高频双向喷射通气和常规机械通气对蒸气吸入性损伤犬治疗效果的比较  

Comparison of therapeutic effect on high frequency twoway jet and conventional mechanical ventilation in treatment of steam inhalation injury in dogs

作　　者：郭光华[1] 李国辉[1] 曹勇[1] 吴燮卿[1] 

机构地区：[1]江西医学院一附院烧伤研究所

出　　处：《中国危重病急救医学》1997年第10期577-579,共3页Chinese Critical Care Medicine

基　　金：国家自然科学基金

摘　　要：目的：观察高频双向喷射通气（ＨＦＴＪＶ）和常规机械通气（ＣＭＶ）对蒸气吸入性损伤犬的呼吸循环动力学参数、肺容量及血气的影响。方法：通过蒸气吸入致伤，复制了犬重度蒸气吸入性损伤模型。结果：①两种通气方式下呼吸系统总阻力（Ｒｒｓ）、肺阻力（ＲＬ）均显著高于对照值（Ｐ均＜０．０１），呼吸系统总顺应性（Ｃｒｓ）、肺顺应性（ＣＬ）均显著低于对照值（Ｐ均＜０．０５），但两者之间比较，Ｒｒｓ、ＲＬ和Ｃｒｓ、ＣＬ的变化均无显著性差异（Ｐ均＞０．０５）。②ＣＭＶ能引起ＣＯ２潴留；ＨＦＴＪＶ比ＣＭＶ显著增加ＣＯ２排出量（ＶＣＯ２，Ｐ＜０．０５），降低过高的ＰａＣＯ２（Ｐ＜０．０１）。③两种通气方式下功能残气量（ＦＲＣ）、心输出量（ＣＯ）、平均动脉压（ＭＡＰ）和ＰａＯ２均无显著变化（Ｐ均＞０．０５）。结论：两种通气方式均能克服气道阻力辅助呼吸，但不能使伤后高气道阻力和低肺顺应性恢复正常。ＣＭＶ的通气效率较低，可引起ＣＯ２潴留；ＨＦＴＪＶ的通气效率则明显优于ＣＭＶ，且能维持吸入性损伤犬的血气至正常水平。Objective:To observe the changes of parameters in respiratory and circulatory dynamics,lung volume as well as blood gases in dogs with steam inhalation injury during high frequency twoway jet ventilation (HFTJV) and conventional mechanical ventilation (CMV).Methods:Severe lung injury model induced by steam inhalation was established in 9 dogs.Results:Respiratory system resistance (Rrs) and lung resistance (R L) were significantly higher than those of baseline values (all P <0 01),and respiratory system compliance (Crs) and lung compliance (C L) were significantly lower than those of baseline values (all P <0 05) in both ventilation,but no significant changes in Rrs and R L as well as Crs and C L were found between HFTJV and CMV (all P >0 05).On the other hand,CMV leaded to retention of CO 2.As compared with CMV,velocity of CO 2 obviously increased ( P <0 05) and PaCO 2 reduced ( P <0 01) in HFTJV.Function residual capacity,cardiac output,mean arterial pressure and PaO 2,however,showed no remarkable changes in HFTJV and CMV(all P >0 05).Conclusions:These ventilation models can overcome airway resistance to assist breath,but can not recover from higher airway resistance and lower lung compliance to normal levels.However,our data suggest that the ventilatory efficiency of HFTJV has advantages superior to that of CMV,which might maintain blood gases within normal range in dogs with steam inhalation injury.

关 键 词：机械通气 蒸气灼伤 吸入性损伤 呼吸 循环 HFTJV 

分 类 号：R644.05[医药卫生—外科学] R605.97[医药卫生—临床医学]