CAJ | 학술논문

不同体位高频振荡通气对重度烟雾吸入性损伤犬氧合及血流动力学的影响
불동체위고빈진탕통기대중도연무흡입성손상견양합급혈류동역학적영향
Effects of different position during high frequency oscillatory ventilation on oxygenation and hemodynamics of dogs with severe smoke inhalation injury

万方数据

中华烧伤杂志中華燒傷雜誌 중화소상잡지
16
2014年 1期 51-55 ,共5页

朱峰%曾能初%罗源李%冯贺德%廖新成%刘名倬%郭光华

주봉%증능초%라원리%풍하덕%료신성%류명탁%곽광화

烧伤,吸入性%高频通气%俯卧位%血流动力学%氧合燒傷,吸入性%高頻通氣%俯臥位%血流動力學%氧閤
소상,흡입성%고빈통기%부와위%혈류동역학%양합
Burns,inhalation%High-frequency ventilation%Prone position%Hemodynamics%Oxygenation

目的探讨不同体位高频振荡通气(H FOV)对重度烟雾吸入性损伤犬氧合及血流动力学参数的影响. 方法将12只行常规机械通气后犬制成重度烟雾吸入性损伤模型,行HFOV30 min,按随机数字表法分为俯卧位HFOV组和仰卧位HFOV组,每组6只,分别行相应体位HFOV8h.于伤前、致伤后即刻及分组后治疗2、4、6、8h分别测定2组犬血气分析指标pH值、PaO2、PaCO2并计算氧合指数(OI),记录血流动力学参数心率、平均动脉压(MAP)、心排血量(CO).对数据行重复测量方差分析和LSD-t检验. 结果 (1)治疗8h,俯卧位HFOV组犬pH值明显高于仰卧位HFOV组(t=3.057 1,P＜0.05).与组内致伤后即刻比较,除仰卧位HFOV组治疗2、4h(t值分别为2.066 5、1.440 7,P值均大于0.05)外,2组犬其余各治疗时相点pH值均显著降低(t值为2.449 5～3.985 3,P＜0.05或P＜0.01).治疗2、4、8h,俯卧位HFOV组犬PaO2分别为(131±26)、(150±40)、(112 ±30)mmHg(1 mmHg =0.133 kPa),均明显高于仰卧位HFOV组的(81 ±15)、(96±5)、(83±6)mmHg(t值为2.366 4 ～4.083 5,P＜0.05或P＜0.01).仰卧位HFOV组和俯卧位HFOV组犬致伤后即刻PaO2分别为(55±15)、(48±±11)mmHg,显著低于2组犬各治疗时相点PaO2水平(t值为2.473 6～7.231 0,P＜0.05或P＜0.01).2组犬各时相点PaCO2比较,均无明显差异(t值为0.661 0～2.1419,P值均大于0.05)；2组犬组内致伤后即刻与各治疗时相点PaO2比较,均无明显差异(t值为0.1262～1.7683,P值均大于0.05).(2)治疗2、4、8h,仰卧位HFOV组犬OI值均明显高于俯卧位HFOV组(t值为3.091 9～3.791 6,P＜0.05或P＜0.01).与组内致伤后即刻比较,2组犬各治疗时相点OI值均显著降低(t值为2.702 0 ～5.969 3,P＜0.05或P＜0.01).(3)治疗6、8h,俯卧位HFOV组犬心率显著高于仰卧位HFOV组(t值分别为4.255 9、4.765 9,P值均小于0.01).与组内致伤后即刻比较,仰卧位HFOV组除治疗2 h(t=1.938 2,P＞0.05)外,其余各治疗时相点心率均显著降低(t值为3.006 2 ～5.135 5,P＜0.05或P＜0.01)；俯卧位HFOV组各治疗时相点心率均无明显差异(t值为0.7865～1.5258,P值均大于0.05).2组犬各时相点MAP比较,差异均无统计学意义(t值为0.045 8～1.783 4,P值均大于0.05).与组内致伤后即刻比较,仰卧位HFOV组治疗8 h MAP明显降低(t=2.368 3,P＜0.05)；俯卧位HFOV组治疗2 h MAP显著降低(t=3.580 1,P＜0.01).治疗2、4h,仰卧位HFOV组犬CO显著高于俯卧位HFOV组(t值分别为2.310 3和4.526 5,P值均小于0.01).与组内致伤后即刻比较,除仰卧位HFOV组治疗2 h(t=1.294 1,P ＞0.05)外,2组犬其余各治疗时相点CO均明显降低(t值为2.247 0 ～4.067 8,P＜0.05或P＜0.01). 结论俯卧位行HFOV有利于改善重度烟雾吸入性损伤犬氧合,且无明显CO2潴留,对主要血流动力学参数无不良影响,值得临床推广应用.
목적 탐토불동체위고빈진탕통기(H FOV)대중도연무흡입성손상견양합급혈류동역학삼수적영향. 방법 장12지행상규궤계통기후견제성중도연무흡입성손상모형,행HFOV30 min,안수궤수자표법분위부와위HFOV조화앙와위HFOV조,매조6지,분별행상응체위HFOV8h.우상전、치상후즉각급분조후치료2、4、6、8h분별측정2조견혈기분석지표pH치、PaO2、PaCO2병계산양합지수(OI),기록혈류동역학삼수심솔、평균동맥압(MAP)、심배혈량(CO).대수거행중복측량방차분석화LSD-t검험. 결과 (1)치료8h,부와위HFOV조견pH치명현고우앙와위HFOV조(t=3.057 1,P＜0.05).여조내치상후즉각비교,제앙와위HFOV조치료2、4h(t치분별위2.066 5、1.440 7,P치균대우0.05)외,2조견기여각치료시상점pH치균현저강저(t치위2.449 5～3.985 3,P＜0.05혹P＜0.01).치료2、4、8h,부와위HFOV조견PaO2분별위(131±26)、(150±40)、(112 ±30)mmHg(1 mmHg =0.133 kPa),균명현고우앙와위HFOV조적(81 ±15)、(96±5)、(83±6)mmHg(t치위2.366 4 ～4.083 5,P＜0.05혹P＜0.01).