CAJ | 학술논문

目的探讨健康犬及急性呼吸窘迫综合征(ARDS)犬模型功能残气量(FRC)与理想体质量的关系,为研究个体化的肺保护性通气方案奠定基础.方法选取24只比格犬为研究对象,静脉注射0.18 mL/kg体质量的油酸,以动脉血气中氧分压与吸氧体积分数的比值(PaO2/FiO2)在100～200 mmHg之间作为中度ARDS模型的标准.造模前后行胸部CT测FRC,并检测动脉血气、血管外肺水指数、呼吸力学等相关参数,采用自身配对t检验.多元线性回归法分析造模前后肺功能残气量与理想体质量(以身长为指标)、月龄及实际体质量之间的关系.结果造模后PaO2/FiO2从(472.4±58.9) mmHg降至(166.2±19.1) mmHg (P＜0.01),血管外肺水指数由(11.0±1.9) mL/kg升至(25.7±7.9) mL/kg (P＜0.01),静态呼吸系统顺应性由(30.5±4.1)L/cmH2O降至(21.2±4.9) L/cmH2O (P＜0.01),静态肺顺应性由(48.7±9.3)L/cmH2O降至(29.7±7.2)L/cmH2O (P ＜0.01),犬FRC自(414±84) mL下降至(214±70) mL (P＜0.01).对于健康犬,FRC的多元线性回归方程为FRC (mL) =21.86×月龄+20.55×身长(cm)-1337.98(P＜0.05),而ARDS肺FRC与理想体质量、月龄及实际体质量之间的多元线性回归方程无效(P =0.305).结论在健康犬,FRC与理想体质量之间成比例关系,但对于犬ARDS模型,FRC与理想体质量、年龄及实际体质量之间均不存在比例关系.在肺保护性通气选择潮气量时,应更多地关注ARDS患者实际的FRC而不仅仅是患者理想体质量.
목적 탐토건강견급급성호흡군박종합정(ARDS)견모형공능잔기량(FRC)여이상체질량적관계,위연구개체화적폐보호성통기방안전정기출.방법 선취24지비격견위연구대상,정맥주사0.18 mL/kg체질량적유산,이동맥혈기중양분압여흡양체적분수적비치(PaO2/FiO2)재100～200 mmHg지간작위중도ARDS모형적표준.조모전후행흉부CT측FRC,병검측동맥혈기、혈관외폐수지수、호흡역학등상관삼수,채용자신배대t검험.다원선성회귀법분석조모전후폐공능잔기량여이상체질량(이신장위지표)、월령급실제체질량지간적관계.결과 조모후PaO2/FiO2종(472.4±58.9) mmHg강지(166.2±19.1) mmHg (P＜0.01),혈관외폐수지수유(11.0±1.9) mL/kg승지(25.7±7.9) mL/kg (P＜0.01),정태호흡계통순응성유(30.5±4.1)L/cmH2O강지(21.2±4.9) L/cmH2O (P＜0.01),정태폐순응성유(48.7±9.3)L/cmH2O강지(29.7±7.2)L/cmH2O (P ＜0.01),견FRC자(414±84) mL하강지(214±70) mL (P＜0.01).대우건강견,FRC적다원선성회귀방정위FRC (mL) =21.86×월령+20.55×신장(cm)-1337.98(P＜0.05),이ARDS폐FRC여이상체질량、월령급실제체질량지간적다원선성회귀방정무효(P =0.305).결론 재건강견,FRC여이상체질량지간성비례관계,단대우견ARDS모형,FRC여이상체질량、년령급실제체질량지간균불존재비례관계.재폐보호성통기선택조기량시,응경다지관주ARDS환자실제적FRC이불부부시환자이상체질량.
Objective To explore the relationship between functional residual capacity (FRC) and predicted body weight (PBW) in beagle dogs with and without acute respiratory distress syndrome (ARDS) in order to provide a rationale for individualized lung protective ventilation strategy.Methods Twenty-four adult male beagle dogs were injected with oleic acid (0.18 mL/kg) to make moderate acute respiratory distress syndrome models,the ratio of the partial pressure of oxygen in arterial blood to fraction of inhaled oxygen (PaO2/FiO2) between 100-200 mmHg was considered as a criterion of moderate ARDS.FRC was measured by chest computer tomography.Blood gas analysis,extra vascular lung water index and respiratory mechanics were tested before and after modeling.Hemodynamics and vital signs were monitored continuously throughout entire course of experiment.Age,body length as a surrogated PBW,and actual body weight were recorded before experiments.Results After modeling,PaO2/FiO2 decreased from (472.4 ± 58.9) mmHg to (166.2 ± 19.1) mmHg (P ＜ 0.01),extra vascular lung water index increased abruptly from (11.0 ± 1.9) mL/kg to (25.7 ± 7.9) mL/kg (P ＜ 0.01),static respiratory system compliance decreased from (30.5 ±4.1) L/cmH2O to (21.2 ±4.9) L/cmH2O (P ＜0.01) and static lung compliance reduced from (48.7 ± 9.3) L/cmH2O to (29.7 ± 7.2) L/cmH2O (P ＜ 0.01).FRC decreased dramatically from (414 ± 84) mL to (214 ± 70) mL (P ＜ 0.01).For healthy lungs,FRC can be estimated by the following formula:FRC (mL) =21.86 × age (months) + 20.55 × body length (cm)-1 337.98 (P ＜ 0.05),while for injured lungs,the formula of multiple linear regression was invalid (P =0.305).Conclusions Functional residual capacity is proportional to PBW in healthy dogs but not in those with lung injury.To set tidal volume,more attention should be paid to the actual FRC or the ratio of tidal volume to FRC in addition to the ratio of tidal volume to PBW during protective ventilation.