摘要
目的:探讨根据压力-容积(P-V)曲线选择不同水平的呼气末正压(PEEP),急性呼吸窘迫综合征(ARDS)犬肺容积的变化情况。方法:用大注射器法绘制ARDS犬P-V曲线,根据曲线不同转折点的压力设定PEEP,CT扫描相应的肺部形态学变化,并且计算肺容积。结果:(1)呼气相曲线曲率变化最大点(PMC,d)处的压力为10．67±0．82 cmH2O,高于吸气相低位转折点(LIP)处的压力8．77±0．88 cmH2O(P<0．05)。(2)在PEEP为0、LIP、PMC．d及UIP时,ARDS犬含气肺客积随着治疗压力的升高而增加,通气差及无通气肺组织明显减少,且均有显著差异;在PLIP及PPMC,d水平上,通气良好肺容积分别为403．16±12．6cm3和469．96±13．7cm3(P<0．05),而过度充气肺组织则相似(P>0．05);随着PEEP 增加至PUIP,通气良好的肺容积进一步增加,但也引起过度通气肺容积的明显增加。结论:根据P-V曲线呼气支PMC,d 来确定PEEP较传统根据LIP水平更有价值。
Objective： To evaluate the variation of the lung volume in acute respiratory distress syndrome （ARDS） dogs when PEEP set at levels of different inflection points on the pressure volume（P-V） curves. Methods： The super-syringe technique was used to obtain the deflation and inflation llmb curves and the inflection points of the curves were ascertained, then scanned with computed tomography（CT） morphology, also the lung volume when PEEP set at different levels were calculated. Results： （1） The pressure of the point of maximum curvature of deflation limb（PMC,d）was higher than the lower inflection point （LIP） （10. 67± 0. 82cmH2O vs 8. 77 ±0. 88 cmH2O, P〈0. 05）. （2）Aerated lung tissue was increased, whereas poorly aerated and nonaerated lung tissue was decreased when PEEP was set at 0, LIP, PMC,d, and UIP, all changes had significant statistic difference. At PLY and PPMc,d, volume of normally aerated parenchyma was 403. 16 ± 12. 6 cm^3 and 469. 96 ± 13.7 cm^3 , respec tively（P〈0. 05）, hyperinflated lung volume was similar（P〉0. 05）. With PEEP increased to PuiP, volume of normally aerated parenchyma was further increased, but hyperinflated lung volume was also increased significantly. Conclusion： These results support the use of PMC,d on deflation limb of the P-V curve for PEEP setting which is more valueable than traditional PEEP set at LIP.
出处
《中国临床医学》
北大核心
2006年第2期207-209,共3页
Chinese Journal of Clinical Medicine
关键词
急性呼吸窘迫综合征
呼气末正压
压力-容积曲线
体层摄影术
Acute respiratory distress syndrome
Positive end-expiratory pressure
Pressure volume curve
Computed tomography
