俯卧位通气联合肺复张对ARDS氧合及肺复张容积的影响  

Effects of prone position ventilation combined with recruitment maneuvers on oxygenation and lung recruited volume in canines with acute respiratory distress syndrome

作　　者：严正[1] 许红阳[1] 梁锋鸣[1] 陈秋华[2] 金科[1] 衡军锋[1] 严洁[1] 邱海波[2] 

机构地区：[1]南京医科大学附属无锡市人民医院急诊科,江苏无锡214023 [2]东南大学附属中大医院ICU,江苏南京210009

出　　处：《南京医科大学学报（自然科学版）》2010年第4期450-453,571,共5页Journal of Nanjing Medical University(Natural Sciences)

摘　　要：目的:探讨俯卧位通气联合肺复张对急性呼吸窘迫综合征(ARDS)氧合及肺复张容积的影响。方法:健康杂种犬24只,油酸静脉注射复制ARDS模型,再随机分为4组,每组6只,分别应用仰卧位常规机械通气(SC组)、仰卧位联合控制性肺膨胀(SI)(SS组)、俯卧位通气(PC组)、俯卧位通气联合SI(PS组)。各组观察5h,记录氧合及肺复张容积等指标的变化。结果:①与SC组相比,SS组PaO2/FiO2仅在成模后2h显著增高(P<0.05),而PC组和PS组PaO2/FiO2在成模后2h及5h均高于SC组(P均<0.05)。成模2h及5h,PS组PaO2/FiO2明显高于SC组、PC组、SS组(P均<0.05);②成模0h,4组的肺复张容积差异无统计学意义(P均>0.05)。成模2h,SS组、PC组、PS组肺复张容积较SC组明显增加(P均<0.05)。成模5h,与SC组相比,SS组肺复张容积呈减少趋势,PC组、PS组肺复张容积呈增高趋势。结论:俯卧位通气联合SI较单应用俯卧位通气及单应用SI能更好的改善ARDS氧合,肺复张容积的显著增加可能是主要机制之一。Objective：To evaluate the effects of prone position ventilation combined with recruitment maneuvers（RM） on oxygenation and lung recruited volume（RV） in oleic acid-induced acute respiratory distress syndrome in canines. Methods：Twenty-four healthy canines were randomly divided into four groups after oleic acid-induced lung injury：supine position group（SC）,supine position＋RM group（SS）,prone position group（PC） and prone position＋RM group（PS）. Oxygenation index and RV were measured for five hours after ARDS was reproduced. Results：（1）Compared to the SC group,oxygenation index in SS group was increased only at 2 h after onset of ARDS（P 〈 0.05）,while that of PC and PS group improved both at 2 h and 5 h after onset of ARDS（all P 〈 0.05）. Compared to the SC,SS,and PC group,PS group oxygenation index was much higher at 2 h and 5 h after onset of ARDS（all P 〈 0.05）. （2）There was no significant difference of RV among the four group at 0 h after onset of ARDS（all P 〉 0.05）. Compared to the SC group,RV in SS,PC and PS group was much higher at 2 h after onset of ARDS（all P 〈 0.05）. At 5 h after onset of ARDS,the RV of the SS group had a tendency to decrease while the RV of the PC and PS group had a tendency to increase. Conclusion：Prone position ventilation combined with RM improved oxygenation significantly. The increase of RV may be one of the most important mechanisms of its positire effect.

关 键 词：急性呼吸窘迫综合征 肺复张 俯卧位通气 肺复张容积 

分 类 号：R563.8[医药卫生—呼吸系统]