高频喷射通气联合气管内吹气对急性肺损伤的治疗作用  

Therapeutic effects of high frequency jet ventilation combined with tracheal gas insufflation on acute lung injury

作　　者：程斌[1] 王瑞兰[1] 熊申生[1] 许建宁[1] 龚园其[1] 况九龙[2] 

机构地区：[1]江西医学院第二附属医院急诊科,江西南昌330006 [2]江西医学院第二附属医院呼吸科,江西南昌330006

出　　处：《中国急救医学》2004年第5期347-349,共3页Chinese Journal of Critical Care Medicine

基　　金：江西省卫生厅基金资助项目 (G0 10 60 5 )

摘　　要：目的　探讨高频喷射通气联合气管内吹气对急性肺损伤的治疗作用。方法　杂种犬 12条 ,随机分为两组 ,用大剂量生理盐水灌洗肺造成急性肺损伤。各组分别给予高频喷射通气 ,调整呼吸机参数使第一组实验犬PaCO2 维持在 35～ 5 0mmHg,第二组实验犬PaCO2 维持在 6 0～ 80mmHg。然后进行 4L/min和 8L/min氧气流量的气管内吹气 ,每阶段进行 30min ,观察血流动力学指标和血气指标的变化。结果　①联合通气后 ,两组PaCO2 及PetCO2 均明显下降 ,且随着吹入气氧流量的增加下降更明显。②联合通气后 ,动脉血氧分压在两组中明显上升 ,但随着吹入气氧流量的增加 ,动脉血氧分压变化无明显差异 (P >0 0 5 )。③联合通气后使各组气道压明显上升。④联合通气对各组犬血流动力学无显著影响 (P >0 0 5 )。结论　高频喷射通气联合气管内吹气能有效地降低肺损伤犬PaCO2 ,促进二氧化碳的排除 。Objective To determine the therapeutic effects of high frequency jet ventilation(HFJV)combined with tracheal gas insufflation(TGI)on acute lung injury.Methods 12 mongrel dogs were divided into two groups at random,and massive saline lavage caused lung injury.They were subjected to high frequency jet ventilation,the first group was let to normal carbonic acidemia(PaCO 2 were maintained between 35 and 50 mmHg),the second group was let to hypercapnia(PaCO 2 were maintained between 60 and 80 mmHg)by selecting ventilation settings.Tracheal gas was insufflated for 30 minutes at gas flow of 4 and 8 L/min.Hemodynamics and gas exchange parameters were measured.Results ①HFJV combined with TGI significantly increased the PaCO 2 and PetCO 2. The catheter flow increased from 4 L/min to 8 L/min, but the PaCO 2 and PetCO 2 has significant difference ( P <0 01).②HFJV combined with TGI significantly increased the PaO 2 in the two groups.The catheter flow increased from 4 L/min to 8 L/min, but the PaO 2 has no significant difference ( P >0 05).③HFJV combined with TGI significantly increased the airway pressure in every group.④HFJV combined with TGI has no obvious influence on hemodynamics in every group( P >0 05) Conclusion TGI is capable of improving oxygenation and ventilation in acute lung injury when combined with HFJV.HFJV combined with TGI can significantly decrease the PaCO 2 level,enhance CO 2 elimination and has no obvious influence on hemodynamics.

关 键 词：高频喷射通气 气管内吹气 急性肺损伤 

分 类 号：R563.8[医药卫生—呼吸系统]