不同潮氣量聯合呼氣末正壓機械通氣對急性肺損傷犬肺的影響_《中國呼吸與危重監護雜志》

作者：

 賴添順 ¹ , 郭振輝 ¹ , 蔡紹曦 ² , 白濤 ¹ , 蘇磊 ¹ , 孫杰 ¹

1 廣州軍區廣州總醫院急危重病中心（廣東廣州 510010）;;
2 南方醫科大學南方醫院呼吸科（廣東廣州 510515）;

關鍵詞：

急性肺損傷油酸呼吸機所致肺損傷潮氣量呼氣末正壓

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目的觀察不同VT 聯合PEEP 機械通氣對油酸型ALI 犬肺損傷的影響。方法用油酸靜脈注射法制備犬ALI 模型, 造模成功后隨機分為小VT 組( 6 mL/kg) 和大VT 組( 20 mL/kg) , 行機械通氣6 h,PEEP均設為10 cm H2O。觀察各組在造模前, 造模成功, 機械通氣1、2、4 及6 h時血氣變化。在機械通氣6 h后處死犬, 取BALF 作蛋白濃度檢查, 取肺組織作病理切片肺損傷評分。結果各組在油酸靜脈注射后( 2. 50 ±0. 80) h達到ALI 標準。各組犬在整個實驗過程中pH 值進行性降低, 但小VT 組pH值下降較同期大VT 組更顯著( P lt;0. 01) 。PaO2 和SaO2 在ALI 造模后下降, 機械通氣后升高, 機械通氣6 h時小VT 組顯著高于大VT 組( P lt;0. 05) 。大VT 組PaCO2 波動不大, 而小VT 組PaCO2 在機械通氣后顯著上升( P lt;0. 01) ; PaO2 /FiO2 在造模后顯著下降( P lt;0. 01) , 在機械通氣1 h進一步下降到約190 mm Hg 后逐漸升高, 機械通氣6 h時小VT 組較大VT 組顯著升高( P lt;0. 05) 。小VT 組BALF 中蛋白濃度和肺組織損傷評分均較大VT 組顯著降低( P 均 lt;0. 05) 。結論 PEEP 為10 cm H2O 的機械通氣可改善油酸型ALI 犬的氧合狀況, 而小VT 較大VT 改善更明顯; 小VT 機械通氣可導致進行性加重的高碳酸血癥, 但可避免因大VT 機械通氣導致的嚴重肺部組織損傷。

引用本文： 賴添順,郭振輝,蔡紹曦,白濤,蘇磊,孫杰. 不同潮氣量聯合呼氣末正壓機械通氣對急性肺損傷犬肺的影響. 中國呼吸與危重監護雜志, 2009, 09(1): 43-47. doi: 復制

1.	宋鵬, 李琦, 王長征, 等.
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4.	燕艷麗, 邱海波, 楊毅, 等. 急性呼吸窘迫綜合征家兔肺部及肺外器官炎癥反應的變化. 中國呼吸與危重監護雜志, 2004, 3:147 -151.
5.	Slutsky AS, Hudson LD. PEEP or no PEEP--lung recruitmentmay be the solution. N Engl JMed, 2006, 354: 1839-1841.
6.	Villar J, Kacmarek RM, Perez-Mendez L, et al. A high positive endexpiratory pressure, low tidal volume ventilatory strategy improves outcome in persistent acute respiratory distress syndrome: a randomized,controlled trial. Crit Care Med, 2006, 34: 1311-1318.
7.	解立新, 劉又寧. 急性肺損傷/急性呼吸窘迫綜合征機械通氣的共識和爭議. 中國呼吸與危重監護雜志, 2004, 3: 194-196.
8.	Choi WI, Quinn DA, Park KM, et al. Systemic microvascular leak in an in vivo rat model of ventilator-induced lung injury. Am J Respir Crit Care Med, 2003, 167: 1627-1632.
9.	Kloot TE, Blanch L, Melynne-Youngblood A, et al. Recruitment Maneuvers in Three Experimental Models of Acute Lung Injury.Effect on Lung Volume and Gas Exchange. AmJ Respir Crit Care Med, 2000, 161: 1485-1494.
10.	Jeon K, Jeon IS, Suh GY, et al. Two methods of setting positive endexpiratory pressure in acute lung injury: an experimental computed tomography volumetric study. J Korean Med Sci, 2007, 22: 476-483.
11.	萬小健, 江來, 朱科明, 等. 肺保護性通氣對急性肺損傷患者的影響. 中國呼吸與危重監護雜志, 2006, 5: 267-270.
12.	Zhang X, Du Y, Jiang H, et al. Experimental study of acute lung injury induced by different tidal volume ventilation in rats. Chinese Med J, 2005, 118: 777-780.
13.	Makiko K, Katsumi T, Yasuko T, et al. Permissive range of hypercapnia for improved peripheral microcirculation and cardiac output in rabbits. Crit Care Med, 2007, 35: 2171-2175.
14.	Parker JC, Mary IT. Evaluation of lung injury in rats and mice. Am J Physiol Lung Cell Mol Physiol, 2004, 286: 231-246.
15.	Broccard AF, Hotchkiss JR, Vannay C. Protective effects of hypercapnic acidosis on ventilator-induced lung injury. Am J Respir Crit Care Med, 2001, 164: 802-806.
16.	例重癥急性呼吸窘迫綜合征臨床資料回顧性分析. 中國呼吸與危重監護雜志, 2006, 5: 35-38.

