常频叠加高频振荡通气对肺损伤大鼠氧合及通气的影响  

Effects of conventional mechanical ventilation plus high frequency oscillatory ventilation on ventilation and oxygenation in experimental acute lung injury in rats

作　　者：李红日[1] 张琪[1] 孙春荣[2] 崔小岱[2] 郭静[1] 宋国维[1] 

机构地区：[1]首都儿科研究所附属儿童医院急诊科,北京100020 [2]首都儿科研究所临床中心实验室

出　　处：《中华临床医师杂志（电子版）》2014年第17期72-75,共4页Chinese Journal of Clinicians(Electronic Edition)

基　　金：北京市自然科学基金(7102022)

摘　　要：目的观察常频叠加高频振荡通气对急性肺损伤大鼠氧合和通气的影响。方法以15只Wistar大鼠为实验对象,给予机械通气,用生理盐水肺灌洗制作急性肺损伤大鼠模型,先后行常频机械通气(CMV参数:FiO2 100%、f 30 bpm、PEEP 6 cmH2O、I∶E 1∶2、MAP 12 cmH2O)、高频振荡通气(HFOV参数:FiO2 100%、f 11 Hz、Paw 12 cmH2O、Ti 33%)、常频叠加高频振荡通气(CMV+HFOV参数同前)各1 h,监测动脉血气。计算PaO2/FiO2、氧合指数(OI)、肺内血分流率(Qs/Qt)。结果损伤前、CMV、HFOV、CMV+HFOV各指标变化:(1)PaCO2分别为(41.04±3.94)mmHg、(100.5±28.73)mmHg、(82.06±22.87)mmHg及(54.01±19.32)mmHg,损伤后均显著高于损伤前(P<0.01);CMV+HFOV显著低于CMV、HFOV(P<0.01);CMV、HFOV两者差异无统计学意义(P>0.05)。(2)PaO2/FiO2分别为(467.9±47.71)mmHg、(105.3±25.39)mmHg、(131.2±67.72)mmHg、(216.3±76.84)mmHg,损伤后均显著低于损伤前(P<0.01);CMV+HFOV显著高于CMV、HFOV(P<0.01);CMV、HFOV两者差异无统计学意义(P>0.05)。(3)OI分别为1.88±0.30、8.84±2.15、6.16±3.19、4.60±1.71,损伤后均显著高于损伤前(P<0.01);CMV+HFOV、HFOV显著低于CMV(P<0.01);CMV+HFOV、HFOV两者差异无统计学意义(P>0.05)。(4)Qs/Qt分别为0.11±0.02、0.29±0.02、0.26±0.05及0.24±0.04,损伤后显著高于损伤前(P<0.01);各通气模式差异无统计学意义(P>0.05)。结论常频叠加高频振荡通气在促进肺损伤大鼠CO2排出及改善氧合方面优于单纯常频通气和单纯高频通气。Objective To investigate the effects of conventional mechanical ventilation plus high-frequency oscillatory ventilation on ventilation and oxygenation in experimental acute lung injury in rats.Methods Fifteen Wistar rats were used, ALI model was induced in rats by lung lavage with normal saline. Conventional mechanical ventilation （CMV： FiO2 100%, f 30 pbm, PEEP 6 cmH2O, I∶E 1∶2, MAP 12 cmH2O）, high frequency oscillatory ventilation （HFOV： FiO2 100%, f 11 Hz, Paw 12 cmH2O, Ti 33%） and conventional mechanical ventilation plus high frequency oscillatory ventilation were applied for 1 hour respectively. Arterial blood gases were recorded, PaO2/FiO2, OI and Qs/Qt were calculated. Results During CMV, HFOV and CMV plus HFOV, PaCO2 were （100.5±28.73）mmHg, （82.06±22.87） mmHg and （54.01±19.32）mmHg respectively, PaCO2 was significantly decreased during CMV plus HFOV than CMV and HFOV（P〈0.01）, there was no significant difference between CMV and HFOV. PaO2/FiO2 were （105.3±25.39） mmHg, （131.2±67.72）mmHg and （216.3±76.84）mmHg respectively, PaO2/FiO2 was significantly higher during CMV plus HFOV than CMV and HFOV（P〈0.01）, there was no significant difference between CMV and HFOV（P〉0.05）. OI were 8.84±2.15, 6.16±3.19 and 4.60±1.71 respectively, OI were significantly decreased during CMV plus HFOV and HFOV than CMV（P〈0.01）, there was no significant difference between CMV plus HFOV and HFOV（P〉0.05）. Qs/Qt were 0.29±0.02, 0.26±0.05 and 0.24±0.04 respectively, there was no significant difference among CMV, HFOV and CMV plus HFOV （P〉0.05）. Conclusion CMV plus HFOV can improve oxygenation and remove CO2 rapidly than CMV and HFOV only.

关 键 词：急性肺损伤 常频机械通气 高频振荡通气 氧合 

分 类 号：R563.8[医药卫生—呼吸系统]