不同潮气量联合呼气末正压机械通气对急性肺损伤犬血气与血流动力学的影响  

Effects of different tidal volumes combining positive end expiratory pressure mechanical ventilation on blood gas and hemodynamics in a canine model of acute lung injury

作　　者：赖添顺[1,2] 蔡绍曦[1] 郭振辉[3] 

机构地区：[1]南方医科大学南方医院呼吸内科,广州510515 [2]南方医科大学南方医院 [3]广州军区广州总医院MICU科,广州510010

出　　处：《广东医学》2009年第11期1607-1610,共4页Guangdong Medical Journal

基　　金：广州市科委攻关引导项目(编号:03Z-E0261)

摘　　要：目的观察不同潮气量(Vt)联合呼气末正压(PEEP)机械通气(MV)对油酸型急性肺损伤(ALI)犬血气与血流动力学的影响。方法用油酸静脉注射法制备犬ALI模型,造模成功后随机分为不同Vt组行机械通气4h:小Vt组(A组,n=6),Vt为6mL/kg;大Vt组(B组,n=6):Vt为20mL/kg,PEEP均为10cmH2O(1cmH2O=0.098kPa)。观察动脉血气、血流动力学的变化。结果各组犬pH持续降低,但A组pH显著低于B组水平(P<0.01);PaO2、SO2造模后下降、MV后升高;B组PaCO2波动不大,而A组PaCO2在MV后上升,组间差异有显著性(P<0.01)。各组犬PAP水平在ALI后较前升高(P<0.05),而MV后继续升高(P<0.05);而各组CO水平在ALI时、MV1h后较前显著降低(P<0.05);但A组犬在MV4h时较MV2h时上升(P<0.05),且机械通气4h时较B组升高(P<0.05)。结论PEEP=10cmH2O机械通气可改善油酸型ALI犬的氧合状况但影响血流动力学;小Vt机械通气可导致高碳酸血症的同时升高CO。Objective To study the effects of different tidal volumes （Vt） combining positive end expiratory pressure（PEEP） mechanical ventilation（MV） on blood gas and hemodynamics in a canine model of oleic acid- induced acute lung injury（ALl）. Methods Models of oleic acid induced ALI were established in 12 dogs, which were randomized into two different tidal volume （Vt） mechanical ventilation groups： low Vt group（ Group A, n = 6） ： Vt 6 mL/kg body weight, positive end expiratory pressure （PEEP） 10 cmH20 （1 emil20 = 0. 098 kPa） ; large Vt group（ Group B, n = 6 ） ： Vt 20 mL/kg body weight, PEEP 10 cmH20. Ventilation in both groups was maintained for 4 hours. The indexes of arterial blood gas and hemodynamic parameters were observed throught the study. Results pH in the both groups decreased, but pH in Group A was significantly lower than that of Group B（P 〈0. 01 ）. PaO2 and SO2 decreased after modeling and increased after MV. There was no significant difference between Group A and B either in the level of PaO2 or SO2. PaCO2 had no significant fluctuation in Group B was found but significantly increased after MV in Group A（ P 〈 0. 01 ）. The level of PAP increased after modeling（ P 〈 0. 05 ） , and after MV （ P 〈 0. 05 ） in both groups. CO decreased after modeling and after 1 h of MV（both P 〈0. 05）. CO significantly increased after 4 h MV when compared with that after2 h MV in Group A（P 〈0. 05）. There was significant difference in the CO level between the two groups after 4 h MV （P 〈0.05）. Conclusion MV combining PEEP（PEEP = 10 cmH2O） can improve the oxygenation in the oleic acid （ inject via venous） induced ALI dog, but affects the homodynamics. Low Vt MV can induce hypercapnia and increase CO.

关 键 词：急性肺损伤 潮气量 呼气末正压 血气 血流动力学 

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