肺保护性通气联合肺复张对急性呼吸窘迫综合征家兔气体交换影响  

Effects of protective ventilation and lung recruitment on gas exchange in rabbits with acute respiratory distress syndrome

作　　者：李家琼[1] 邱海波[1] 杨毅[1] 陈永铭[1] 黄英姿[1] 徐晓婷[1] 

机构地区：[1]东南大学附属中大医院危重病医学科

出　　处：《中华急诊医学杂志》2006年第11期978-981,共4页Chinese Journal of Emergency Medicine

基　　金：江苏省135重点人才基金;江苏省六大人才高峰基金(1190000009);教育部跨世纪优秀人才基金(NECT-0476)

摘　　要：目的探讨肺保护性通气联合肺复张对急性呼吸窘迫综合征(ARDS)家兔气体交换的影响。方法肺泡灌洗法复制家兔ARDS模型,随机分为三组:(1)常规潮气量(VT)零呼气末正压(PEEP)组(MVZP);(2)小VT零PEEP组(LVZP);(3)小VT+最佳PEEP+控制性肺膨胀(SI)组(LVBP+SI)。观察肺泡灌洗前的基础状态,ARDS0、1、2、3h时氧合指数(PaO2/FiO2)、动脉血二氧化碳分压(PaCO2)的变化,同时监测呼吸力学、平均动脉压和心率的变化。结果MVZP、LVZP、LVBP+SI组PaO2/FiO2在基础状态为(524±37)、(537±31)、(459±133)mmHg;在ARDS0h为(41±4)、(50±11)、(39±9)mmHg,三组间差异无统计学意义(P>0·05),但均显著低于基础值(P<0·05)。LVBP+SI组PaO2/FiO2在1、2、3h为(287±200)、(307±166)、(302±161)mmHg,较0h显著升高(P<0·05);但MVZP和LVZP组PaO2/FiO2在1、2、3h与0h相比差异无统计学意义(P>0·05);LVBP+SI组PaO2/FiO2在1、2、3h均显著高于MVZP和LVZP组(P<0·05)。LVBP+SI和LVZP组PaCO2在1、2、3h较0h有显著性升高(P<0·05)。在实验中LVBP+SI组心率、血压无明显变化(P>0·05)。结论肺保护性通气联合肺复张可显著改善ARDS家兔氧合。Objective To study the effects of protective ventilation and lung recruitment on gas exchange in rabbits with acute respiratory distress syndrome （ARDS）. Methods Saline - lavaged anesthetized ARDS rabbits were randomly divided into three groups： （1） MVZP group： VT 12 ml/kg, PEEP0 cmH2O; （2） LVZP group： VT 6 ml/kg, PEEP0 cmH2O; （3） LVBP＋ SI group： VT 6 ml/kg, PEEP 10 cmH2O, sustained inflation （SI）. PaO2/FiO2 and PaCO2 were measured at base before saline-lavaged, at 0, 1, 2 and 3 hours after ARDS model establishment. Respiratory mechanics, arterial pressure, and heart rate were also recorded at the same time. Results In MVZP, LVZP and LVBP ＋ SI groups, PaO2/FiO2 was （524±37）, （537±31） and （459± 133） mmHg at base; at 0 hours, PaO2/FiO2 was （41±4） , （50±11 ） and （39±9） mmHg. The was no significant difference on the PaO2/FiO2 in the three groups at 0 hours （P 〉 0.05）, but it was significantly lower than that at base （P 〈 0.05） . In LVBP ＋ SI group, PaO2/FiO2 was （287±200） , （307±166） and （302±161） mmHg at 1, 2, 3 hours, which was significantly higher than that at 0 hours （P 〈0.05） ; PaO2/Fi02 at 1, 2, 3 hours was similar to that at 0 hours in MVZP and LVZP groups. Compared with PaO2/ FiO2 at 1, 2, 3 hours in MVZP and LVZP groups, PaO2/FiO2 in LVBP＋ SI group was obviously increased （P〈0.05） . In LVBP ＋ SI and LVZP groups, PaCO2 at 1, 2, 3 hours was significantly higher than that at 0 hours （ P〈0.05） . Heart rate and arterial pressure were stable in LVBP ＋ SI group （ P〉0.05 ）. ConcIusion Lung protective ventilation and lung recruitment could significantly improve oxygenation of ARDS.

关 键 词：急性呼吸窘迫综合征 气体交换 保护性通气 肺复张 家兔 

分 类 号：R563.8[医药卫生—呼吸系统]