CAJ | 학술논문

目的根据吸气与呼气压力-容积曲线(P-V曲线)确定呼气末正压(PEEP),探寻最适PEEP治疗急性呼吸窘迫综合征(ARDS)的方法.方法 20只ARDS模型犬按配对随机法分成两组.用软件根据列文伯格-马夸尔特算法(Levenberg-Marquardt iterative algorithm)求解Boltzmann公式参数,根据公式计算P-V曲线呼气支真正拐点压力(Pinf d)或吸气支相应的低位转折点压力(Plip)值.对照组(吸气支)应用P-V曲线Plip+2 cm H2O(1 cm H2O=0.098 kPa)作为最佳PEEP值;实验组(呼气支)应用P-V曲线Pinfd作为最佳PEEP 值.两组分别监测0、2、6、12、24及48 h的心率(HR)、血压(BP)、指尖脉搏血氧饱和度(SpO2)、肺静态顺应性(Cst)、动脉血氧分压(PaO2)及动脉血二氧化碳分压(PaCO2).结果两组ARDS模型犬氧合指数均明显升高,实验组监测12、24、48 h时氧合指数(mm Hg,1 mm Hg=0.133 kPa)明显高于对照组(12 h:177.63±8.94比165.60±8.90,24 h:194.19±10.67比168.70±10.60,48 h:203.15±13.21比171.26±9.21,均P＜0.01);监测2、6、12、24及48 h Cst(ml/cm H2O)明显高于对照组(2 h:41.00±4.17比36.20±3.90,6 h:44.00±4.65比36.88±3.39,12 h:46.92±5.47比37.92±3.10,24 h:42.83±8.97比37.92±3.09,48 h:42.64±9.04比37.97±2.98,P＜0.05或P＜0.01).结论根据P-V曲线呼气支确定最佳PEEP治疗ARDS较吸气支更优.
목적 근거흡기여호기압력-용적곡선(P-V곡선)학정호기말정압(PEEP),탐심최괄PEEP치료급성호흡군박종합정(ARDS)적방법.방법 20지ARDS모형견안배대수궤법분성량조.용연건근거렬문백격-마과이특산법(Levenberg-Marquardt iterative algorithm)구해Boltzmann공식삼수,근거공식계산P-V곡선호기지진정괴점압력(Pinf d)혹흡기지상응적저위전절점압력(Plip)치.대조조(흡기지)응용P-V곡선Plip+2 cm H2O(1 cm H2O=0.098 kPa)작위최가PEEP치;실험조(호기지)응용P-V곡선Pinfd작위최가PEEP 치.량조분별감측0、2、6、12、24급48 h적심솔(HR)、혈압(BP)、지첨맥박혈양포화도(SpO2)、폐정태순응성(Cst)、동맥혈양분압(PaO2)급동맥혈이양화탄분압(PaCO2).결과 량조ARDS모형견양합지수균명현승고,실험조감측12、24、48 h시양합지수(mm Hg,1 mm Hg=0.133 kPa)명현고우대조조(12 h:177.63±8.94비165.60±8.90,24 h:194.19±10.67비168.70±10.60,48 h:203.15±13.21비171.26±9.21,균P＜0.01);감측2、6、12、24급48 h Cst(ml/cm H2O)명현고우대조조(2 h:41.00±4.17비36.20±3.90,6 h:44.00±4.65비36.88±3.39,12 h:46.92±5.47비37.92±3.10,24 h:42.83±8.97비37.92±3.09,48 h:42.64±9.04비37.97±2.98,P＜0.05혹P＜0.01).결론 근거P-V곡선호기지학정최가PEEP치료ARDS교흡기지경우.
Objective To determine the optimal positive end-expiratory pressure (PEEP) according to inflation and deflation pressure-volume curve (P-V curve) in patients with acute respiratory distress syndrome (ARDS).Methods ARDS models were reproduced in 20 dogs,and they were randomly divided into two groups.In both groups,Levenberg-Marquardt iterative algorithm was employed using software to explore parameters fitting with Boltzmann formula,by which the real inflection point of pressure (Pinf d) in deflation limb or lower inflection point pressure (Plip) in inflation limb on P-V curve were defined.For the control group (inflation curve) P-V curve of Plip + 2 cm H2O ( 1 cm H2O =0.098 kPa) was applied as the best PEEP value.In the experimental group (deflation curve)the Pinf d was taken as the best PEEP value.The heart rate (HR),blood pressure (BP),fingertip pulse oxygen saturation (SpO2),static lung compliance (Cst),arterial partial pressure of oxygen (PaO2) and arterial partial pressure of carbon dioxide (PaCO2) were monitored at 0,2,6,12,24 and 48 hours.Results Oxygenation index increased significantly both in control and experimental groups.In experimental group,oxygenation index (mm Hg,1 mm Hg =0.133 kPa) of 12,24 and 48 hours was respectively significantly higher than that of the control group (12 hours:177.63 ± 8.94 vs.165.60 ± 8.90,24 hours:194.19 ± 10.67 vs.168.70 ± 10.60,48 hours:203.15 ± 13.21 vs.171.26 ± 9.21,all P＜0.01 ).Cst (ml/cm H2O) at 2,6,12,24 and 48 hours was respectively higher than that of the control group (2 hours:41.00 ± 4.17 vs.36.20 ± 3.90,6 hours:44.00 ± 4.65 vs.36.88 ± 3.39,12 hours:46.92 ± 5.47vs.37.92 ± 3.10,24 hours:42.83 ± 8.97 vs.37.92 ± 3.09,48 hours:42.64 ± 9.04 vs.37.97 ± 2.98,P＜0.05 or P＜0.01 ).Conclusion Determining optimal PEEP for ARDS with deflation P-V curve was better than that of inflation curve.