上海交通大学学报（医学版）

上海交通大学学报（医学版）

• 论著（基础研究） • 上一篇    下一篇

肺损伤模型中压力与容量通气模式的比较

吴静波，周文贤，吴丽珍，王雪玲，蔡杰衡   

  1. 广东药学院附属第一医院麻醉科， 广州510080
  • 出版日期:2015-09-28 发布日期:2015-09-30
  • 作者简介:吴静波（1971—）， 男， 副主任医师， 硕士; 电子信箱: wjb25867@163.com。
  • 基金资助:

    广东省医学科学技术研究基金（A2013330）

Comparison of pressure support ventilation and controlled mechanical ventilation in lung injury model

WU Jing-bo, ZHOU Wen-xian, WU Li-zhen, WANG Xue-ling, CAI Jie-heng   

  1. Department of Anaesthesiology, the First Affiliated Hospital of Guangdong College of Pharmacy, Guangzhou 510080, China
  • Online:2015-09-28 Published:2015-09-30
  • Supported by:

    Guangdong Province Medical Science and Technology Research Foundation, A2013330

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摘要：

目的  确定压力支持通气（PSV）对实验性肺损伤的长期作用。方法  20只健康雌兔通过反复灌洗建立急性肺损伤的动物模型。将实验动物随机分成两组(n=10):PSV组将压力水平设在维持潮气量>4 mL/kg，呼吸频率<40/min;控制通气（CMV）组，潮气量为10 mL/kg，呼吸频率为20/min;两组呼气末正压均设为10 cmH2O。在急性肺损伤发生即刻及发生后2、4、8和12 h分别进行血气分析和通气-血流（VA/Q）分布的测定。结果  在PSV组,由于肺内分流的减少和VA/Q比正常的区域面积增加，氧合明显改善。CMV组与PSV组相比，肺内分流显著降低（P<0.05）。结论  在急性肺损伤动物模型中，PSV通过减少VA/Q比值的失衡明显改善气体交换，然而在改善VA/Q分布方面，CMV比PSV更为有效。

关键词: 急性肺损伤, 压力支持通气, 通气血流比值, 肺内分流

Abstract:

Objective  To determine the long-term effect of pressure support ventilation (PSV) on experimental lung injury. Methods  The animal model of acute lung injury (ALI) was established by repetitive lung lavage for 20 healthy adult female rabbits. Rabbits were randomly divided into the PSV group (n=10) with the pressure level of tidal volume>4 mL/kg and respiratory rate of <40/min and controlled mechanical ventilation (CMV) group (n=10) with the pressure level of tidal volume of 4 mL/kg and respiratory rate of 20/min. The positive end-expiratory pressure of two groups was set at 10 cmH2O. Blood gas analysis and determination of ventilation-perfusion (VA/Q) distribution were performed at the onset of ALI and 2, 4, 8, and 12h after the onset of ALI. Results  The oxygenation of PSV group improved remarkably because the pulmonary shunt remarkably decreased and the area with normal VA/Q ratio increased. Compared with the PSV group, the pulmonary shunt of CMV group significantly decreased (P<0.05). Conclusion  PSV remarkably improves the gas exchange by reducing the inequality of VA/Q in the animal model of ALI. However, as far as the improvement of VA/Q distribution is concerned,  CMV is more effective than PSV.

Key words: acute lung injury, pressure support ventilation, ventilation-perfusion distribution, pulmonary shunt