1. 宋鵬, 李琦, 王長征, 等.
2. The ARDS Network. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med, 2000 , 342 :1301-1308.
3. Smith KM, Mrozek JD, Simonton SC, et al. Prolonged partial liquid ventilation using conventional and high-frequency ventilatory techniques:gas exchange and lung pathology in an animal model of respiratory distress syndrome. Crit Care Med, 1997, 25: 1888-1897.
4. 燕艷麗, 邱海波, 楊毅, 等. 急性呼吸窘迫綜合征家兔肺部及肺外器官炎癥反應的變化. 中國呼吸與危重監護雜志, 2004, 3:147 -151.
5. Slutsky AS, Hudson LD. PEEP or no PEEP--lung recruitmentmay be the solution. N Engl JMed, 2006, 354: 1839-1841.
6. Villar J, Kacmarek RM, Perez-Mendez L, et al. A high positive endexpiratory pressure, low tidal volume ventilatory strategy improves outcome in persistent acute respiratory distress syndrome: a randomized,controlled trial. Crit Care Med, 2006, 34: 1311-1318.
7. 解立新, 劉又寧. 急性肺損傷/急性呼吸窘迫綜合征機械通氣的共識和爭議. 中國呼吸與危重監護雜志, 2004, 3: 194-196.
8. Choi WI, Quinn DA, Park KM, et al. Systemic microvascular leak in an in vivo rat model of ventilator-induced lung injury. Am J Respir Crit Care Med, 2003, 167: 1627-1632.
9. Kloot TE, Blanch L, Melynne-Youngblood A, et al. Recruitment Maneuvers in Three Experimental Models of Acute Lung Injury.Effect on Lung Volume and Gas Exchange. AmJ Respir Crit Care Med, 2000, 161: 1485-1494.
10. Jeon K, Jeon IS, Suh GY, et al. Two methods of setting positive endexpiratory pressure in acute lung injury: an experimental computed tomography volumetric study. J Korean Med Sci, 2007, 22: 476-483.
11. 萬小健, 江來, 朱科明, 等. 肺保護性通氣對急性肺損傷患者的影響. 中國呼吸與危重監護雜志, 2006, 5: 267-270.
12. Zhang X, Du Y, Jiang H, et al. Experimental study of acute lung injury induced by different tidal volume ventilation in rats. Chinese Med J, 2005, 118: 777-780.
13. Makiko K, Katsumi T, Yasuko T, et al. Permissive range of hypercapnia for improved peripheral microcirculation and cardiac output in rabbits. Crit Care Med, 2007, 35: 2171-2175.
14. Parker JC, Mary IT. Evaluation of lung injury in rats and mice. Am J Physiol Lung Cell Mol Physiol, 2004, 286: 231-246.
15. Broccard AF, Hotchkiss JR, Vannay C. Protective effects of hypercapnic acidosis on ventilator-induced lung injury. Am J Respir Crit Care Med, 2001, 164: 802-806.
16. 例重癥急性呼吸窘迫綜合征臨床資料回顧性分析. 中國呼吸與危重監護雜志, 2006, 5: 35-38.

《中國呼吸與危重監護雜志》

不同潮氣量聯合呼氣末正壓機械通氣對急性肺損傷犬肺的影響

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《中國呼吸與危重監護雜志》

不同潮氣量聯合呼氣末正壓機械通氣對急性肺損傷犬肺的影響

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