膈肌起搏联合机械通气对兔油酸型急性呼吸窘迫综合征呼吸力学影响  

Effect of diaphragm pace-making combined with mechanical ventilation on mechanics of breathing of oleic acid acute respiratory destress syndrome

作　　者：卢仲谦 邓义军 LU Zhongqian DENG Yijun(Intensive Care Unit, the First People＇s Hospital of Yancheng, Jiangsu 224001)

机构地区：[1]盐城市第一人民医院重症医学科,江苏224001

出　　处：《交通医学》2017年第3期212-215,共4页Medical Journal of Communications

基　　金：江苏省自然科学基金资助项目(BK2008201)

摘　　要：目的:观察膈肌起搏联合机械通气对兔油酸型急性呼吸窘迫综合征(ARDS)呼吸力学影响。方法:取健康成年家兔20只,耳缘静脉注射油酸制备兔ARDS模型,行气管切开机械通气,采用自身前后对照,对照组为单纯机械通气组,实验组为膈肌起搏联合机械通气,观察两组呼吸力学变化。结果:与对照组比较,实验组平均气道压(m Paw,cm H2O)、平台压(Pplat,cm H2O)明显降低(m Paw7.5±1.5比6.3±1.2;Pplat13.0±2.4比10.9±1.9),差异均有统计学意义(P<0.05);峰食道压力(PPEAK ES,cm H2O)、峰食道压力与基准食道压力差(d PES,cm H2O)负值明显增加(PPEAK ES-3.0±1.3比-7.8±1.6;d PES-7.9±2.0比-10.3±2.2),差异均有统计学意义(P<0.05);吸气末屏气期间的跨肺压(PL-ins,cm H2O)、呼吸系统静态顺应性(Cst,m L/cm H2O)明显增加(PL-ins14.8±2.3比20.1±2.9;Cst:44±6.2比49.9±7.0),差异均有统计学意义(P<0.05);气道阻力(Raw)、肺部阻力(RL)无明显改变(Raw3.5±0.4比3.3±0.3;RL:4.1±0.6比4.0±0.5,均P>0.05),患者呼吸功(WOBp,J/L)明显增加,机械呼吸功(WOBv,J/L)明显降低(WOBp 0.09±0.01比0.18±0.03;WOBv0.46±0.12比0.35±0.08),差异均有统计学意义(P<0.05)。结论:正压机械通气与膈肌起搏联合通气进行呼吸支持可以明显降低气道压力,明显增加胸腔内压负值和跨肺压,降低机械通气做功。Objective：To observe the effect of diaphragm pace-making combined with mechanical ventilation on mechanics of breathing of oleic acid acute respiratory destress syndrome. Methods： 20 healthy adult rabbits wree selected as experimental animals, male and female, weighing 1.5～2.5kg, and those rabbits were fed steadily for 1 week, fasting 12 h before the experiment, ear vein injections of oleic acid were prepared for rabbit ARDS model, tracheotomy mechanical ventilation, the use of self controlled method, namely the control group was simply mechanical ventilation group, and the experimental group was the diaphragm pacing joint mechanical ventilation group. The change in mechanics of breathing between two groups was observed. Results：Compared with the control group, the mean airway pressure（m Paw, cm H2O） and the plateau pressure（Pplat, cm H2O） were significantly decreased in the experimental group（m Paw 7.5±1.5 vs 6.3±1.2; Pplat13.0±2.4vs10.9±1.9, both P〈0.05）, while the nagative value of the peak esophageal pressure（PPEAK ES, cm H2O）, the nagative value of the difference between the peak and the basic esophageal pressures（d PES, cm H2O）, the transpulmonary pressure at the end of inspiration hold（PL-ins, cm H2O）, and the static compliance（Cst, ml/cm H2O） were significantly increased in the experimental group（PPEAK ES-3.0±1.3 vs-7.8±1.6; d PES-7.9±2.0 vs-10.3±2.2; PL-ins14.8±2.3 vs 20.1±2.9; Cst： 44±6.2 vs49.9 ±7.0, all P〈0.05）. No differences were found in airway resistance（Raw, cm H2O·L-1·s-1） and lung resistance（RL,cm H2O·L-1·s-1） between the experimental group and the control group（Raw3.5 ±0.4 vs 3.3±0.3; RL： 4.1±0.6 vs 4.0±0.5both P〈0.05）. The work of breath by patient（WOBp, J/L） was significantly increased and the work of breath by ventilator（WOBv, J/L） was significantly decreased in the experimental group compared with the control group（WOB p： 0.09±0.01 vs0.18±0.03; WOBv： 0.46±0.12 vs 0.35±0.08, both P〈0.05）.

关 键 词：油酸 兔 急性呼吸窘迫综合征 正压机械通气 膈肌起搏 呼吸力学 

分 类 号：R563.8[医药卫生—呼吸系统]