腹腔压力对急性肺损伤家猪呼吸力学及血流动力学的影响  

Effects of High Intra-abdomianl Pressure on Respiration and Hemodynamics in A Porcine Model of Acute Lung Injury

作　　者：祁慧[1] 顾勤[1] 韩云宏[1] 徐颖[1] 刘宁[1] 牛晓蓉[1] 

机构地区：[1]南京大学医学院附属鼓楼医院重症医学科,江苏南京210008

出　　处：《中国呼吸与危重监护杂志》2012年第6期532-536,共5页Chinese Journal of Respiratory and Critical Care Medicine

基　　金：南京市医学科技发展项目(编号:YKK10069)

摘　　要：目的探讨不同腹腔内压力(IAP)对急性肺损伤(ALI)家猪呼吸力学及血流动力学的影响。方法将8只家猪经耳缘持续静脉泵入油酸0.1 mL/kg制作急性肺损伤模型,采用氮气气腹法制作不同腹腔压力模型,随机将IAP设置为0、15和25 mm Hg,即分为IAP0组、IAP15组和IAP25组,动态监测心率(HR)、平均动脉压(MAP)、中心静脉压(CVP),采用脉搏轮廓持续心排出量监测(PiCCO)法动态监测心排出量(CO)、胸腔内血容量指数(ITBVI)等血流动力学指标,同时置入食管内压管动态监测食管内压(Pes)的变化。结果 IAP15组、IAP25组与IAP0组比较,Pes和气道峰压(Ppeak)均显著增加(P<0.01),肺顺应性(Cstat)则显著下降(P<0.05),跨肺压(Ptp)呈下降趋势,PaO2亦呈下降趋势,PaCO2则呈上升趋势,但均无统计学意义(P>0.05)。IAP15组、IAP25组与IAP0组比较,HR和CVP显著增加(P<0.05),CI和ITBVI则显著下降(P<0.05),但MAP无明显改变(P>0.05);ΔPes与CI的变化(ΔCI)呈负相关(r=-0.648,P<0.05)。结论急性肺损伤时,腹腔内压增高引起胸腔内压力增高,导致肺顺应性下降和心排出量下降。Objective To investigate the effects of different levels of intra-abdominal pressure （IAP） on respiration and hemodynamics in a porcine model of acute lung injury （ALI）. Methods A total of 8 domestic swine received mechanical ventilation. Following baseline observations, oleic acid O. lmL/kg in 20mL of normal saline was infused via internal jugular vein. Using a nitrogen gas pneumoperitongnm, the IAP increased from 0 to 15 and 25mmHg,and the groups were named IAP0 ,IAP15 and IAP25 ,respectively. During the experimental period, hemodynamic parameters including heart rate （ HR）, cardiac output （ CO ）, mean arterial pressure（ MAP）, central venous pressure（ CVP）, intrathoracic blood volume index（ITBVI） and so on were obtained by using thermodilution technique of pulse induced continuous cardiac output （PiCCO）. The esophageal pressure （Pes） was dynamicly monitored by the esophageal catheter. Results Pes and peak airway pressure（Ppeak） increased and static lung compliance （Cstat） decreased significantly in IAP15 and IAP25 groups compared with IAPo group（ all P 〈 O. Ol ）. Transpulmonary pressure （Ptp） showed a downward trend（P 〉0. 05 ）. PO2 and oxygenation index showed a downward trend while PCO2 showed a upward trend （ P 〉 0. 05 ）. HR and CVP increased significantly, cardiac index（CI） and ITBV index decreased significantly （ all P 〈 0.05 ）, MAP didn＇t change significantly（P 〉 0. 05 ）. The changes in Pes were negatively correlated with the changes in CI （ r = - 0. 648, P = 0.01 ）. Conclusion In the porcine model of ALI, Pes increases because of a rise in IAP which decreased pulmonary compliance and CI.

关 键 词：腹腔内压 急性肺损伤 食管内压 跨肺压 心排出量 

分 类 号：R563.8[医药卫生—呼吸系统]