正常分钟通气量机械通气不同潮气量和频率影响活体山羊颈动脉血氧动态变化的初步实验研究  

Preliminary experimental study on the influence of different tidal volume and frequency of normal minute ventilation on the dynamic changes of carotid blood oxygen in living goats

作　　者：王桂芝 孙兴国[1,2] 陈荣声[3] 杨希营[2] 赵晓勇 于剑锋[2] 张蕊 冀玉萍[2,4] 李军[2,4] 李浩 张也[1] 马铭欣 陈荣[1] 邹昱馨 WANG Gui-zhi;SUN Xing-guo;CHEN Rong-sheng;YANG Xi-ying;ZHAO Xiao-yong;YU Jian-feng;ZHANG Rui;JI Yu-ping;LI Jun;LI Hao;ZHANG Ye;MA Ming-xin;CHEN Rong;ZOU Yu-xin(Fuwai Hospital,Chinese Academy of Medical Sciences/National Center for Cardiovascular Diseases/State Key Laboratory of Cardiovascular Diseases/Chinese Academy of Medical Sciences/Peking Union Medical College,Beijing 100037,China;Weifang Medical University,Weifang 261053,China;Oxford University,Oxford OX12JD,UK;Weifang Hospital of traditional Chinese Medicine,Weifang 261041,China;Dalian Children’s Hospital,Dalian 116000,China;Liaocheng People’s Hospital,Liaocheng 252000,China)

机构地区：[1]国家心血管病中心中国医学科学院阜外医院心血管疾病国家重点实验室国家心血管疾病临床医学研究中心,北京协和医学院,中国北京100037 [2]潍坊医学院,中国山东潍坊261053 [3]牛津大学,英国牛津OX12JD [4]潍坊市中医院,中国山东潍坊261041 [5]辽宁省大连儿童医院,大连116000,中国 [6]山东省聊城市立医院儿童医院,聊城252000

出　　处：《中国应用生理学杂志》2021年第1期45-50,共6页Chinese Journal of Applied Physiology

基　　金：国家高技术研究发展计划(863计划)课题资助项目(2012AA021009);国家自然科学基金医学科学部面上项目(81470204);中国康复医疗机构联合重大项目基金(20160102);中国医学科学院国家心血管病中心阜外医院科研开发启动基金(2012-YJR02);首都临床特色应用研究与成果推广(Z161100000516127);北京康复医院2019-2021科技发展专项(2019-003);北京协和医学院教学改革项目(2018E-JG07);北京协和医学院-国家外国专家局外国专家项目(2015,2016,T2017025,T2018046,G2019001660);重庆市卫计委医学科研计划项目(2017MSXM090);重庆市科委社会事业与民生保障科技创新专项项目(cstc2017shmsA130063)。

摘　　要：目的:在初步验证超快反应聚合物基质光纤氧传感器及其测定系统记录颈动脉氧分压(PaO_(2))连续动态变化使用基础上,为了分析探讨肺通气对PaO_(2)连续动态变化的影响,我们设计本活体整体动物实验观察研究。方法:选择杂种山羊4只,全身麻醉气管插管空气机械通气下,切皮直接暴露把后接测定系统的氧传感器直接插入左侧颈动脉连续记录PaO_(2)动态变化。正常分钟通气量机械通气分别通过三种潮气量实施:正常潮气量(潮气量V_(T)=15 ml/kg、呼吸频率Rf=20 bpm)、减半潮气量(V_(T)减半、Rf加倍)和加倍潮气量(V_(T)加倍、Rf减半)。三种潮气量通气时间分别稳定10~15 min,选取后180 s分析计算PaO_(2)平均值、呼吸间PaO_(2)变化的升降幅度和肺-颈动脉延迟时间。以ANOVA及两两比较统计学差异分析不同潮气量的影响。结果:活体山羊正常通气量机械通气实验时心率和血压均稳定;肺-颈动脉延迟时间为1.4~1.8 s(约为此时的3次心跳)。机械通气正常潮气量下PaO_(2)平均值在(102.94±2.40,99.38~106.16)mmHg,升降幅度是(21.43±1.65,19.21~23.59)mmHg,占平均值的(20.80±1.34,18.65~22.22)%;减半潮气量下,PaO_(2)平均值维持在(101.01±4.25,94.09~105.66)mmHg,虽略降但不显著(与正常机械通气比较P>0.05),但PaO_(2)升降变化幅度却显著降低为(18.14±1.43,16.46~20.05)mmHg,占平均值的(17.95±1.07,16.16~18.98)%(与正常机械通气比较P<0.01);加倍潮气量机械通气下,虽仅略升的PaO_(2)平均值维持在(106.42±4.74,101.19~114.08)mmHg(与正常机械通气比较P>0.05,与减半潮气量机械通气比较P<0.05),但PaO_(2)升降幅度却显著增大为(26.58±1.88,23.46~28.46)mmHg,占平均值的24.99%±1.58%(与正常机械通气和减半潮气量比较P均<0.01)。结论:正常肺通气的吸气和呼气是颈动脉PaO_(2)上升和下降的始动因素。正常通气量机械通气下减半潮气量和倍增潮气量显著改变PaO_(2)升降幅度,但PaO_(Objective:On the basis of preliminarily verifying the use of ultra-fast reaction polymer matrix optical fiber oxygen sensor and its measuring system to record the continuous and dynamic changes of carotid artery oxygen partial pressure(PaO_(2)),in order to analyze and discuss the influence of lung ventilation on the continuous and dynamic changes of PaO_(2),we designed a whole animal experimental study in vivo.Methods:Four hybrid goats were selected,and the skin was cut and exposed directly under general anesthesia and tracheal intubation.The oxygen sensor,connected with the measuring system,was inserted directly into the left carotid artery to continuously record the dynamic changes of PaO_(2).With normal minute ventilation,mechanical ventilation is implemented through three tidal volumes:normal tidal volume(V_(T)=15 ml/kg,Rf=20 bpm),half tidal volume(halved V_(T),doubled Rf)and double tidal volume(doubled V_(T),halved Rf).Each tidal volume was stable for 10~15 min respectively.We analyzed and calculated the average values of PaO_(2),the fluctuation magnitudes of PaO_(2) changes between breaths of last 180 s and the delay times of lung-carotid artery were.We analyzed the effects of different tidal volumes.Results:The heart rate and blood pressure of living goats were maintained stable during the mechanical ventilation experiment with normal ventilation volume Lung-carotid artery delay time is 1.4~1.8 s(about 3 heartbeats at this time).Under normal tidal volume of mechanical ventilation,the average value of PaO_(2) was(102.94±2.40,99.38~106.16)mmHg,and the fluctuation range was(21.43±1.65,19.21~23.59)mmHg,accounting for(20.80±1.34,18.65~22.22)%of the average value.Under the condition of halving tidal volume,the average value of PaO_(2) was maintained at(101.01±4.25,94.09~105.66)mmHg,which was slightly decreased but not significant(P>0.05 compared with normal mechanical ventilation),but the fluctuation range of PaO_(2) was significantly reduced to(18.14±1.43,16.46~20.05)mmHg,accounting for 17.5%of the average

关 键 词：超快反应聚合物光纤氧传感器 整体整合生理学医学 活体整体山羊 颈动脉血管内氧分压测定 潮气量 动脉血氧分压波动幅度 动脉血氧分压平均值 肺-颈动脉时间延迟 呼吸调节控制信号 

分 类 号：R332[医药卫生—人体生理学]