俯卧位通气联合肺复张对肺内／外源性急性呼吸窘迫综合征犬血流动力学的影响  

Effects of recruitment maneuvers in prone position for pulmonary or extra-pulmonary acute respiratory distress syndrome on hemodynamics in dog

作　　者：陈秋华[1] 杨毅[1] 邱海波[1] 许红阳[1] 郭涛[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,东南大学急诊与危重病医学研究所,江苏南京210009

出　　处：《中国危重病急救医学》2008年第6期349-352,共4页Chinese Critical Care Medicine

基　　金：教育部新世纪优秀人才支持计划基金资助项目（NCET-04-476）;江苏省医学领军人才基金资助项目（2006-11）;江苏省六大人才高峰基金资助项目（1190000009）

摘　　要：目的探讨俯卧位通气联合肺复张（RM）对肺内／外源性急性呼吸窘迫综合征（ARDS）血流动力学的影响。方法杂种犬48只被随机分为8组，气管内注入盐酸复制肺内源性ARDS（ARDSp）模型，静脉注射油酸复制肺外源性ARDS（ARDSe）模型，两种模型分别应用常规机械通气（A组）、俯卧位通气（B组）、控制性肺膨胀（SI，C组）、俯卧位通气联合SI（D组）。观察各组基础状态、模型复制成功0、2和5h4个时间点血流动力学参数的变化。结果①ARDSp模型：中心静脉压（CVP）在A组、C组成模5h明显增加；肺动脉楔压（PAWP）在C组、D组成模5h明显增加；平均肺动脉压（MPAP）在A组、C组、D组成模2h、5h明显增加；胸腔内血容量指数（ITBI）在C组成模5h明显降低；4组血管外肺水指数（EVLWI）在成模0、2和5h均明显增加；心排血指数（CI）在B组、C组成模2和5h明显降低，在D组成模2h明显降低，组内各时间点间比较差异均有统计学意义（P均〈0．05）。②ARDSe模型：EVLWI在4组成模0、2和5h均较基础值明显增加；其余心脏前负荷、心功能、后负荷相关参数在各组内差异均无统计学意义（P均〉0．05）。结论对于不同原因ARDS，俯卧位通气联合SI较单纯应用俯卧位通气或SI血流动力学影响小，其中对ARDSe血流动力学参数更稳定。Objective To evaluate the effect of recruitment maneuvers in prone positioning on hemodynamic in dogs with acute respiratory distress syndrome （ARDS） of pulmonary or extra pulmonary origin. Methods Forty-eight mongrel dogs were randomly divided into 8 groups with six dogs in each group. Hydrochloric acid was instilled into trachea to reproduce pulmonary ARDS （ARDSp） and oleic acid was intravenously injected to produce extra-pulmonary ARDS （ARDSe）. ARDSp and ARDSe dogs were divided into conventional mechanical ventilation group （group A）, prone-position ventilation group （group B）, sustained inflation （SI） group （group C） and prone-position ventilation ＋ SI group （group D） respectively. Hemodynamic parameters were monitored before injury and 0, 2 and 5 hours after ARDS was reproduced. Results （1） In group A and group C, central venous pressure （CVP） increased significantly at 5 hours after ARDSp. Five hours after the establishment of ARDSp, pulmonary arterial wedge pressure （PAWP） increased in group C and group D. Mean pulmonary arterial pressure （MPAP） increased remarkably in group A, group Cand group D at 2 hours and 5 hours after onset of ARDSp. In group C, intrathoratic blood volume index （ITBI） decreased at 5 hours after the onset of ARDSp. In all the four groups, extravascular lung water index （EVLWI） increased sharply at 0, 2 and 5 hours after onset of ARDSp. In group B and group C, cardiac index （CI） decreased to a greater extent at 2 and 5 hours after onset of ARDSp. CI decreased at 2 hours after onset of ARDSp in group D with statistically significant difference at different time points （all P〈0.05）. （2） In all four groups, EVLWI increased sharply at 0, 2 and 5 hours after onset of ARDSe. In ARDSe model, there was no significant difference in other hemodynamic parameters between groups （all P〉0.05）. Conclusion There are less influence on hemodynamics when SI is performed in prone position, and it is even more significantly so i

关 键 词：急性呼吸窘迫综合征 肺复张 俯卧位 控制性肺膨胀 血流动力学 

分 类 号：R563.8[医药卫生—呼吸系统] R445.1[医药卫生—内科学]