四种通气模式对烟雾吸入伤犬早期氧供求平衡影响的比较  

Effect of four mechanical ventilation modes on oxygen supply and consumption in early stage after severe smoke inhalation injury in dogs.

作　　者：陶国才[1] 杨宗城[2] 刘志远[2] 傅琼芳[2] 何保斌[2] 魏钜菊[2] 黎鳌[2] 

机构地区：[1]第三军医大学西南医院麻醉科,重庆400038 [2]第三军医大学西南医院全军烧伤研究所,重庆400038

出　　处：《重庆医学》2002年第10期913-916,共4页Chongqing medicine

基　　金：全军"九五"指令性课题 (96L0 4 3)

摘　　要：目的　观察比较四种通气模式对严重烟雾吸入伤犬早期氧供求平衡的影响。方法　 35只犬分为PEEP组、PC组、CPAP组、IRV组和对照组。伤后 1h开始连续 2 4h机械通气。FiO2 =0 .4 ,PIP =1 6kPa,PEEP CPAP =0 6kPa,除IRV组I∶E =2∶1外 ,其他通气组I∶E =1∶2。结果　伤后对照组CI呈进行性降低 ,而各机械通气组分别于伤后 6h或 12h降至最低点后呈回升趋势。伤后 3h始对照组PaO2 、SaO2 呈进行性降低。PEEP组和CPAP组PaO2 、SaO2 伤后 2 4h仍维持在 17.1kPa、97%以上 ,且显著高于对照组、PC组和IRV组。而PC组和IRV组PaO2 、SaO2 与对照组无显著差异。伤后 30min各组DO2 I降至最低值后有所回升。与此相反 ,VO2 I于伤后 30min达峰值后 ,呈不同程度降低。结论　本实验所采用的四种通气模式及参数于烟雾吸入伤早期持续 2 4h通气治疗在没有明显抑制CI的同时 ,可明显改善机体供氧能力 ,且不促使病理性VO2 DO2 依赖关系的发生。其中持续气道正压 (PEEP或CPAP)有益作用更为明显。Objective To observe and compare the effect of four mechanical ventilation modes on oxygen supply and consumption in early stage after severe smoke inhalation injury in dogs. Methods 35 healthy dogs were divided into 5 groups: PEEP,PC,CPAP,IRV, control(n=7 in each group). Continuous 24 hours mechanical ventilation were performed one hour after smoke inhalation injury .FiO 2=0.4,PIP=1 6kPa,PEEP/CPAP=0 6kPa, I∶E=2∶1 in IRV group,I∶E=1∶2 in other ventilation groups. Results CI progressive decreased in control group. Meanwhile CI decreased to the lowest point 6 hours or 12 hours after injury in four ventilation groups then showed increasing trend. PaO 2 and SaO 2 began to progressive decreased 3 hours after injury in control group. 24 hours after injury PaO 2 and SaO 2 in CPAP and PEEP groups still maintained above 17.1kPa and 97% separately, which markedly higher than that in PC,IRV and control groups. Meanwhile, PaO 2,SaO 2 in PC and IRV groups have no significant difference with that in control group. DO 2I decresed to the lowest point 30 minutes after injury, then increased back at different levels in all groups. Oppositely, VO 2I incresed to the highest point 30 minutes after injury then decreased at different levels in all groups. Conclusion Modes and parameters with which continuous 24 hours mechanical ventilation in this study had no significant effect to decrease CI and could increase the capacity of oxygen delivery markedly. Furthermore, it could not accelerate the developing of pathologic oxygen delivery consumption relationship. In which continuous positive airway pressure (PEEP or CPAP) have more beneficial effects.

关 键 词：烟雾吸入伤 影响 机械通气 氧供求平衡 动物实验 持续气道正压 烧伤 

分 类 号：R644[医药卫生—外科学] R605.973[医药卫生—临床医学]