自主呼吸状态下气道压力释放通气联合持续气道吹气对急性肺损伤犬心肺功能影响的研究  

The Efficacy of Combination of Continous Tracheal Gas Insufflation and Airway Pressure Release Ventilation on Cardiopulmonary Function in Spontaneously Breathing Canine Model of Acute Lung Injury.

作　　者：黄志俭[1] 陈荣昌 刘杰[1] 江荣斌[1] 李靖[1] 钟南山[1] 

机构地区：[1]广州医学院第一附属医院广州呼吸疾病研究所,广东广州510120

出　　处：《中国实用内科杂志》2007年第S1期159-164,共6页Chinese Journal of Practical Internal Medicine

摘　　要：目的比较压力限制控制通气和气道压力释放通气这两种保护性通气策略,以及联合持续气道内吹气对急性肺损伤(ALI)犬心肺功能的影响,探寻出一种更有效而且不良反应小的治疗急性肺损伤的通气方法。方法将24只健康杂种犬,麻醉后仰卧位固定经右心房缓慢注入油酸(0.1 mL/kg)制成急性肺损伤模型后,随机平均分为压力限制控制通气组(A 组)、压力限制控制通气联合持续气道内吹气组(B 组),气道压力释放通气组(C 组)和气道压力释放通气联合持续气道内吹气组(D 组)。A 组和 B 组吸气压调至潮气量达6～8 mL/kg,吸呼比1:2,呼气末正压(PEEP)为8 cmH_2O(1 cmH_2O=0.098 kPa),呼吸频率(RR)20/min;C 和 D 组保留自主呼吸,低压水平(Plow)为8 cmH_2O,高压水平(Phigh)调定方法同上,高压持续时间(Thigh)2 s,低压持续时间(Tlow)1 s,释放频率20/min,吸氧浓度(FiO_2)均为100%,;CTGI 的流量为10 L/min 的纯氧行气管内吹气。各组分别记录分析 ALI 时以及通气后每隔1 h 时的氧和、呼吸动力学、血流动力学指标;于通气4 h 实验结束时处死,开胸取肺部组织置入10%甲醛溶液中待行肺损伤评分。结果通气后各组氧合指数(OI)均显著高于 ALI 时(P<0.05);各组第3 h、4 h,明显高于1 h;D 组4 h 高于2 h(P<0.05);C 和 D 组分别高于 A、B 组(P<0.05)。动脉血二氧化碳分压(PCO_2),A 和 C 组于通气后进行性升高,各时点之间差异均有显著性意义(P<0.05);B 组第2 h、3h、4 h 时高于 ALI 时,3h 和4h 时分别高于1 h(P<0.05);D 组无显著改变;通气过程 A 组显著高于其他组(P<0.05),C 组高于 B 和 D 组(P<0.05),B 和 D 两组之间差异无显著性意义(P>0.05)。动静脉分流(Qs/QT)各组通气后均显著低于 ALI 时(P<0.05),4 h 明显低于1 h(P<0.05);C 和 D 组分别低于 A 和 B 组(P<0.05)。通气最后,A 和 B 组的呼吸系统静态顺应性(CRS,sta)显著高于通气前(P<0.05),C 和 D 组于通气2 h 和4 h 时高于 ALI 时(P<0.0Objective To explore a more effective ventilatory method with less adverse effect to treat acute lung injury (ALI) through comparison of the effects on cardiopulnonary function in ALI canine between pressure limited controlled ventilation(PLCV) and airway pressure release ventilation (APRV),and both of them combined with continous tracheal gas insufflation(CTGI).Methods 24 hybrid healthy dogs after being anesthetized and intubated were placed in supine position,ALl were induced by injection of 0.1 mL/kg purified oleic acid into the right atrial catheter slowly,and then, were randomized into four groups to receive pressure limited controlled ventilation (group A),pressure limited controlled ventilation combined with continous tracheal gas insufflation (groupB),airway pressure release ventilation(group C)and airway pressure release ventilation combined with continous tracheal gas insufflation (group D) respectively.There were six dogs in each group.Positive end expiratory pressure (PEEP) was set at 8cmH2O,inspiratory airway pressure was adjusted to the value that produced a tidal volume of 6-8 mL/kg,the inspiratory to expiratory time ratio was set at 1:2 and the ventilator rate was maintained at 20Bpm,in group A and B; Dogs in group C and D were maintained spontaneous breathing,the low pressure(Plow)was set at 8 cmH_2O,the duration of Plow (Tlow) was set for 2 second,the method of setting high pressure level (Phigh) was similar to previous approach,the duration of high pressure was set for 1 second,the total release rate were 20 Bpm,the fraction of inspiratory oxygen(FiO2) was 100%;Flow rate of CTGI was set at 10L/min of pure oxgen.The condition of oxygenation,respiratory mechanics and hemodynamics were measured during experiment.Results During ventilation,oxygenation index (OI) were significantly higher than thoseof ALI(P<0.05),and which were greater after 3 and 4 hour of ventilation than those of 1 hour in each group;At the end of ventilation,OI in group C and group D were significantly increased than those of 2

关 键 词：自主呼吸状态 气道压力释放通气 压力限制控制通气 持续气道内吹气 

分 类 号：R563.8[医药卫生—呼吸系统]