· 论著·

    APRV2 B I PAP模式对急性肺损伤猪肺

    复张 /开放策略实验研究

    殷娜1

    宋志芳1

    谢伟1

    吴增斌1

    杨晓路2

    葛晓莉1

    王莹1

    作者单位:

    1

    200092 上海,上海交通大学医学院附属新华医院成人 I CU;

    2

    321000 浙江,浙江金华市广福医院 I CU

    通信作者:宋志芳, E2 mial : s ongzfk@hotmail . com

    【摘要】 目的 探讨压力释放 -双相正压通气 (APRV /B IPAP)模式下 ,不同压力组合肺复张 /

    开放 (RMs)策略疗效 ,摸索最佳压力组合 ,观察对血流动力学等影响。方法 大肠杆菌腹腔注射制

    作猪急性肺损伤 (AL I)模型 , APRV2 B IPAP下 ,逐步递增压力组合 ( Phigh /Pl ow) ,即 RM1 (30 /15)、RM2 (35 /20)、 RM2 (40 /25)、 RM4 (45 /30)、 RM5 (50 /35)、 RM6 (55 /40)、 RM7 (60 /45) cm H2O实施

    RMs,吸气相 CT扫描 ,评价 RMs疗效 ,监测氧合指数 ( PaO2 /Fi O2 )、 血流动力学指标、 平均气道压

    ( Pmean)变化。RMs完成后 ,处死取肺组织行病理学检查。结果 健康幼猪 8头 ,成模后 CT扫描

    均显示不同程度肺泡萎陷。 随 RMs, PaO2 / Fi O2改善 ,肺泡萎陷减少 ,以 RM2后改善最明显 ( P <

    0 . 05) ,但非病变区域有肺泡过度膨胀;随压力递增 ,心率 (HR )增快 ( P < 0 . 05 ) ,平均动脉压

    (MAP)下降 ( P < 0 . 05) , P IP、 Pmean和中心静脉压 (CVP)升高 ( P < 0 . 05) ,但 RMs完成后能恢复到

    RMs前水平 ( P > 0 . 05) ;研究过程中未发生气胸、 纵隔气肿等 ,但病理检查有肺泡过度膨胀和间隔

    断裂。结论 借助 APRV2 B IPAP模式实施 RMs疗效好 , 35 /20 cm H2O是最佳压力组合 ,对血流动力

    学和气道压等影响小;一旦 RMs获得疗效满意 ,设置 30 /15 cm H2O维持 20 min, RMs疗效好。

    【关键词 】 急性肺损伤; 气道压力释放 -双相正压通气; 肺复张 /开放;氧合指数 ( PaO2 /

    Fi O2 ) ; 肺泡萎陷; 计算机断层扫描 (CT) ; 血流动力学

    中图法分类号: R563 . 8; R33 文献标识码: A

    Lung recru itment / open maneuvers by APRV2 BIPAP ven til a ti on i n p i glets with acute lung i n jury

    YIN N a

    1

    , SONG Zhifang

    1

    , X I E W ei

    1

    , WU Zengbin

    1

    , YANG X iaolu

    2

    , Ge X iaoli

    1

    , WANG Ying

    1

    (

    1

    Depart m ent of

    M edical Intensive Care Unit , X inhua Hospital of Shanghai J iaotong Univer sity, Shanghai 200092;

    2

    Depart m ent of M edical

    Intensive Care Unit , J inhua Guangfu Hospital , J ianhua 321000, Zhejiang Province, China)

    【Abstract】 Objecti ve To evaluate lung recruit ment /open maneuvers (RMs) by air way p ressure

    release ventilati on (APRV) / bi phasic positive air way p ressure (B IPAP) mode and exp l ore the best lev2

    els of high and l ow air way p ressure combinati on and the effects on hemodynamic indexes . Methods The

    model of acute lung injury (AL I ) was induced by intraperit oneal injecti on of E. coli . in p iglets . The dif2

    ferent p ressure combinati ons ( Phigh /Pl ow) of RMswere increased sequentially on APRV / B IPAP mode,i . e . RM1 ( 30 /15) , RM2 ( 35 /20 ) , RM2 ( 40 /25 ) , RM4 ( 45 /30 ) , RM5 ( 50 /35 ) , RM6 ( 55 /40 ) ,RM7 (60 /45) cm H2O. The efficacy of RMswas evaluated by computed t omography (CT) at ins p irat ory

    phase and PaO2 /Fi O2 , hemodynamic indexes and mean p ressure of air way ( Pmean) were monit ored con2

    tinuously . The p iglets were sacrificed when RMs were finished and pul monary pathol ogical examinati on

    was done routinely by op ticalmicroscopy . Results Eight p igletswith AL Imodelwere established and all

    of them showed different degrees of alveolar collap se by CT scan . During RMs, the levels of PaO2 /Fi O2

    increased significantly ( P < 0 . 05) and the area of alveolar collap se decreased significantly ( P < 0 . 05)

    t oo, es pecially after RM2 was finished ( P < 0 . 05) . But the alveolar over inflati on could be found in

    s ome independent or non2lesi onal areas . The heart rate (HR) increased but mean artery bl ood p ressure

    (MBP) decreased significantlywhile the p ressure combinati ons( Phigh /Pl ow) of RMs increased gradually

    501 中华肺部疾病杂志(电子版) 2 0 0 8年 2月 第 1卷第 2期 试刊 Chin J LungDis(Electr onic Versi on) , February 2 0 0 8,Vol 1, No . 2( P < 0 . 05) . Meanti me the Pmean and peak ins p irat ory p ressure ( P IP) of air way and central venous ......