CAJ | 학술논문

目的探讨气道压力释放.双相气道正压通气(APRV-BIPAP)模式下,逐步递增压力组合水平肺复张/开放策略(lung recruitment/open maneuvers,RMs)的疗效,摸索最佳压力组合,观察对血流动力学等影响.方法经腹腔注射大肠杆菌制作猪急性肺损伤(acute lung iniuw,All)模型,APRV-BI-PAP下,逐步递增压力组合(Phigh/Plow),即RM1(30/15)、RM2(35/20)、RM3(48/25)、RM4(45/30)、RM5(50/35)、RM6(55/40)、RM7(60/45)cmH2O实施RMs,监测氧合指数(PaO2/FiO2)、血流动力学指标、平均气道压(Pmean)变化,吸气相CT扫描,评价RMs疗效.RMs完成后,处死取肺组织行病理学检查.所有资料应用SPSS 11.5统计软件包对数据进行统计学分析,采用自身前后对照,各种测定值以均数±标准差(x±s)表示,多组间采用随机区组方差分析,PaO2/FiO2与肺组织萎陷程度相关性比较采用Pearson相关分析,P<0.05为差异具有统计学意义.结果健康幼猪8头,成模后CT扫描均显示不同程度肺泡萎陷.随 RMs,PaO2/FiO2改善,肺泡萎陷减少,以RM2后改善最明显(P<0.05),但非病变区域有肺泡过度膨胀;随压力递增,心率(HR)增快(P<0.05),平均动脉压(MAP)下降(P<0.05),PIP、Pmean和中心静脉压(CVP)升高(P<0.05),但RMs完成后能恢复到RMs前水平(P>0.05);研究过程中未发生气胸、纵隔气肿等,但病理检查有肺泡过度膨胀和间隔断裂.结论借助APRV-BIPAP模式逐步递增压力组合实施RMs,35/20 cmH2O是最佳压力组合,对血流动力学和气道压等影响小;一旦RMs获得疗效满意,设置30/15 cmH2O维持20 min,RMs疗效好.
목적 탐토기도압력석방.쌍상기도정압통기(APRV-BIPAP)모식하,축보체증압력조합수평폐복장/개방책략(lung recruitment/open maneuvers,RMs)적료효,모색최가압력조합,관찰대혈류동역학등영향.방법 경복강주사대장간균제작저급성폐손상(acute lung iniuw,All)모형,APRV-BI-PAP하,축보체증압력조합(Phigh/Plow),즉RM1(30/15)、RM2(35/20)、RM3(48/25)、RM4(45/30)、RM5(50/35)、RM6(55/40)、RM7(60/45)cmH2O실시RMs,감측양합지수(PaO2/FiO2)、혈류동역학지표、평균기도압(Pmean)변화,흡기상CT소묘,평개RMs료효.RMs완성후,처사취폐조직행병이학검사.소유자료응용SPSS 11.5통계연건포대수거진행통계학분석,채용자신전후대조,각충측정치이균수±표준차(x±s)표시,다조간채용수궤구조방차분석,PaO2/FiO2여폐조직위함정도상관성비교채용Pearson상관분석,P<0.05위차이구유통계학의의.결과 건강유저8두,성모후CT소묘균현시불동정도폐포위함.수 RMs,PaO2/FiO2개선,폐포위함감소,이RM2후개선최명현(P<0.05),단비병변구역유폐포과도팽창;수압력체증,심솔(HR)증쾌(P<0.05),평균동맥압(MAP)하강(P<0.05),PIP、Pmean화중심정맥압(CVP)승고(P<0.05),단RMs완성후능회복도RMs전수평(P>0.05);연구과정중미발생기흉、종격기종등,단병리검사유폐포과도팽창화간격단렬.결론 차조APRV-BIPAP모식축보체증압력조합실시RMs,35/20 cmH2O시최가압력조합,대혈류동역학화기도압등영향소;일단RMs획득료효만의,설치30/15 cmH2O유지20 min,RMs료효호.
Objective To study the effects of APBV (airway pressure release ventilation) / BIPAP(bipha-sic positive airway pressure) on lung recmitment/open maneuvers in piglets with acute lung injury. Method The model of acute lung injury (ALI) was induced by E. coll. intraperitoneal injection in piglets. Based APRV/BI-PAP model, the different pressure combinations (Phigh/Plow) of RMs increased gradually, such as RMI(30/15),RM2(35/20), RM3(40/25), RM4(45/30),RM5(50/35), RM6(55/40), RM7(60/45) cmH2O. The effects of stepwise RMs were studied by computed tomography (CT) at iaspiratory phase. Meantime the oxygen index (PaO2/FiO2), hemodynamic parameter and mean pressure of airway (Pmean) were continuously observed. The piglets were killed when RiMs finished and pulmonary pathological examination were done routinely by optical microscope. Data was analyzed by self-contrast method, using SPSS 11.5 software package. Results were expressed as mean ± standard deviation (x±s). Multiple comparisons were made with One-way ANOVA. Pearson correlative analysis was used to describe the relativity of PaO2/FiO2 and the collapsed alveolar area. Changes were considered as statistically significant if P value was less than 0.05. Results Eight piglets with ALl model were successfully made and all of them showed different degree of alveolar collapse under chest CT scan. During RMs their PaO2/FiO2 increased obviously (P<0.05) were decreased obviously (P<0.05) too, specially after RM2 finished (P<0. 05). But the alveolar over-inflatian could be found in some non-diseased area. The heart rate (HR) increased and mean artery blood pressure (MAP) decreased significantly while the pressure combinations (Phigh/Plow) of RMs were added gradual]y ( P<0.05). Meantime the Pmean and Ppeak inspiratory pressure (PIP) of airway and central venous pressure (CVP) were increased significantly ( P<0.05). But when RMs were finished,all of these indexes were hack to the levels of pre-RMs. Even there were no barowaumas happened, such as pneumothorax and pneumomedistinum, the alveolar overdistention and interruption of the alveolar separation still could be seen by pathologic examination. Conclusions RMs could be done well by APRV/BIPAP. Phigh/Plow (35/20cmH2O) would be the best pressure combination with more efficacy of RMs and less influence on hemodynamics,airway pressure indexes and others. When the effect of RMs was satisfied enough, setting Phigh/Plow to 30/15cmH2O for 20 mitt may maintain the good efficacy of RMs.