CAJ | 학술논문

目的评价通过监测食道压设定呼吸机参数,对重症急性胰腺炎腹高压模型猪血流动力学和氧代谢的影响.方法采用自身对照研究,将6只家猪进行麻醉、气管插管后接呼吸机辅助呼吸,使用含5％牛磺胆酸钠和0.5％胰蛋白酶生理盐水1 ml/kg胰管内注射制作重症急性胰腺炎模型,呼吸机参数为容量控制10 ml/kg,FiO240％,PEEP5 cm H2O(常规机械通气)(1 cm H2O=0.098 kPa).置入动脉导管和Swan-Ganz导管测定心率(HR)、平均动脉压(MAP)、心指数(CI)、中心静脉压(CVP)、肺动脉嵌压(PAWP)及气道峰压(Ppeak)、平台压(Pplat)、胸内压(Pes)、肺顺应性(Cstat)并行血气分析检查.3h后通过腹腔内注入氮气法制作25 mm Hg(1mm Hg=0.133 kPa)腹高压模型,呼吸机参数不变,持续3h观察上述指标的变化；随后置入食道测压管,调整PEEP使呼气末跨肺压为正值(跨肺压导向机械通气),其余呼吸机参数不变,持续3h观察上述指标的变化.结果 6只家猪均制模成功,无一发生气压伤.常规机械通气时,腹高压1h、3h与胰腺炎相比HR增快；MAP、CVP和PAWP上升；CI下降.Ppeak、Pplat、Pes上升；Cstar下降.PaO2和氧输送(DO2)等氧代谢指标下降(均P＜0.05)；跨肺压导向机械通气与常规机械通气相比,模型猪的PaO2以及Cstat明显改善,Pplat升高,CI下降,血乳酸降低(均P＜0.05)；PaCO2、HR、MAP、CVP、PAWP差异无统计学意义(均P＞0.05).结论通过食道压监测设定呼吸机参数能改善重症急性胰腺炎腹高压模型猪的氧分压及肺顺应性,对血流动力学指标影响较小.
목적 평개통과감측식도압설정호흡궤삼수,대중증급성이선염복고압모형저혈류동역학화양대사적영향.방법 채용자신대조연구,장6지가저진행마취、기관삽관후접호흡궤보조호흡,사용함5％우광담산납화0.5％이단백매생리염수1 ml/kg이관내주사제작중증급성이선염모형,호흡궤삼수위용량공제10 ml/kg,FiO240％,PEEP5 cm H2O(상규궤계통기)(1 cm H2O=0.098 kPa).치입동맥도관화Swan-Ganz도관측정심솔(HR)、평균동맥압(MAP)、심지수(CI)、중심정맥압(CVP)、폐동맥감압(PAWP)급기도봉압(Ppeak)、평태압(Pplat)、흉내압(Pes)、폐순응성(Cstat)병행혈기분석검사.3h후통과복강내주입담기법제작25 mm Hg(1mm Hg=0.133 kPa)복고압모형,호흡궤삼수불변,지속3h관찰상술지표적변화；수후치입식도측압관,조정PEEP사호기말과폐압위정치(과폐압도향궤계통기),기여호흡궤삼수불변,지속3h관찰상술지표적변화.결과 6지가저균제모성공,무일발생기압상.상규궤계통기시,복고압1h、3h여이선염상비HR증쾌；MAP、CVP화PAWP상승；CI하강.Ppeak、Pplat、Pes상승；Cstar하강.PaO2화양수송(DO2)등양대사지표하강(균P＜0.05)；과폐압도향궤계통기여상규궤계통기상비,모형저적PaO2이급Cstat명현개선,Pplat승고,CI하강,혈유산강저(균P＜0.05)；PaCO2、HR、MAP、CVP、PAWP차이무통계학의의(균P＞0.05).결론 통과식도압감측설정호흡궤삼수능개선중증급성이선염복고압모형저적양분압급폐순응성,대혈류동역학지표영향교소.
Objective To study the effect of mechanical ventilation guided by esophageal pressure on hemodynamics and oxygen metabolism of severe acute pancreatitis (SAP) swine model with intra-abdominal hypertension (IAH) Methods By self-controlled study,SAP model was made by infusing sodium taurocholate (5％) into the pancreatic duct in 6 domestic swine.Mechanical ventilator mode was volumeassist control with tidal volume 10 ml/kg ; FiO2 40％ and PEEP 5 cm H2O (routine ventilation) given to SAP model swine.After 3 h ventilation,pneumo-peritoneum was made with N2 gas to increase the intraabdominal pressure (IAP) to 25 mm Hg in SAP swine.Three more hours later,PEEP was adjusted as the measurement of esophageal pressure (Pes guided ventilation) to such a level that trans-pulmonary pressure stayed above 0 cm H2O during end-expiratory occlusion.During the investigation period,heart rate (HR),cardiac output index (CI),central venous pressure (CVP),mean arterial pressure (MAP) and pulmonary arterial wedge pressure (PAWP) were continuously recorded with the aid of Swan-Ganz catheter and ECG monitor,and oxygen partial pressure of artery (PaO2) and carbon dioxide partial pressure of artery (PaCO2) were measured by blood-gas analysis.In addition,systemic oxygen delivery (DO2) and systemic oxygen consumption (VO2) were calculated by using the data of blood-gas analysis of arterial and central venous blood.Results No swine model was subjected to barotrauma.After routine mechanical ventilation,there were significant differences in HR,CI,MAP,CVP,PAWP,Ppeak,Pplat,Pes,pulmonary compliance (Cstat),PaO2,and DO2 between SAP and IAH in swine (all P ＜ 0.05).Compared with routine ventilation,however,PaO2 and Cstat improved significantly with lower CI and increased Pplat after PEEP adjusted according to measurements of esophageal pressure (all P ＜ 0.05).The lactate decreased significantly after esophageal pressure guided ventilation (all P ＜ 0.05).There were no significant changes in PaCO2,HR,MAP,CVP and PAWP in IAH swine after mechanical ventilation with routine parameters (all P ＞ 0.05).Conclusions There were remarkable effects on oxygen metabolism in response to mechanical ventilation guided by esophageal pressure.In case of clinical application of mechanical ventilation,the results of this study are in favor of setting transpulmonary pressure according to measurements of esophageal pressure in SAP patients with IAH in an early stage.