium clearance); total blood volume (chromium 51 radiolabeled RBCs); glomerular filtration rate; urinary output; fractional excretion of sodium (FE Na+); plasma concentrations of antidiuretic hormone (ADH), plasma renin activity (PRA), norepinephrine and epinephrine; urinary concentration of PGE(2) (PGE(2)u). Although LBPP application corrected PEEP deleterious effects on systemic and renal hemodynamics, sustained fall in Vu and in FE Na+ were observed. Antidiuresis was not due to ADH release. Sympathetic activation and high PRA appeared the main determinants of renal function alterations in PEEP ventilation.