机械通气对改良腹腔高压液体动物模型腹腔压力-容量关系的影响  

Effect of mechanical ventilation on pressure-volume relationship of abdominal cavity in a modified abdominal hypertension liquid animal model

作　　者：王宏业[1] 尉继伟[1] 张庆明[2] Wang Hongye;Yu Jiwei;Zhang Qingming(Department of Tumor Surgery,Datong 037005,China;Department of Anesthesiology,the Affiliated Hospital of Shanxi Datong University,Datong 037005,China)

机构地区：[1]大同大学附属医院肿瘤科,037005 [2]大同大学附属医院麻醉科,037005

出　　处：《中华诊断学电子杂志》2019年第1期42-47,共6页Chinese Journal of Diagnostics(Electronic Edition)

基　　金：山西省重点研发计划(指南)项目(201603D321054);山西大同科技攻关项目(201497)

摘　　要：目的探讨机械通气对腹腔高压液体动物模型腹腔压力-容量关系的影响。方法以12只实验猪为研究对象,采用随机数字表法随机分为A组(机械通气组)和B组(非机械通气组),各6只。两组均采用全身麻醉,A组行气管插管后接机械通气,模式为容量控制通气(VCV),设定潮气量(VT) 10 ml/kg,呼吸频率16次/min,吸入氧浓度(Fi O_2) 0. 40,高呼气末正压通气(PEEP) 5 cm H_2O(1 cm H_2O=0. 098 k Pa)。按照水囊法制作腹腔高压液体动物模型,每注入生理盐水10 ml,测压1次,记录腹腔内注入总液体量,同步记录腹腔压力(IAP),绘制腹腔压力-增容量曲线,并在IAP为0,10,20,30,40,50 cm H_2O时(0是指腹腔压力升高的0界点)记录注液量。腹内压维持在35 cm H_2O,观察4 h后处死实验动物,切取心脏、肺脏,用10%甲醛溶液固定24 h后常规石蜡包埋,切片,苏木精-伊红(HE)染色,生物光学显微镜下观察。结果 12只家猪均制模成功,无一发生气压伤和死亡。A组腹腔压力-增容量曲线为不规则的"S"形双函数曲线,IAP在22 cm H_2O为节点,IAP<22 cm H_2O,IAP与增容量存在线性相关关系(r^2=0. 78,P <0. 05),IAP> 22 cm H_2O,IAP与增容量存在线性相关关系(r^2=0. 96,P <0. 01); B组腹腔压力-增容量曲线为单函数曲线,IAP与增容量存在正相关关系(r^2=0. 87,P <0. 01)。A组在IAP为0,10,20,30,40,50 cm H_2O时注液量[(2 018. 22±108. 66) ml,(2 032. 60±114. 42) ml,(2 038. 54±112. 60) ml,(2 080. 88±118. 44) ml,(2 162. 38±118. 86) ml,(2 310. 78±124. 20) ml]均低于B组[(2 890. 40±164. 50) ml,(3 000. 58±176. 22) ml,(3 060. 24±178. 24),(3 098. 50±183. 40) ml,(3 120. 00±184. 20) ml,(3 145. 80±188. 60) ml],均差异有统计学意义(t=4. 42,4. 61,4. 85,4. 66,4. 37,5. 35;均P <0. 01)。心脏标本病理检查:A组心脏心肌纤维玻璃样变性,横纹明显减少,部分心肌纤维萎缩; B组心脏心肌纤维部分萎缩,部分肥大,心肌纤维玻璃样变性,心肌间动脉扩张充血。肺脏病理检查:A组Objective To explore the effect of mechanical ventilation on the pressure-volume relationship of abdominal cavity via making an improved abdominal hypertension liquid animal model by means of water bag superposition pressurization.Methods 12 experimental pigs were randomly divided into group A(mechanical ventilation group)and group B(non mechanical ventilation group),6 pigs in each group.Both groups were anesthetized under general anesthesia.In group A,ventilator was used to assist breathing after tracheal intubation.The breathing mode was volume controlled ventilation(VCV),tidal volume(VT)10 ml/kg,breathing rate 16 times/min,inhaled oxygen concentration(FiO2)0.40,positive end expiratory pressure(PEEP)5 cm H2O(1 cmH 2O=0.098 kPa).The abdominal hypertensive fluid models of group A and group B were made according to the operation procedure of the abdominal hypertensive fluid model made by the water sac method,the abdominal hypertensive fluid models of group A and group B were injected with normal saline through the drainage pipe of the drainage bag,the abdominal pressure was measured once every 10 ml,the total fluid volume was recorded,the abdominal pressure was recorded synchronously,and the abdominal pressure increase curve was drawn.The volume of fluid injection was recorded when the abdominal pressure was 0,10,20,30,40,50 cm H 2O(0 refers to the zero point of abdominal pressure rise).The intraabdominal pressure was maintained at 35 cm H2O(25.74 mmHg).After 4 hours of observation,the experimental animals were killed,the hearts and lungs were harvested and fixed with 10%formaldehyde solution for 24 hours.The samples were embedded in paraffin and stained with HE.Results All 12 pigs were successfully moulded without barometric injury or death.In group A,the abdominal pressure-volume increase curve was an irregular“S”hyperfunction curve.The turning point of abdominal pressure 22 cm H2O,there was a positive correlation between the abdominal pressure and volume increase when the abdominal pressure was less than 22

关 键 词：机械通气 腹腔高压 动物模型 水囊 压力-容积曲线 

分 类 号：R442.8[医药卫生—诊断学] R-332[医药卫生—临床医学]