单肺复张对单侧急性呼吸窘迫综合征猪血流动力学和死腔比例的影响  

Effect of unilateral lung recruitment maneuver on hemodynamics and dead space ratio in pigs with unilateral acute respiratory distress syndrome

作　　者：杨万杰[1] 魏凯[1] 安友仲[2] 冯庆国[1] 赵雪峰[1] 李昶[1] 王伟[1] 滕洪云 

机构地区：[1]天津市第五中心医院重症医学科,300450 [2]北京大学人民医院重症医学科,100044

出　　处：《中华危重病急救医学》2014年第8期554-557,共4页Chinese Critical Care Medicine

基　　金：国家发明专利（ZL 2012 1 0195200.8）;天津市医药卫生科技计划项目（2010KZ23）;天津市滨海新区医药卫生科技项目（2011BHKZ006）

摘　　要：目的 比较单侧急性呼吸窘迫综合征（ARDS）动物实施分侧肺机械通气基础上单肺复张与传统肺复张的效果,探寻单侧肺病变情况下合理的机械通气策略.方法 实验动物为健康杂种家猪,按随机数字表法（信封封闭隐藏）分为两组,每组20只.对照组应用1台呼吸机同时对两肺实施常规机械通气;分肺组在分侧肺机械通气（即应用2台呼吸机分别对两肺实施通气）基础上,进行患侧单肺复张.制作左侧ARDS动物模型后,两组根据不同肺复张方法分别实施控制性肺膨胀.观察两组在20、40、60cmH2O（1 cmH2O=0.098 kPa）肺复张压力下血流动力学和死腔比例（VD/VT）的差异.结果 ①血流动力学参数变化：随着肺复张压力增高,对照组心率（HR）逐渐加快,60 cmH2O明显高于20 cmH2O时（次/min：192.65±22.99比178.20±18.25,P＜0.05）;平均动脉压（MAP）逐渐降低,60 cmH2O时明显低于20 cmH2O和40 cmH2O时[mmHg（1 mmHg=0.133 kPa）：78.55±25.77比112.40±10.84、106.15±13.54,均P＜0.01];心排血量（CO）逐渐降低,20、40、60 cmH2O复张压力间两两比较差异均有统计学意义（L/min：11.14±2.65、9.56±2.17、6.01±1.39,P＜0.05或P＜0.01）.随着肺复张压力增高,分肺组HR、MAP和CO无明显改变;60 cmH2O复张压力下HR较对照组明显降低（次/min：178.20±18.26比192.65±22.99,P＜0.05）,MAP和CO则明显增高[MAP（mmHg）：110.80±11.60比78.55±25.77,CO（L/min）：9.68±2.08比6.01±1.39,均P＜0.01].②VD/VT变化：随着肺复张压力的增高,对照组氧合指数（PaO2/FiO2）逐渐降低,60 cmH2O时明显低于20 cmH2O和40 cmH2O时（mmHg：126.40±37.55比187.40±21.66、175.20±23.00,均P＜0.01）;右侧VD/VT逐渐增高,20、40、60 cmH2O复张压力间两两比较差异有统计学意义（0.52±0.12、0.60±0.15、0.72±0.12,P＜0.05或P＜0.01）,左侧VD/VT无明显变化.随着肺复张压力增高,分肺组PaO2/FiO2逐渐升高,40 cmH2O、60 cmH2O时明显高于20 cmH2O时�Objective To compare unilateral lung and traditional lung recruitment maneuver （RM） in animals with unilateral acute respiratory distress syndrome （ARDS） by implementing independent lung ventilation,and to explore the rational mechanical ventilation strategy for unilateral lung lesions.Methods Healthy hybrid pigs were used as experimental animals,and they were divided into two groups according to random number table method （sealed concealed envelope）.There were 20 pigs in each group.According to different methods of lung RM,the conventional mechanical ventilation （i.e.implementing ventilation for both lung by using a ventilator） was performed as control group; the individual lung ventilation （that was,implementing ventilation for both lung individually by using two ventilators） as independent lung ventilation group.The model of left lung ARDS was reproduced,and the respective RM was implemented according to respective method of the two groups.The differences in hemodynamic parameters and dead space ratio （VD/VT） between two groups under the RM pressure of 20,40,60 cmH2O （1 cmH2O=0.098 kPa） were observed.Results ① Hemodynamics parameters changes：with the increase in RM pressure,the heart rate （HR） incontrol group showed a tendency of gradual increase,and the level at 60 cmH2O was significantly higher than that at 20 cmH2O （bpm：192.65 ± 22.99 vs.178.20 ± 18.25,P〈0.05）.Mean arterial pressure （MAP） showed a tendency of gradual decrease,and that at 60 cmH2O was lower significantly than that at 20 cmH2O and 40 cmH2O [mmHg （1 mmHg=0.133 kPa）：78.55 ±25.77 vs.112.40± 10.84,106.15 ± 13.54,both P〈0.01].Cardiac output （CO） gradually lowered,and the differences at 20,40,60 cmH2O were logistically significant （L/min：11.14 ± 2.65,9.56 ± 2.17,6.01 ± 1.39,P〈0.05 or P〈0.01）.With an increase in RM pressure,the difference in HR,MAP,CO in independent lung ventilation group were not significant,and the HR at 60 cmH2O was significantly lower than that of the

关 键 词：单肺复张 分侧肺机械通气 血流动力学 死腔比例 

分 类 号：R563.8[医药卫生—呼吸系统]