앙와위HFOV조화부와위HFOV조견치상후즉각PaO2분별위(55±15)、(48±±11)mmHg,현저저우2조견각치료시상점PaO2수평(t치위2.473 6～7.231 0,P＜0.05혹P＜0.01).2조견각시상점PaCO2비교,균무명현차이(t치위0.661 0～2.1419,P치균대우0.05)；2조견조내치상후즉각여각치료시상점PaO2비교,균무명현차이(t치위0.1262～1.7683,P치균대우0.05).(2)치료2、4、8h,앙와위HFOV조견OI치균명현고우부와위HFOV조(t치위3.091 9～3.791 6,P＜0.05혹P＜0.01).여조내치상후즉각비교,2조견각치료시상점OI치균현저강저(t치위2.702 0 ～5.969 3,P＜0.05혹P＜0.01).(3)치료6、8h,부와위HFOV조견심솔현저고우앙와위HFOV조(t치분별위4.255 9、4.765 9,P치균소우0.01).여조내치상후즉각비교,앙와위HFOV조제치료2 h(t=1.938 2,P＞0.05)외,기여각치료시상점심솔균현저강저(t치위3.006 2 ～5.135 5,P＜0.05혹P＜0.01)；부와위HFOV조각치료시상점심솔균무명현차이(t치위0.7865～1.5258,P치균대우0.05).2조견각시상점MAP비교,차이균무통계학의의(t치위0.045 8～1.783 4,P치균대우0.05).여조내치상후즉각비교,앙와위HFOV조치료8 h MAP명현강저(t=2.368 3,P＜0.05)；부와위HFOV조치료2 h MAP현저강저(t=3.580 1,P＜0.01).치료2、4h,앙와위HFOV조견CO현저고우부와위HFOV조(t치분별위2.310 3화4.526 5,P치균소우0.01).여조내치상후즉각비교,제앙와위HFOV조치료2 h(t=1.294 1,P ＞0.05)외,2조견기여각치료시상점CO균명현강저(t치위2.247 0 ～4.067 8,P＜0.05혹P＜0.01). 결론 부와위행HFOV유리우개선중도연무흡입성손상견양합,차무명현CO2저류,대주요혈류동역학삼수무불량영향,치득림상추엄응용.
Objective To study the effects of high frequency oscillatory ventilation (HFOV) with different position on oxygenation and hemodynamics of dogs with severe smoke inhalation injury.Methods After being treated with conventional mechanical ventilation,12 dogs were inflicted with severe smoke inhalation injury and treated by HFOV for 30 min.They were divided into HFOV + prone positioning (PP) group and HFOV + supine positioning (SP) group according to the random number table,with 6 dogs in each group.They received HFOV with corresponding position for 8 hours respectively.Results of blood gas analysis (pH,PaO2 and PaCO2 levels),oxygen index (OI) and hemodynamic parameters [heart rate,mean arterial pressure (MAP),and cardiac output (CO)] were recorded or calculated before injury,immediately after injury,and at post ventilation hour (PVH) 2,4,6,8.Data were processed with analysis of variance of repeated measurement,and LSD-t test.Results (1) At PVH 8,pH value of dogs in group HFOV +PP was significantly higher than that in group HFOV + SP (t =3.0571,P ＜0.05).Compared with those observed immediately after injury,except for group HFOV + SP at PVH 2 and 4 (with t values respectively 2.066 5 and 1.440 7,P values all above 0.05),the pH values in both groups at other treatment time points were decreased (withtvalues from 2.449 5 to 3.985 3,P ＜0.05 orP ＜0.01).At PVH 2,4,8,the PaO2 levelsingroup HFOV+PP [(131±26),(150±40),(112±30) mmHg,1 mmHg=0.133 kPa]were higher than those in group HFOV+SP [(81 ±15),(96 ±5),(83 ±6) mmHg,with t values from 2.366 4 to 4.083 5,P ＜0.05 orP ＜0.01].The PaO2 levels in both groups from PVH 2 to PVH 8 were increased,compared with those observed immediately after injury [(55 ± 15) mmHg in group HFOV + SP and (48 ± 11) mmHg in group HFOV + PP,with t values from 2.473 6 to 7.2310,P ＜0.05 or P ＜0.01].No statistically significant differences were observed in PaCO2 level at each time point between two groups (with t values from 0.661 0 to 2.141 9,P values all above 0.05).No statistically significant differences were observed in PaCO2 levels from PVH 2 to PVH 8 compared with those observed immediately after injury in both groups (with t values from 0.126 2 to 1.7683,Pvalues all above 0.05).(2) The OI values in group HFOV + SP were significantly higher than those in group HFOV + PP from PVH 2 to PVH 8 (with t values from 3.091 9 to 3.791 6,P ＜0.05 orP ＜0.01).The OI values in both groups from PVH 2 to PVH 8 were significantly decreased,compared with those observed immediately after injury (with t values from 2.702 0 to 5.969 3,P ＜0.05 orP ＜0.01).(3) AtPVH6 and PVH8,heart rate in groupHFOV+PPwassignificantly higher than that in group HFOV + SP (with t values respectively 4.255 9 and 4.765 9,P values both below 0.01).Compared with that observed immediately after injury,heart rate in group HFOV + PP was significantly decreased (witht values from 3.006 2 to 5.135 5,P ＜0.05 orP ＜0.01) except for PVH 2 (t =1.938 2,P ＞0.05).However,there was no statistical significant difference at each treatment time point in group HFOV + PP (with t values from 0.786 5 to 1.525 8,P values all above 0.05).There was no statistically significant difference in MAP between two groups at each time point (with t values from 0.045 8 to 1.783 4,P values all above 0.05).Compared with that observed immediately after injury,MAP in group HFOV+SPwas significantly decreased at PVH8 (t =2.368 3,P ＜0.05); MAP in group HFOV+PP was significantly decreased at PVH 2 (t =3.580 1,P ＜ 0.01).At PVH 2 and 4,the CO values in group HFOV + SP were significantly higher than those in group HFOV + PP (with t values respectively 2.310 3 and 4.526 5,P values both below 0.01).Except for group HFOV+SPatPVH2 (t =1.294 1,P ＞0.05),CO values at other treatment time points in both groups were significantly lower than that observed immediately after injury (withtvalues from 2.2470 to4.0678,P ＜0.05 orP ＜0.01).Conclusions HFOV+ PP can improve oxygenation with no obvious CO2 retention or adverse effect on hemodynamic parameters of dogs with severe smoke inhalation injury.Therefore,it is recommended for clinical application.