不同体位高频振荡通气对重度烟雾吸入性损伤犬氧合及血流动力学的影响  

Effects of different position during high frequency oscillatory ventilation on oxygenation and hemody-namics of dogs with severe smoke inhalation injuryOxygenation

作　　者：朱峰[1] 廖新成 刘名倬 郭光华 曾能初 罗源李 冯贺德 

机构地区：[1]330006南昌大学第一附属医院重症医学科 [2]烧伤科 [3]遂川县人民医院急诊科

出　　处：《中华烧伤杂志》2014年第1期51-55,共5页Chinese Journal of Burns

基　　金：国家自然科学基金（30960400）

摘　　要：目的探讨不同体位高频振荡通气（HFOV）对重度烟雾吸人性损伤犬氧合及血流动力学参数的影响。方法将12只行常规机械通气后犬制成重度烟雾吸人性损伤模型，行HFOV 30min，按随机数字表法分为俯卧位HFOV组和仰卧位HFOV组，每组6只，分别行相应体位HFOV8h。于伤前、致伤后即刻及分组后治疗2、4、6、8h分别测定2组犬血气分析指标pH值、PaO2、PaCO2并计算氧合指数（OI），记录血流动力学参数心率、平均动脉压（MAP）、心排血量（CO）。对数据行重复测量方差分析和LSD-f检验。结果（1）治疗8h，俯卧位HFOV组犬pH值明导高于仰卧位HFOV组（t=3．057l，P〈0．05）。与组内致伤后即刻比较，除仰卧位HFOV组治疗2、4h（t值分别为2．0665、1．4407，P值均大于0．05）外，2组犬其余各治疗时相点pH值均显著降低（￡值为2．4495～3．9853，P〈0．05或P〈0．01）。，治疗2、4、8h，俯卧位HFOV组犬PaO，分别为（13I±26）、（150±40）、（112±30）mrnHg（ImmHg=0．133kPa），均明屁高于仰卧位HFOV组的（81±15）、（96±5）、（83±6）mmHg（t值为2．3664～4．0835，P〈0．05或P〈0．01）。仰卧位HFOV组和俯卧位HFOV组犬致伤后即刻PaO，分别为（55±15）、（48±11）mmHg，显著低于2组犬各治疗时相点PaO，水平（t值为2．4736～7．23l0，P〈0．05或P〈0．01）。2组犬各时相点PaCO，比较，均无明显差异（t值为0．6610～2．14l9，P值均大于O．05）；2组犬组内致伤后即刻与各治疗时相点PaO，比较，均无明显差异（t值为0．1262～1．7683，P值均大于0．05）。（2）治疗2、4、8h，仰卧位HFOV组犬0I值均明显高于俯卧位HFOV组（t值为3．0919～3．7916，P〈0．05或P〈0．01）。与组内致伤后即刻比较，2组犬各治疗时相点0I值均显著降低（t值为2．7020～5．9693，P〈0．05或P〈0．01）。（3）治疗6、8h，俯卧位HFOV组犬心率显著高于仰�different position on oxygenation and hemodynamics of dogs with severe smoke inhalation injury. Methods After being treated with conventional mechanical ventilation, 12 dogs were inflicted with severe smoke inha- lation injury and treated by HFOV for 30 min. They were divided into HFOV ＋ prone positioning （PP） group and HFOV ＋ supine positioning （SP） group according to the random number table, with 6 dogs in each group. They received HFOV with corresponding position for 8 hours respectively. Results of blood gas analy- sis （pH, PaO2 and PaCO2 levels） , oxygen index （OI） and hemodynamic parameters [ heart rate, mean ar- terial pressure （MAP）, and cardiac output （CO） ] were recorded or calculated before injury, immediately after injury, and at post ventilation hour （PVH） 2, 4, 6, 8. Data were processed with analysis of variance of repeated measurement, and LSD- t test. Results （ 1 ） At PVH 8, pH value of dogs in group HFOV ＋ PP was significantly higher than that in group HFOV ＋ SP （ t = 3. 0571, P 〈 0.05 ）. Compared with those observed immediately after injury, except for group HFOV ＋ SP at PVH 2 and 4 （with t values respectively 2. 066 5 and 1. 440 7, P values all above 0.05 ） , the pH values in both groups at other treatment time points were decreased （witht values from 2.449 5 to 3.985 3, P 〈0.05 orP 〈0.01）. At PVH 2, 4, 8, the PaO2levels in group HFOV＋PP [（131~26）, （150＋40）, （112 ~30） mmHg, 1 mmHg=0.133 kPa] were higher than those in group HFOV＋SP [（81 ~ 15）, （96 ~5）, （83 ~6） mmHg, witht values from 2. 366 4 to 4. 083 5, P 〈0.05 orP 〈0.01 ]. The PaOz levels in both groups from PVH 2 to PVH 8 were in- creased, compared with those observed immediately after injury [ （55 ~ 15） mmHg in group HFOV ＋ SP and （48 ~11） mmHg in group HFOV＋PP, with t values from 2. 473 6 to 7. 2310, P 〈0.05 orP 〈0.01]. No statistically significant differences were observed in PaCO2 level at each time point between two groups （wi

关 键 词：烧伤 吸入性 高频通气 俯卧位 血流动力学 氧合 

分 类 号：R644[医药卫生—外科学]