不同机械通气水平对急性呼吸窘迫综合征右心功能影响的动物实验研究  

An experimental study on the effect of different mechanical ventilation levels on right ventricular function in acute respiratory distress syndrome animals

作　　者：王子丹 李荣[2] 李俊芳[2] 刘伟刚[2] 孙冬梅[2] 邢燕[1] 王士忠[3] 袁莉[4] 单亮[1] Wang Zidan;Li Rong;Li Junfang;Liu Weigang;Sun Dongmei;Xing Yan;Wang Shizhong;Yuan Li;Shan Liang(Intensive Care Unit,the Affiliated Hospital of Qingdao University,Qingdao 266061,China;Department of Echocardiography,the Affiliated Hospital of Qingdao University,Qingdao 266555,China;Intensive Care Unit of Cardiac Surgery,the Affiliated Hospital of Qingdao University,Qingdao 266003,China;Anesthesiology Department,the Affiliated Hospital of Qingdao University,Qingdao 266061,China)

机构地区：[1]青岛大学附属医院重症医学科,266061 [2]青岛大学附属医院心脏超声科,266555 [3]青岛大学附属医院心脏外科重症监护室,266003 [4]青岛大学附属医院麻醉科,266061

出　　处：《中华急诊医学杂志》2020年第3期365-372,共8页Chinese Journal of Emergency Medicine

基　　金：青岛市博士后应用研究项目(80101220066)。

摘　　要：目的通过建立比格犬急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)动物模型,施加不同水平机械通气,探讨ARDS机械通气时呼吸力学与右心功能变化关系,为ARDS右心保护通气策略提供理论依据。方法以比格犬为实验对象(n=6),麻醉成功后置入肺动脉漂浮导管、食管测压管及股动脉导管。压力控制模式下固定驱动压,调整呼气末正压(PEEP)由2 cmH2O逐步上升至14 cmH2O,观察在此过程中呼吸力学、血流动力学和右心功能指标的变化。通过中心静脉注射油酸建立比格犬ARDS模型,成功造模后均予以相同参数的机械通气。以自身为对照,分析造模前后实验犬的呼吸力学、血流动力学和右心功能指标的变化。造模前后不同PEEP各项指标比较采用方差分析,事后Student-Newman-Keuls比较,组间t检验比较,以P<0.05为差异有统计学意义。结果造模前在PEEP递增时气道峰压(Ppeak)、平台压(Pplat)增大(F值分别为232.733、196.33),吸气末跨肺压(Ptrans-I)、呼气末跨肺压(Ptrans-E)、肺静态顺应性(Cstat)、潮气量(Vt)变小(F值分别为4.524、6.499、64.803、2.31),右心室变化面积(FAC)变小(F值为3.09);每搏输出量(SV)先增大后减小(F值为3.24),中心静脉压(CVP)、平均肺动脉压(MPAP)变大(F值分别为19.07、14.81),差异有统计学意义(P<0.05);三尖瓣收缩期位移(TAPSE)、平均动脉压(MAP)、心率(HR)、指脉血氧饱和度(SpO2)差异无统计学意义(P>0.05)。造模后在PEEP递增时Ppeak、Pplat、PES-I、PES-E增加(F值分别为24.829、41.95、9.78、87.86),Vt、Ptrans-I、Ptrans-E、Cstat先增大后减小(F值分别为2.91、4.29、5.84、48.890),TAPSE、SV先增大后减小(F值分别为6.22、6.54),CVP、MPAP递增(F值分别为5.23、19.24),MAP先变大后变小(F值为5.02),SpO2变大(F值为2.77),差异有统计学意义(P<0.05);FAC、HR差异无统计学意义(P>0.05)。结论跨肺压及肺顺应性更好体现ARDS肺复张有效性,具有良好�Objective To explore the relationship between respiratory mechanics and right heart function during ARDS mechanical ventilation through the establishment of Beagle dogs acute respiratory distress syndrome(ARDS)animal model and the application of different levels of mechanical ventilation,which will provide theoretical basis for right heart protective ventilation strategy of ARDS.Methods Beagle dogs were anesthetized successfully and then pulmonary artery floating catheter,esophageal manometric catheter and femoral artery catheter were inserted.Under the pressure control mode,the driving pressure was fixed.After adjustment,PEEP gradually increased from 2 cmH2O to 14 cmH2O.The changes of respiratory mechanics,hemodynamics and right heart function were observed.ARDS model was established by injecting oleic acid into central vein,and mechanical ventilation with the same parameters was given after the model was established successfully.In contrast to itself,the changes of respiratory mechanics,hemodynamics and right heart function indexes of experimental dogs before and after modeling were analyzed.In the group,the indexes of different PEEP were compared by ANOVA,and then compared by Student-Newman-Keuls.The difference was statistically significant at a P value<0.05.Results Before modeling,the peak airway pressure(Ppeak)and plateau pressure(Pplat)increased with the increase of PEEP(F=232.733,196.33,P<0.05).However,Ptrans-I,Ptrans-E,Cstat and Vt decreased significantly(F=4.524,6.499,64.803,2.31,P<0.05).The area of change of right ventricle(FAC)became smaller(F=3.09,P<0.05);SV first increased and then decreased(F=3.24,P<0.05),and CVP and MPAP increased(F=19.07,14.81,P<0.05).There was no significant difference in TAPSE,MAP,HR and SpO2(P>0.05).After modeling,as PEEP increased,Ppeak,Pplat,PES-I and PES-E increased significantly(F=24.829,41.95,9.78,87.86,P<0.05).Vt,Ptrans-I,Ptrans-E,Cstat and Vt first increased and then decreased(F=2.91,4.29,5.84,48.890,P<0.05).TAPSE and SV first increased and then decreased(F=6.22,6.54,P<0

关 键 词：急性呼吸窘迫综合征 右心室 肺动脉高压 跨肺压 肺顺应性 比格犬 

分 类 号：R563.8[医药卫生—呼吸系统]