摘要
目的:比较不同方法滴定急性呼吸窘迫综合征(ARDS)动物模型中最佳呼气末正压(PEEP)效果的差异,阐明所研究4种方法对确定最佳PEEP的可行性,为临床治疗ARDS提供依据。方法:油酸静脉注射法复制猪ARDS模型(n=7),应用压力控制法进行肺复张,根据最佳氧分压+二氧化碳分压法(PaO2+PaCO2)、最佳氧合法、静态顺应性(Cst)法和动态顺应性(Cdyn)法4种不同方法确定最佳PEEP。记录在基础状态、ARDS状态和最佳PEEP下,ARDS猪模型的肺内分流(Qs/Qt)、Cst、Cdyn、氧合指数(OI)、动脉血氧饱和度(SaO2)、中心静脉压(CVP)、心排量(CO)、全心舒张末容量(GEDV)、胸腔内血容量(ITBV)和血管外肺水(EVLW)等参数。结果:PaO2+PaCO2、最佳氧合法、Cst和Cdyn法确定的最佳PEEP分别为(13.14±1.35)、(13.43±1.51)、(14.43±4.12)和(14.14±2.91)cmH2O,两两比较差异均无统计学意义(P>0.05)。在ARDS状态下OI、Cst和Cdyn等指标较基础值明显降低(P<0.05),应用最佳PEEP通气后这3个指标较ARDS状态明显升高(P<0.05),但仍不能达到基础状态水平;在ARDS状态下猪的Qs/Qt较基础值明显增加(P<0.05),在ARDS状态下SaO2较基础值明显降低(P<0.05),应用最佳PEEP通气后,猪的Qs/Qt和SaO2能恢复到基础状态水平;在基础状态、ARDS状态和最佳PEEP状态下,心脏的CO、ITBV和GEDV差异均无统计学意义(P>0.05);ARDS状态下猪的EVLW明显高于基础状态(P<0.05),应用最佳PEEP并未改善EVLW。结论:PaO2+PaCO2、最佳氧合法、Cst和Cdyn 4种不同方法均可以作为滴定最佳PEEP的方法。最佳PEEP可以有效改善呼吸顺应性、提高氧合和降低肺内分流,并对心功能无明显影响。
Objective To compare the differences of effects between four kinds methods on setting the optimal positive end expiratory pressure （PEEP） in animal models with acute respiratory distress syndrome （ARDS）, and to clarify the feasibility of these methods to confirm the optimal PEPP and to provide basis for ARDS treatment in clinic. Methods The ARDS pig models were induced by intravenously infusing oleic acid （n = 7）. The optimal PEEP level was determined by four kinds of methods after lung recruitment., such as optimal PaO2 ＋ PaCO2 method, optimal oxygenation method, optimal static compliance （Cst） method, and optimal dynamic compliance （Cdyn） method. Intrapulmonary shunt fraction （Qs/Qt）, plateau airway pressure （Pplat）, Cst, dynamic compliance （Cdyn）, oxygen index （OI）, central venous pressure （CVP）, cardiac output （CO）, global end-diastolic volume （GEDV）, intra-thoracic blood volume （ITBV）, extravascular lung water （EVLW） of ARDS pigs were recorded before infusing oleic acid, after stabilization of ARDS model and at optimal PEEP level. Results The optimal PEEP （cmH2O） eleterminated by optimal PaO2 ＋ PaCO2 method （13.14±1.35）, optimal oxygenation method （13.43±1.51）, optimal Cst method （ 14. 43±4.12 ） and optimal cdyn method （14.14±2.91） had no significant differences （P〉0.05）. The values of OI, Cst, Cdyn and arterial oxygen saturation （SaO2） in ARDS model were significantly lower than those at the baseline level （P〈0.05）. Compared with ARDS model, the values of OI, Cst, Cdyn and SaO2 were significantly improved after using optimal PEEP （P〈0.05）. The value of Qs/Qt was increased in ARDS model compared with the baseline level （P〈0.05） ; and the value of SaO2 was decreased （P〈0.05）. The values of Qs/Qt and SaO2 were decreased to the baseline level after using optimal PEEP. The values of CO, GEDV, and ITBV showed no significant differences （P〉0.05） between the baseline level, ARDS model and optimal PEEP level; the value of EVLW in ARDS model was significantly higher than that at the baseline level （P%0.05）, but the optimal PEEP did not change EVLW. Conclusion The four kinds of methods can identify the optimal PEEP. The optimal PEEP can improve lung compliance and oxygenation, and decrease the intrapulmonary shunt, but has no effect on heart function.
出处
《吉林大学学报（医学版）》
CAS
CSCD
北大核心
2013年第6期1132-1137,共6页
Journal of Jilin University：Medicine Edition
基金
北京市卫生局重大科研项目资助课题(2005-32)
关键词
急性呼吸窘迫综合征
最佳呼气末正压
静态顺应性
动态顺应性
acute respiratory distress syndrome
positive end expiratory pressure
static compliance
dynamic compliance
