机构地区:[1]都医科大学附属北京朝阳医院-北京呼吸疾病研究所,100020 [2]蚌埠医学院第一附属医院呼吸内科 [3]现在卫生部中日友好医院呼吸内科
出 处:《中华结核和呼吸杂志》2008年第5期341-347,共7页Chinese Journal of Tuberculosis and Respiratory Diseases
基 金:基金项目:北京市科技新星计划资助项目(2005803);北京市教育委员会科技发展计划资助项目(KM200510025007)
摘 要:目的 在肺保护性通气策略的基础上,评价俯卧位通气联合肺复张法对犬急性呼吸窘迫综合征(ARDS)模型氧合及肺内分流的影响。方法将24只犬建立油酸ARDS模型后行定容控制通气,在小潮气量(10 ml/kg)+呼气末正压(16cm H2O,1 cm H2O=0.098 kPa)的通气基础上,按随机数字表法分为对照组、俯卧组、仰卧+肺复张组、俯卧+肺复张组,每组6只。分组通气后各组均观察4h,监测动脉血及混合静脉血的血气分析,记录并计算下列指标。统计学处理采用SPSS 11.5软件,数据以x±s表示。所有数据做方差齐性检验,符合正态分布的数据,组间比较采用单因素方差分析,有统计学意义时采用LSD法进行两两比较;不符合正态分布的数据,采用多个独立样本的秩和检验。结果(1)通气15min时,仰卧+肺复张组、俯卧组及俯卧+肺复张组PaO2/吸入氧浓度(FiO2)分别为(368+45)mm Hg(1mm Hg=0.133kPa)、(349±80)mmHg、(423±43)mm Hg,与对照组[(269±72)mm Hg]比较差异有统计学意义(q值分别为2.77、2.23、4.31,P均〈0.05);通气2h时,俯卧组和俯卧+肺复张组PaO2/FiO2分别为(401±82)mm Hg、(416±23)mm Hg,与对照组[(232±40)mm Hg]比较差异有统计学意义(q值分别为3.99、4.35,P均〈0.05);通气4h时,俯卧+肺复张组PaO2/FiO2为(384±68)mm Hg,与对照组[(256±75)mm Hg]、仰卧+肺复张组[(267±92)mm Hg]、俯卧组[(284±83)mm Hg]比较差异有统计学意义(q值分别为2.75、2.56、2.17,P均〈0.05);(2)俯卧组肺内分流率(Qs/Qr)在30min及1、2h时分别为(9.9±4.4)%、(9.7±4.5)%和(8.3±4.6)%,与对照组[(15.0±1.6)%、(16.0±2.0)%、(16.2±1.8)%]比较差异有统计学意义(q值分别为2.86、3.00、3.65,P均〈0.05);俯卧+肺复张组Qs�Objective To evaluate the effects of prone position ventilation (PPV) combined with reeruitment maneuver (RM) on oxygenation and intrapulmonary shunting in oleic acid-induced acute respiratory distress syndrome (ARDS) in canines while ventilated with lung protective ventilation strategy. Methods ARDS was induced by oleic acid in 24 dogs, and the animals were ventilated with volume controlled ventilation (VCV), 16 cm H2O (1 cm H2O =0. 098 kPa) of positive end-expiratory pressure (PEEP) and small tidal volumes (VT 10 mL/kg). All the dogs were randomly divided by random digit table into 4 groups (6 each), a control group (supine position, SP group), a prone position group (PP group),a supine position + RM group ( SPRM group), and a prone position + RM group ( PPRM group), and then were ventilated by VCV for 4 h. Arterial and mixed venous blood gas analyses were measured. Data were analyzed using the SPSS for windows ( version 11.5 ). Results were expressed as x± s. Homogeneity of variance test was performed. The differences in means were calculated using one-way ANOVA. Post-hoc multiple comparisons of means were performed using Least Significant Difference. Nonparametric tests for several independent samples were performed to compare differences between the ranks in the groups studied. P value of 〈 0. 05 was considered statistically significant. Results (1) At 15 min, PaO2/FiO2 in the SPRM group, the PP group and the PPRM group [ (368±45) ram Hg ( 1 mm Hg =0. 133 kPa), (349 ± 80)mm Hg, ( 423 ±43)mm Hg, respectively] was significantly higher than that in the SP group [ (269 ± 72) mm Hg, q = 2. 77, 2. 23, 4. 31, respectively, all P 〈 0. 05 ]. At 2 h, PaO2/FiO2 in the PP group and the PPRM group [ (401±82) mm Hg, (416±23) mm Hg, respectively] was significantly higher than that in the SP group [ (232± 40) mm Hg, q = 3.99, 4. 35, respectively, all P 〈 0. 05 ]. At 4 h, PaO2/FiO2 in the PPRM group [(384±68) mm Hg]
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