两种肺复张法对重度烟雾吸入性损伤犬相关指标的影响  

Effects of two kinds of lung recruitment maneuvers on the correlated indexes of dogs with severe smoke inhalation injury

作　　者：廖新成[1] 郭光华[1] 朱峰[2] 王年云[1] 付忠华[1] 刘名倬[1] 

机构地区：[1]南昌大学第一附属医院烧伤科,330106 [2]南昌大学第一附属医院重症医学科,330106

出　　处：《中华烧伤杂志》2014年第4期299-304,共6页Chinese Journal of Burns

基　　金：国家自然科学基金（30960400）;高等学校博十学科点专项科研綦金（20093601110005）;江阿省科技支撑计划（2010BSA10300）

摘　　要：目的观察比较控制性肺膨胀（SI）和呼气末正压（PEEP）递增法（IP）这2种肿复张方法对重度烟雾吸入性损伤犬氧合、呼吸以及血流动力学的影响，方法将12只常规机械通气后全制成重度烟雾吸入性损伤模型，按随机数7表法分为SI组和IP组，每组6只-SI组全改行持续气道正压通气，吸气压力25cmH2O（1cmH2O=0．098 kPa），持续20s；IP组逐步升高PEEP水平，每隔5min增加5cmH2O直至25cmH2O，后每隔5min降低5cmH2O直至2～3cmH2O随后2组全均改行分组前通气模式，持续通气8h。于伤前、致伤后即刻及分组后治疗2、4、6、8h测定2组犬血分析指标pH值、PaO2、PaCO2并计算氧合指数（01），记录呼吸力学参数吸气峰压（PIP）、平均气道压、动态肺应性以及血流动力学参数心率、平均动脉压（MAP）、肺动脉压（PAP）、心排血压（CO）。对数据行重复测量差分析和LSD-t检验，结果（1）治疗6、8h，SI组犬pH值显著低于IP组（t值分别为2．431、2．261，P值均小于0．05）；PaO2分别为（87±24）、（78±14）mmHg（1mmHg=0．133kPa），均明显低于IP组的（114±18）、（111±17）mmHg（t值分别为2．249、3．671，P＜0．05或P＜0．01）；01显著高于IP组（t值分别为2．363、5．010，P＜0．05或P＜0．01）。组间及组内PaCO2水平比较，均未见明显差异（t值为0．119～1．042，P值均大于0．05）。与组内致伤后即刻比较，2组犬各治疗时相点pH值均显著降低（IP组治疗6、8h除外，t值为2．292～3．222，P＜0．05或P＜0．01），PaO2均显著升高（t值为4．443～6．315，P＜0．05或P＜0．01），明显著降低（t值为2．773～9．789，P＜0．05或P＜0．01）。（2）2组犬各时相点PIP水平接近（t值为0．399～1．167，P值均大于0．05）。SI组治疗4、8h时平均气道压显著高于IP组（t值分别为1．926、1．190，P值均小于0．05）；治疗4、6、8h时动态肺顺应性分别�Objective To observe and compare the effects of two kinds of lung recruitment maneuvers,namely sustained inflation （SI） and incremental positive end-expiratory pressure （PEEP） （IP） on oxygenation,respiratory mechanics,and hemodynamics of dogs with severe smoke inhalation injury.Methods After being treated with conventional mechanical ventilation,12 dogs were inflicted with severe smoke inhalation injury.They were divided into group SI and group IP according to the random number table,with 6 dogs in each group.Dogs in group SI were subjected to continuous positive airway pressure ventilation,with inspiratory pressure of 25 cmH2O （1 cmH2O =0.098 kPa）,and it was sustained for 20 s.PEEP level in group IP was gradually increased by 5 cmH2O every 5 min up to 25 cmH2O,and then it was decreased by 5 cmH2O every 5 min until reaching 2-3 cmH2O.Then the previous ventilation mode was resumed in both groups for 8 hours.Blood gas analysis （pH value,PaO2,and PaCO2）,oxygenation index （OI）,respiratory mechanics parameters [peak inspiratory pressure （PIP）,mean airway pressure,and dynamic lung compliance],and hemodynamic parameters [heart rate,mean arterial pressure （MAP）,pulmonary arterial pressure （PAP）,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 6 and 8,pH values of dogs in group SI were significantly lower than those in group IP （with t values respectively 2.431 and 2.261,P values below0.05）; PaO2 levels in group SI [（87 ±24）,（78 ± 14） mmHg,1 mmHg=0.133 kPa] were lower than those in group IP [（114 ± 18）,（111 ± 17） mmHg,with t values respectively 2.249 and 3.671,P 〈 0.05 or P 〈 0.01] ; OI values in group SI were significantly higher than those in group IP （with t values respectively 2.363 and 5.010,P 〈 0.05 or P 〈 0.01）.No significant differences were obs

关 键 词：烧伤 吸入性 正压呼吸 呼吸力学 血流动力学 肺复张 氧合 

分 类 号：R563.8[医药卫生—呼吸系统]