腹腔高压对急性肺损伤猪呼吸系统的影响  

Effect of intraabdominal hypertension on respiratory mechanics in swine with acute lung injury

作　　者：严姝瑛[1] 陈远卓[2] 彭沪[2] 高成金[2] 葛奎[3] 张翔宇[2] 

机构地区：[1]同济大学医学院,上海200083 [2]同济大学附属第十人民医院急诊重症医学科,上海200072 [3]上海交通大学附属第九人民医院急诊重症医学科,上海200011

出　　处：《同济大学学报（医学版）》2012年第6期68-71,共4页Journal of Tongji University(Medical Science)

基　　金：上海市科委项目(10411964800);上海市卫生局科研课题(2009143)

摘　　要：目的评价在急性肺损伤(acute lung injury,ALI)时腹腔高压(intraabdominal hypertension,IAH)对呼吸系统的影响。方法将6只家猪按实验过程中的不同状态分组,分为基础状态,ALI和ALI+IAH组,基础状态为ALI成模前状态,ALI是稀盐酸(pH<2.5)气管内灌注直至PaO2/FiO2≤150,IAH是通过气腹机注入氮气将腹内压提升至20 mmHg。观察以上三组维持机械通气1 h后的氧合指标和呼吸力学指标的变化。结果 (1)氧合:ALI+IAH组PaO2/FiO2为(84±10)mmHg明显低于基础状态(374±46)mmHg和ALI组(135±15)mmHg(P<0.05)。(2)呼吸力学:ALI+IAH组胸壁顺应性(Ccw)为(26.0±2.8)ml/cmH2O显著低于基础状态(117.1±6.4)ml/cmH2O和ALI组(86.7±5.6)ml/cmH2O,(P<0.05)。ALI和ALI+IAH的肺顺应性(Cl)分别为(15.1±1.1)ml/cmH2O及(13.0±0.9)ml/cmH2O,均明显低于基础状态(40.5±2.6)ml/cmH2O,(P<0.05)。ALI与ALI+IAH比较,差值无统计学意义(P>0.05)。ALI+IAH组呼气末跨肺压(Ptp)为(-3.5±0.8)cmH2O显著低于基础状态(-0.5±1.2)cmH2O和ALI组(-1.3±0.5)cmH2O,(P<0.05)。结论当ALI伴IAH时以胸壁顺应性显著下降为主,同时引起跨肺压进一步下降,在ALI伴IAH行机械通气时更应关注腹内压(IAP)对胸壁顺应性的影响及跨肺压的改变。University,Shanghai 200011,China） Objective To evaluate the respiratory mechanism of acute lung injury（ALI） with intra-abdominal hypertension（IAH） in swine.Methods The experiments were carried out on 6 pigs.The acute lung injury was induced by repeated lung lavage with diluted hydrochloric acid（pH2.5）until PaO2/FiO2 reach to 150;intra-abdominal hypertension was induced by an nitrogen inflator to reach intra-abdominal pressure of 20mmHg.Respiratory parameters were continuously recorded at end of 1h after each process.Results The PaO2/FiO2 in baseline,ALI and ALI ＋ IAH were（374±46）,（135±15） and（84±10）mmHg,respectively,PaO2/FiO2 in ALI＋ IAH was significantly lower than that of baseline and ALI groups（P0.05）.Chest wall compliance（Ccw） in baseline,ALI and ALI ＋ IAH were（117.1±6.4）,（86.7±5.6） and（26.0±2.8）ml/cmH2O respectively,Ccw in ALI ＋ IAH group was significantly lower than that of baseline and ALI groups（P0.05）.Lung compliance（Cl） in ALI（15.1±1.1）ml/cmH2O and ALI ＋ IAH（13.0±0.9）ml/cmH2O was significantly lower than that of baseline（40.5±2.6）ml/cmH2O（P0.05）.There was no significant different in Cl between ALI and ALI ＋ IAH groups（P0.05）.End-expiratory transpulmonary pressure（Ptp） in ALI＋IAH（-3.5±0.8）cmH2O was significantly lower than baseline（-0.5±1.2）cmH2O and ALI（-1.3±0.5）cmH2O groups.Conclusion Results indicate that the effect on chest wall and end-expiratory Ptp should be considered during mechanical ventilation,particularly in ALI with IAH.

关 键 词：急性肺损伤 腹腔高压 机械通气 呼吸力学 

分 类 号：R56[医药卫生—呼吸系统]