压力控制通气方式的肺复张手法减轻家兔重复去复张相关肺损伤  

Influence of recruitment maneuvers with pressure control ventilation on repeated derecruitment associated lung injury in rabbits

作　　者：吴彬[1] 邱海波[2] 王兵[1] 陈辉民[1] 

机构地区：[1]厦门市第三医院ICU,福建厦门361100 [2]东南大学附属中大医院ICU,江苏南京210009

出　　处：《海南医学院学报》2009年第9期1006-1011,共6页Journal of Hainan Medical University

基　　金：江苏省六大人才高峰基金资助项目(NO.1190000009)~~

摘　　要：目的:研究应用压力控制通气(pressure control ventilation,PCV)方式的肺复张手法(recruitment maneuvers,RM)对家兔重复去复张相关肺损伤的影响。方法:生理盐水肺泡灌洗法复制急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)家兔模型,分为3组。分别为:(1)肺保护性通气组(LP组):潮气量(tidal volume,Vt)6mL/kg,呼气末正压(positive end-expiratory pressure,PEEP)根据静态压力-容积曲线低位转折点水平(lower inflection point in static pressure-volume curve,LIP)设定;(2)去复张组(DR组):通气条件同LP组,在3h机械通气期间每10min将呼吸机管路脱开1min实施去复张;(3)去复张+压力控制组(PCV组):去复张后用PCV法给予RM,具体方法为:将呼吸机模式调整为压力控制通气,吸气压力设定为30cmH20、PEEP水平设定为LIP水平、I:E=1:2,维持90s。机械通气期间监测动脉血气分析及呼吸力学,机械通气3h处死动物,测定肺湿/干重比(W/D)及肺组织病理损伤评分。结果:去复张后1,2和3h时,DR组动脉氧分压(PaO2)均显著低于同时间点的LP与PCV组(P均<0.05),在LP与PCV两组间同时间点PaO2比较无显著性差异(P均(0.05);DR组静态肺顺应性(Cst)与气道平台压力(Pplat)与同时间点LP、SI与PCV组比较差异不显著(P均(0.05);DR组肺W/D与LP与PCV组比较也无显著性差异(P(0.05);机械通气3h时DR组肺组织病理损伤评分为(10.9±0.8),显著高于LP与PCV组(P均<0.05),LP与PCV组间比较无显著性差异(P均(0.05)。结论:重复去复张明显恶化氧合,加重ARDS肺组织损伤,PCV方式的RM可以改善氧合,减轻组织损伤。Objective：To evaluate the influence of recruitment maneuvers（RM） with pressure control ventilation （PCV） on repeated derecruitment associated lung injury in rabbits. Methods： The rabbit models of acute respiratory distress syndrome （ARDS） were duplicated using saline alveoli-lavaged, and the rabbits were divided into three groups： （1） LP group： tidal volume （tidal volume, tory pressure, PEEP） was set based on low turning point in the level ume curve, LIP） of static pressure - volume curve; （2） DR group： ） 6 mL/kg, PEEP （positive end - expiralower inflection point in static pressure-vole ventilation condition was the same as LP group, derecruitment was repeatedly induced by intentional disconnection of the ventilatory circuit for 1 min every 10 min for 3 h ; （3） PCV group ： using PCV for RM after derecruitment, setting the mode of ventilator as PCV, inspiratory pressure set to 30 cmH20, PEEP levels set to LIP level, I：E = 1：2, time of maintenance 90 s. Arterial blood gas parameters and respiratory mechanics were monitored during mechanical ventilation; the rabbits were sacrificed 3h after mechanical ventilation to determine the lung wet/dry weight ratio （W/D） and underwent pathological score of lung tissue injury. Results： PaO2 in group DR was significant lower than that in group LP and PCV at the same time （P all 〈0.05） 1,2 and 3 h after derecruitmen; PaO2 showed no significant differences between LP and PCV at the same time （ P all 〉 0.05 ） ; static lung compliance （Cst） and airway platform pressure （Pplat） between group DR and group LP and PCV at the same time had no significant differences（P all 〉 0.05 ） ; lung W/ D between DR group and LP group and PCV group showed no significant differences （P 〉 0.05 ） ; pathological injury score of lung tissue 3 h after mechanical ventilation in group DR was （ 10.9 ± 0.8 ）, which was significant higher than that in group LP and group PCV （ P all 〈 0.05 ）, There was no signific

关 键 词：呼吸窘迫综合征 肺保护性通气 人工呼吸 肺不张 肺复张手法 兔 

分 类 号：R563.8[医药卫生—呼吸系统] R-332[医药卫生—内科学]