中华急诊医学杂志
中華急診醫學雜誌
중화급진의학잡지
CHINESE JOURNAL OF EMERGENCY MEDICINE
2012年
7期
713-717
,共5页
肺栓塞%死腔%肺内分流%气体交换%病理生理学
肺栓塞%死腔%肺內分流%氣體交換%病理生理學
폐전새%사강%폐내분류%기체교환%병리생이학
Pulmonary thromboembolism%Dead space%Shunt%Gas exchange%Pathophysiology
目的 研究肺栓塞死腔、肺内分流及气体交换的变化特点,探讨肺栓塞发生的病理生理学机制及意义.方法 建立肺栓塞模型,将8只健康幼猪于栓塞前30 min,栓塞后0、30、60和120 min 5个时间点,对生理死腔(VDphy)、肺泡死腔(VDalv)、气道死腔(VDaw)、肺内分流(Qs/Qt)、肺动脉压(PAP)、动脉血氧分压(PaO2)、二氧化碳分压(PaC02)及肺泡动脉氧分压差(PA-aDO2)进行测定.结果 研究发现VDphy、VDalv、Qs/Qt、PAP、PA-aDO2栓塞后较栓塞前明显增大(P＜0.01).PaO2栓塞后较栓塞前明显减小(P＜0.05和P＜0.01).VDaw、PaCO2栓塞前后差异无统计学意义(P＞0.05).SNK检验VDphy、VDalv栓塞后60 min和120 min较30min减小；PAP于栓塞后30 min、60 min、120 min较0 min减小；其余各组栓塞后各时间点差异无统计学意义.血液动力学指标栓塞前后无明显变化.结论 肺栓塞发生后,机体发生了一系列病理生理学变化,即死腔和肺内分流增大,氧分压减小,肺泡动脉氧分压差增大,而二氧化碳分压保持不变.
目的 研究肺栓塞死腔、肺內分流及氣體交換的變化特點,探討肺栓塞髮生的病理生理學機製及意義.方法 建立肺栓塞模型,將8隻健康幼豬于栓塞前30 min,栓塞後0、30、60和120 min 5箇時間點,對生理死腔(VDphy)、肺泡死腔(VDalv)、氣道死腔(VDaw)、肺內分流(Qs/Qt)、肺動脈壓(PAP)、動脈血氧分壓(PaO2)、二氧化碳分壓(PaC02)及肺泡動脈氧分壓差(PA-aDO2)進行測定.結果 研究髮現VDphy、VDalv、Qs/Qt、PAP、PA-aDO2栓塞後較栓塞前明顯增大(P＜0.01).PaO2栓塞後較栓塞前明顯減小(P＜0.05和P＜0.01).VDaw、PaCO2栓塞前後差異無統計學意義(P＞0.05).SNK檢驗VDphy、VDalv栓塞後60 min和120 min較30min減小；PAP于栓塞後30 min、60 min、120 min較0 min減小；其餘各組栓塞後各時間點差異無統計學意義.血液動力學指標栓塞前後無明顯變化.結論 肺栓塞髮生後,機體髮生瞭一繫列病理生理學變化,即死腔和肺內分流增大,氧分壓減小,肺泡動脈氧分壓差增大,而二氧化碳分壓保持不變.
목적 연구폐전새사강、폐내분류급기체교환적변화특점,탐토폐전새발생적병리생이학궤제급의의.방법 건립폐전새모형,장8지건강유저우전새전30 min,전새후0、30、60화120 min 5개시간점,대생리사강(VDphy)、폐포사강(VDalv)、기도사강(VDaw)、폐내분류(Qs/Qt)、폐동맥압(PAP)、동맥혈양분압(PaO2)、이양화탄분압(PaC02)급폐포동맥양분압차(PA-aDO2)진행측정.결과 연구발현VDphy、VDalv、Qs/Qt、PAP、PA-aDO2전새후교전새전명현증대(P＜0.01).PaO2전새후교전새전명현감소(P＜0.05화P＜0.01).VDaw、PaCO2전새전후차이무통계학의의(P＞0.05).SNK검험VDphy、VDalv전새후60 min화120 min교30min감소；PAP우전새후30 min、60 min、120 min교0 min감소；기여각조전새후각시간점차이무통계학의의.혈액동역학지표전새전후무명현변화.결론 폐전새발생후,궤체발생료일계렬병리생이학변화,즉사강화폐내분류증대,양분압감소,폐포동맥양분압차증대,이이양화탄분압보지불변.
Objective To investigate the alterations of pulmonary dead space,pulmonary shunt fraction (Qs/Qt) and gas exchange after thromboembolism of lungs in swines and to evaluate the mechanism in respect of pathophysiology and implication.Methods Swine model of pulmonary thromboembolism was made by injection of thrombus into pulmonary artery.Eight swine were used for study of physiologic dead space (VDphy),alveoli dead space (VDalv),airway dead space (VDaw),Qs/Qt,pulmonary arterial pressure (PAP),oxygen partial pressure in arterial blood (PaO2 ),carbon dioxide partial pressure in arterial blood (PaCO2 ),alveolar-arterial O2 gradient (PA-aDO2) determined 30 min before thromboembolism and 0 min,30 min,60 min,120 min after thromboembolism.Results The results showed that VDphy,VDalv,Qs/Qt,PAP,PA-aDO2 increased markedly after thromboembolism in comparison with pre-thromboembolism (P ＜ 0.01 ),while PaO2 declined significantly (P ＜ 0.01 ),and the differences in VDaw and PaCO2 were not significant ( P ＞ 0.05 ).SNK test showed that VDphy and VDalv declined to be smaller at 60 min,120 min than those at 30 min,and PAP declined to be lower at 30 min,60 min,120 min than that at 0 min.Other variables did not change at different intervals after thromboembolism.Hemodynamics did not change significantly after embolization.Conclusions After pulmonary thromboembolism,a various of changes in pathophysiology happened such as increase in dead space,Qs/Qt and PA-aDO2 and decrease in PaO2,but PaCO2 did not change.
