[收稿日期 ] 20092 052 26 [修回日期 ] 20092 062 25

    [基金项目 ]江苏省六大人才高峰基金资助项目 (NO. 1190000009)

    [作者简介 ]吴彬 (19762 ) ,男,安徽蚌埠人,主治医师,硕士, Tel : 13559258875, Email : binwu1018@yahoo . com. cn。

    压力控制通气方式的肺复张手法减轻家兔重复去复张相关肺损伤

    吴 彬1

    ,邱海波2

    ,王 兵1

    ,陈辉民1

    (1 .厦门市第三医院 I CU,福建 厦门 361100; 2 .东南大学附属中大医院 I CU,江苏 南京 210009)

    [摘要 ]目的:研究应用压力控制通气 (p ressure control ventilati on, PCV)方式的肺复张手法 ( recruit ment

    maneuvers, RM)对家兔重复去复张相关肺损伤的影响。方法:生理盐水肺泡灌洗法复制急性呼吸窘迫

    综合征 ( acute res p irat ory distress syndr ome, ARDS)家兔模型 ,分为 3组。分别为: (1)肺保护性通气组

    (LP组 ) :潮气量 ( tidal volume, Vt) 6 mL /kg,呼气末正压 (positive end 2 exp irat ory p ressure, PEEP) 根据

    静态压力 2 容积曲线低位转折点水平 ( l ower inflecti on point in static p ressure2 volume curve, L IP)设定; (2)

    去复张组 (DR组 ) :通气条件同 LP组 ,在 3 h机械通气期间每 10 min将呼吸机管路脱开 1 min实施去复

    张; (3)去复张 +压力控制组 ( PCV组 ) :去复张后用 PCV法给予 RM,具体方法为:将呼吸机模式调整为

    压力控制通气 ,吸气压力设定为 30 cmH2 0、 PEEP水平设定为 L IP水平、I∶E = 1∶2,维持90 s。机械通

    气期间监测动脉血气分析及呼吸力学 ,机械通气 3 h处死动物 ,测定肺湿 /干重比 (W /D)及肺组织病理

    损伤评分。结果:去复张后 1, 2和 3 h时 ,DR组动脉氧分压 ( PaO2 )均显著低于同时间点的 LP与 PCV

    组 ( P均 < 0105) ,在 LP与 PCV两组间同时间点 PaO2 比较无显著性差异 ( P均 ? 0 . 05) ; DR组静态肺

    顺应性 (Cst)与气道平台压力 ( Pp lat)与同时间点 LP、 SI与 PCV组比较差异不显著 ( P均 ? 0 . 05) ; DR

    组肺 W /D与 LP与 PCV组比较也无显著性差异 ( P ? 0 . 05) ;机械通气 3 h时 DR组肺组织病理损伤评

    分为 (10 . 9 ± 0 . 8) ,显著高于 LP与 PCV组 ( P均 < 0 . 05) , LP与 PCV组间比较无显著性差异 ( P均 ?

    0105)。结论:重复去复张明显恶化氧合 ,加重 ARDS肺组织损伤 , PCV方式的 RM可以改善氧合 ,减轻

    组织损伤。

    [关键词 ]呼吸窘迫综合征;肺保护性通气;人工呼吸;肺不张;肺复张手法;兔

    [中图分类号 ] R563 . 8; R2 332 [文献标识码 ] A [文章编号 ] 10072 1237 (2009) 092 10062 06

    I nfluence of recru itmen t maneuvers with pressure con trol ven tila tion on repea ted dere2

    cru itmen t a ssoc i a ted lung i n jury i n rabb its

    WU Bin

    1

    ,Q IU Hai2 bo

    2

    , WANG B ing

    1

    , CHEN Hui2 min

    1

    (1 . Depart m ent of ICU, The Th ird Hospital of X iam en X iam en 361100; 2 . Depart m ent of ICU, Zhongda Aff ili2

    ated Hospital of Southeast Univer sity N anjing 210009, China)

    [ Foundation Proj ect ]: Fund for S ix Kinds of Talen ts Supported Project of J iangsu Province (N o . 1190000009)

    [Author]:WU B in (19762 ) , M ale, B engbu Anhui , A ttending Physician, M. M. Tel : 13559258875 , Em ail :

    binwu1018@yahoo . com. cn .

    Received: 20092 042 20 Accepted: 20092 062 25 JHMC, 2009; 15 (9) : 10062 1011

    Vi ew from spec i a l ist: It is crea ti ve, and of cert a i n sc i en ti f i c and educa ti ona l va lue .

    [ABSTRACT ] O b j e c ti ve: To evaluate the influence of recruit ment maneuvers (RM) with p ressure contr ol

    ventilati on ( PCV) on repeated derecruit ment ass ociated lung injury in rabbits . Me tho d s: The rabbitmodels of a2

    cute res p irat ory distress syndrome (ARDS) were dup licated using saline alveoli2lavaged, and the rabbits were di2

    6001

    海南医学院学报 2009, 15 (9)

    Journal of Hainan M edical Collegevided int o three group s : (1) LP gr oup: tidal volume ( tidal volume, Vt) 6 mL / kg, PEEP (positive end 2exp ira2

    t ory p ressure, PEEP) was set based on l ow turning point in the level ( l ower inflecti on point in static p ressure2 vol2

    ume curve, L IP) of static p ressure 2 volume curve; (2) DR gr oup: the ventilati on conditi on was the same as LP

    gr oup, derecruit ment was repeatedly induced by intenti onal disconnecti on of the ventilat ory circuit for 1 min every

    10 min for 3 h; (3) PCV group: using PCV for RM after derecruit ment, setting the mode of ventilat or as PCV, in2 ......