急性呼吸窘迫综合征家兔肺不同区域有效血流灌注变化及肺保护性通气对其的影响  被引量:3

The changes in effective local blood perfusion and compensatory ventilation in different lung areas of acute respiratory distress syndrome rabbits model

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作  者:解立新[1] 刘又宁[1] 赵晓巍[2] 陈良安[1] 赵秀梅[3] 刘育英[3] 

机构地区:[1]解放军总医院呼吸科,北京100853 [2]武警总医院呼吸科 [3]解放军总医院微循环室,北京100853

出  处:《中华内科杂志》2004年第7期522-526,共5页Chinese Journal of Internal Medicine

基  金:国家自然科学基金资助项目 (3 0 2 0 0 114 ) ;军队十五重点攻关课题资助项目 (0 12 0 74)

摘  要:目的 通过观察家兔急性呼吸窘迫综合征 (ARDS)模型肺不同区域有效血流灌注变化及肺保护性通气对其的影响 ,探讨ARDS所致严重低氧血症的发生机制。方法 采用静脉注射油酸的方法建立家兔ARDS模型 ,应用PIM Ⅱ激光多普勒血流灌注扫描仪观察不同肺通气模式 [(大潮气、小潮气 +外源性呼气末正压 (PEEP)、大潮气 +俯卧位、俯卧位 +小潮气 +PEEP]下肺不同区域(肺上区、肺下区腹侧和肺下区背侧 )局部有效血流灌注及动脉血气指标的变化。结果 家兔静脉注射油酸后 ,(1)肺不同区域氧合指数明显下降 ,应用肺保护性通气 (小潮气 +PEEP ,俯卧位 +小潮气 +PEEP)后氧合指数明显改善 ;(2 )肺不同区域局部有效血流灌注均有不同程度的下降 ,以肺下区背侧最为明显 ,肺下区腹侧次之 ,肺上区变化最小 ,应用肺保护性通气后 ,小潮气 +PEEP对改善肺下区背侧胸膜下肺局部有效血流灌注的效果不如俯卧位 +小潮气 +PEEP。结论 小潮气 +PEEP、俯卧位+小潮气 +PEEP均可良好改善肺局部有效血流灌注 ,其中俯卧位 +小潮气 +PEEP效果尤为明显 ;右 左分流导致的肺内分流可能是ARDS发生严重进行性低氧血症的主要原因之一。ObjectiveTo discuss the mechanism of severe hypoxemia that induced with acute respiratory distress syndrome (ARDS) by way of observing the effective local blood perfusion in different lung areas of ARDS rabbits. MethodsARDS rabbit models were established by injecting oleic acid through central vein,and the results of effective local blood perfusion in different areas of rabbit lung (upper area,abdominal area,and dorsal area of right lung)with PIM-Ⅱ laser perfusion imager and arterial blood gas under different ventilation modes [large tidal volume ventilation,low tidal volume ventilation + positive end-expiratory pressure (PEEP),prone position + large tidal volume ventilation,and prone position + low tidal volume ventilation + PEEP] were measured. ResultsThe results of oxygenation index were significantly getting worsen after lung injury,and after receiving lung protective ventilation (including low tidal volume + PEEP,prone position + low tidal volume + PEEP),the indexes were taking a turn to the better. After lung injury,the results of effective local lung blood perfusion index (including upper area,abdominal area,and dorsal area) under right lung of ARDS rabbits decreased in the experimental ARDS groups. The results of experimental dorsal area group decreased most significantly,and the results of experimental upper area group changed most lightly. We observed that the effects of receiving low tidal volume + PEEP ventilation were not as good as prone position + low tidal volume + PEEP ventilation in the dorsal area of the rabbit lung compared to the results of effective local area lung blood perfusion index between two ventilation modes,there showed significantly differences in statistics. ConclusionWe indicated that the one of the main mechanisms of severe hypoxemia in ARDS might be caught by the shunt between pulmonary artery and pulmonary vein just like physiological right to left shunt,which caused severe ventilation/ perfusion disturbance. Both low tidal volume ventilation +PEEP and prone position + low t

关 键 词:急性呼吸窘迫综合征 家兔 血流灌注 肺保护性通气 严重低氧血症 

分 类 号:R563.8[医药卫生—呼吸系统]

 

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