机械通气治疗ARDS犬中两种氧合指数的判断价值  

The value of two kinds of oxygenation index during treating ARDS with mechanical ventilation

作　　者：宋元林[1] 白春学[1] 洪群英[1] 方智野[1] 任自力[1] 钮善福[1] 

机构地区：[1]上海医科大学中山医院肺科,200032

出　　处：《上海医学》1998年第3期143-145,共3页Shanghai Medical Journal

摘　　要：目的 :应用间歇正压通气 ( Intermittent positive pressure ventilation,IPPV) (定容 )和双水平气道正压通气 ( Biphasic positive airway pressure,Bi PAP)两种通气模式治疗 ARDS犬 ,探讨两种氧合指数 ( Oxygenation Index,OI)在判断治疗效果上的价值和地位。材料和方法 :杂种犬 10只 ,静脉用戊巴比妥钠麻醉后经口腔气管插管 ,机械通气。应用油酸复制 ARDS动物模型 ,在预设呼气末正压 ( posi-tive end of expiratory pressure,PEEP)相同和动脉血 CO2 分压相同情况下 ,观察两种通气模式下部分血流动力学、呼吸力学和血气分析的变化 ,分别计算 Pa O2 / Fi O2 ( OI1)和 MAP×Fi O2 × 10 0 / Pa O2 ( OI2 )( Mean Airway Pressure,MAP为平均气道压 ) ,并进行评价。结果 :应用 Bi PAP通气可在较低平均气道压下获得与 IPPV相同甚至更高的氧分压 ,OI1分别是 170 .63± 33.57和 156.0 8± 16.67( P>0 .0 5) ,OI2 分别是 19.0 3± 9.68和 30 .2 3± 10 .67( P<0 .0 5)。结论 :尽管 OI1可在一定程度上反映肺的氧合功能 ,但在机械通气治疗中由于未能考虑到平均气道压的因素 ,因而对评价通气模式和治疗效果有一定局限性。我们认为对机械通气患者应用 OI2Objective:To estimate the value of two kinds of Oxygenation Index in the therapy of ARDS with IPPV (volume control) and BIPAP(Biphasic positive airway pressure) ventilation.Material and Methods:Ten dogs were anesthesized with intravenous sodium barbital,intubated via canine mouth,ventilated respectively with IPPV and Bi- PAP after ARDS model had been induced with oleic acid. We observed the changes of hemodynamics,respiratory me- chanics and bloodguas analysis with the two ventilatory modes,then calculated their Pa O2 / Fi O2 (OI1 ) and MAP× Fi O2 × 10 0 / Pa O2 (MAP=mean airway pressure) (OI2 ) for assessment.Results:The Pa O2 so obtained was as high as IPPV in BIPAP m odel,the OI1 was170 .6 3± 33.5 7and15 6 .0 8± 16 .6 7(P>0 .0 5 ) ,and the OI2 was19.0 3± 9.6 8and30 .2 3± 10 .6 7(P<0 .0 5 ) ,respectively.Conclusion:Though OI1 can reflect oxygenation of lung to a certain degree,yer There is limitation in estimating the ventilation mode by ignoring the mean airway pressure in mechanical ventilaton. We believe that OI2 is a better parameter than OI1 in assessing the effects of mechanical ventilation.

关 键 词：氧合指数 呼吸窘迫综合征 机械通气 

分 类 号：R563.805[医药卫生—呼吸系统] R459.6[医药卫生—内科学]