协和医学杂志

2013, (03)

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急性呼吸窘迫综合征肺复张后正常通气容积比例决定动脉血氧合
Arterial oxygenation was determined by the volume partition of normal aeration region after sustained inflation.

刘大为;隆云

摘要(Abstract):

目的 研究ARDS时的肺复张手法,分析影响动脉血气的肺影像因素,以探讨适合的肺复张手法。方法 在10只肺泡灌洗致ARDS的新西兰家兔中,应用动态肺部CT扫描,监测随气道压力递增和递减时肺内气体容积及分布的变化。使用Image-J软件分析CT影像。然后分别以五种不同的方式进行控制性肺膨胀以探讨开放肺泡的压力和维持肺泡开放的PEEP水平,测量控制性肺膨胀后2分钟及20分钟时的动脉血气。分析以不同压力水平下的影像学特征和动脉血气的相互关系。结果 在使用不同气道压力进行控制性肺膨胀后并应用相同PEEP水平进行通气时发现,肺复张后2分钟与20分钟时的动脉血氧分压(PaO2)随控制性肺膨胀压力的增加而增加(P<0.05)。PaO2与不同气道压力下正常通气容积比例(r=0.597,P=0.001)正相关,与通气不良容积比例(r=-0.592,P=0.001)和塌陷容积比例(r=-0.475,P=0.012)负相关,而与过度通气容积比例无关(r=0.202,P=0.311)无关。在相同气道压力进行控制性肺膨胀后,应用不同 PEEP进行通气。发现肺复张后2分钟时的不同PEEP水平下PaO2无差异(P>0.05);而在通气20分钟时,高PEEP水平下PaO2明显高于低PEEP水平(P<0.05)。正常通气区域容积比例与PaO2正相关(r=0.597,P=0.001),通气不良区域(r=-0.592,P=0.001)和塌陷区域比例(r=-0.544,P=0.002)与PaO2负相关。结论 完全肺复张需要较高的开放肺泡和维持肺泡开放的气道压力。肺复张后正常通气区域容积比例决定PaO2。
Objective Analyzing the correlation of arterial blood gas and pulmonary CT scan image after sustained inflation(SI), in order to explore the optimal recruitment maneuvers(RMs) in ARDS. Method Dynamic pulmonary CT scan was done to monitor the intrapulmonary gas volume and distribution during increment and decrement of airway pressure gradually in 10 warm-saline-lavage New Zealand rabbits. CT scan was analyzed by Images-J software. In order to look for optimal airway pressure for opening lung and optimal PEEP for maintaining lung open, five different SIs were implemented by individually and randomly, rabbits arterial blood gases were measured in 2mins and 20mins after every SI. Pulmonary CT scan and PaO2 under different airway pressure were combined to be analyzed. Result After different airway pressure of SI and equal PEEP ventilation, PaO2 was increased accompanied with airway pressure of sustained inflation in 2mins and 20mins after RMs(P<0.05). When PaO2 was combined with CT images,we found PaO2 was correlated well with the volume partition of normal aeration region(r=0.597,P=0.001), and insufficient aeration region(r=-0.592,P=0.001)and nonaeration region(r=-0.475,P=0.012), instead of overdistension region(r=0.202,P=0.311). While after equal airway pressure of SI and different PEEP ventilation, the different of PaO2 was nonsignificent in 2mins after RMs(P>0.05),and PaO2 was increased accompanied with PEEP in 20mins(P<0.05). In this situation,we found PaO2 was correlated well with the volume partition of normal aeration region(r=0.597,P=0.001), insufficient aeration region(r=-0.592,P=0.001), and nonaeration region(r=-0.592,P=0.001). Conclusion High airway pressure was needed for opening up the lung and keeping the lung open. Arterial oxygenation was determined by the volume partition of normal aeration region after SI.

关键词(KeyWords): |急性呼吸窘迫综合征 肺复张手法 控制性肺膨胀 动脉血氧分压 计算机断层摄像术|
|acute respiratory distress syndrome| recruitment maneuvers| sustained inflation| arterial oxygen partial pressure| computed tomography|

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作者(Author): 刘大为;隆云

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