高频震荡通气治疗吸入性肺损伤的作用  

Effects of high frequency oscillatory ventilation for the treatment of inhalation injury

作　　者：王少根[1] 郭光华[1] 付忠华[1] 周四芳[1] 

机构地区：[1]南昌大学医学院一附院烧伤中心,南昌330006

出　　处：《中华急诊医学杂志》2007年第2期170-173,共4页Chinese Journal of Emergency Medicine

基　　金：国家自然科学基金资助项目（30460134）

摘　　要：目的探讨治疗吸入性肺损伤合并急性呼吸衰竭的呼吸支持手段。方法按第三军医大学的方法，利用新西兰大白兔，制造兔重度蒸汽吸入性损伤并呼吸衰竭模型，用CMV、HFOV方法进行通气治疗．分别在伤后1、2、3、4h，抽股动脉血检测血气；4h后处死，取兔右肺下叶称重后，计算干湿重比；右肺中叶4个不同部位（依赖区和非依赖区）取标本，做病理检查。结果①HFOV组和CMV组PaO2均在伤后1h明显上升，伤后4h内动脉血仍有良好氧合，自伤后2h点动脉血氧合和PO2 a／A，HFOV组明显优于CMV组，差异具有统计学意义（P〈0．01）；P（A-a）O2在2h和4h点，CMV组明显高于HFOV组（P〈0．05）；PaCO2在各时相点均差异无统计学意义（P〉0．05）。②兔肺湿干重比两组差异无统计学意义（P〉0．05）。③组织学损伤HFOV组较CMV明显减轻（P〈0．05）。结论高频震荡通气能显著提高蒸汽吸人性损伤兔的动脉血氧合，减轻兔肺的损伤，是治疗蒸汽吸入致急性呼吸衰竭的良好通气模式。Objective To find an optimal ventilatory mode for acute respiratory failure caused by inhalation injury. Method According to the method established by the Third Military Medical Univemity, acute respiratory failure model caused by steam inhalation injury in rabbits was made, and ventilated by CMV or HFOV. Femoral arterial blood samples were collected respectively at 1, 2, 3, 4 hours posthum for blood gas analysis. After the animals were euthanized at 4 hours following inhalation injury, lower lobe of the right lung was weighed for calculating wet-dry ratio. Four different parts, including dependent area and non-dependent area, of middle lobe of the right lung were collected for pathological examination. Results （1） PaO2 increased significantly since 1 hour after inhalation injury, and rabbits had better arterial oxygenation within 4 hours. PaO2 and PO2 a/A in HFOV group were better than those in CMV group since 2 hours after inhalation injury, and there existed significant difference. P（A.a）O2 in CMV was higher than that in HFOV at 2 hours and 4 hours; PaCO2 had no statistical difference between the groups. （1） Wet-dry ratio didn＇t show significant difference in two groups. （3） Histological injury by was more alleviated in HFOV group than in CMV group. Conclusions HFOV could improve arterial oxygenation in rabbits with steam inhalation injury, and alleviate histological change, and it was also an optimal ventilatory mode for acute respiratory failure caused by steam inhalation.

关 键 词：高频震荡通气 常规机械通气 吸入性损伤 

分 类 号：R686[医药卫生—骨科学]