监测肺顺应性联合潮气CO_2排除在ARDS家兔肺复张中的应用评价  

Evaluation of monitoring lung compliance combined with tidal elimination of CO_2 in lung recruitment in rabbits with acute respiratory distress syndrome

作　　者：田加坤[1] 孙键[1] 张群[1] 刘德新[1] TIAN Jia-kun SUN Jian ZHANG Qun et al.(The Second Hospital of J ilin Univer sity , Changchun 130041, China)

机构地区：[1]吉林大学第二医院急救医学科,吉林长春130041

出　　处：《中国实验诊断学》2016年第11期1840-1843,共4页Chinese Journal of Laboratory Diagnosis

基　　金：吉林省卫生厅课题(2009Z076)

摘　　要：目的 ARDS肺复张确定最佳PEEP,是临床工作中ARDS肺保护性通气的难点。我们通过对比最大氧合法与监测肺动态顺应性法联合潮气二氧化碳排除确定的最佳PEEP对ARDS家兔的复张影响,比较这两种选择最佳PEEP方法之间的优劣。方法气管内灌洗生理盐水建立ARDS家兔模型,PCV法肺复张后治疗组以动态顺应性联合潮气二氧化碳排除PEEP滴定法确定最佳PEEP,对照组采用最大氧合法确定最佳PEEP,监测呼吸力学及血流动力学指标。结果两组家兔肺复张后及复张后期滴定的PEEP治疗组明显低于对照组,差异有显著性(P<0.05);治疗组较对照组肺顺应性明显改善(P<0.05);治疗组肺复张后期PaCO2明显降低(P<0.05);对照组复张前后MAP及CVP变化明显(P<0.05),治疗组无明显变化;两组间肺复张后氧合指数无明显差异,肺湿重干重比(W/D)无明显差异。结论肺复张能够改善ARDS家兔的氧合水平,监测Cdyn联合VTCO2较最大氧合法获得PEEP值低,肺顺应性改善明显,对血流动力学影响小。Objective To evaluate the effect of two methods（maximal oxygenation and monitoring lung compliance combined with tidal elimination of CO2）of determining optimal PEEP to the lung recruitment of rabbits with ARDS.Methods Established saline-lavaged ARDS rabbits model and underwent pressure controlled ventilation.Rabbits were randomly divided into two groups,Treatment group：to determine the optimal PEEP by monitoring lung compliance combined with titration of tidal elimination of CO2.Control group：using maximal oxygenation to determine optimal PEEP.Respiratory mechanics and hemodynamics were recorded.Results Lung compliance and oxygenation index were significantly improved in the two groups after lung recruitment.PEEP in treatment group was lower than control group.Lung compliance in treatment group was improved significantly than control group.There was no significant difference on MAP,CVP,PaO2 and pulmonary dry-and-wet ratio between two groups.Conclusion Lung recruitment could significantly improve the oxygenation index and lung compliance in ARDS rabbits.Monitoring Cdyn and VTCO2 could reach lower PEEP and had small effect to hemodynamics.

关 键 词：ARDS 肺复张 PEEP 动态顺应性 潮气二氧化碳排除 

分 类 号：R563.8[医药卫生—呼吸系统]