摘要
目的用动物实验模拟早期急性呼吸窘迫综合征（ＡＲＤＳ），比较几种呼气末正压（ＰＥＥＰ）治疗的呼吸循环效应，确定适当ＰＥＥＰ治疗水平。方法利用绵羊ＡＲＤＳ模型，比较０ｃｍＨ２ＯＰＥＥＰ，最大静态顺应性ＰＥＥＰ，吸气相静态ＰＶ曲线低位曲折点消失的最小压力作为曲折点ＰＥＥＰ，和曲折点ＰＥＥＰ３ｃｍＨ２Ｏ（１ｃｍＨ２Ｏ＝００９８ｋＰａ）与曲折点ＰＥＥＰ＋３ｃｍＨ２Ｏ条件下，血流动力学、肺力学参数和肺气体交换的变化。结果（１）曲折点ＰＥＥＰ（６８±１４ｃｍＨ２Ｏ）显著小于最大静态顺应性ＰＥＥＰ（９３±１４ｃｍＨ２Ｏ，Ｐ＜００１）；（２）与０ｃｍＨ２ＯＰＥＥＰ比较，曲折点ＰＥＥＰ时血流动力学差异无显著性（Ｐ＞００５）；改良氧合指数（ＰａＯ２／ＦｉＯ２），显著改善，肺顺应性提高，阻力降低（Ｐ＜００１）；（３）与曲折点ＰＥＥＰ比较，最大静态顺应性ＰＥＥＰ与曲折点ＰＥＥＰ＋３ｃｍＨ２Ｏ时血流动力学差异无显著意义（Ｐ＞００５），肺血管阻力指数明显增加；ＰａＯ２／ＦｉＯ２无显著改变，平均气道压及气道峰值压显著增加。结论早期ＡＲＤＳ的ＰＥＥＰ治疗中，所需ＰＥＥＰ水平较一般认为的取得最大静态顺应确定的“最佳ＰＥ?
Objective To study the optimal level of PEEP at early stage of ARDS. Method The parameters of hemodynamics, lung mechanics, and gas exchange were compared at different levels of PEEP, including maximal static compliance PEEP, point inflection PEEP, 3 cmH 2O higher or lower than point inflection PEEP, and zero end expiratory pressure. Results Point inflection PEEP (6 8±1 4 cmH 2O) was significantly lower than maximal static compliance PEEP (9 3±1 4 cmH 2O), P <0 01 The hemodynamic parameters were not significantly different in point inflection PEEP compared with 0cmH 2O PEEP ( P >0 05), but oxygenation index (PaO 2/FiO 2) and lung mechanics (static compliance and airway resistance) were improved significantly at point inflection PEEP ( P <0.01). At maximal static compliance PEEP or 3 cmH 2O higher than point inflection PEEP, the hemodynamic parameters and PaO 2/FiO 2 were not different from those at point inflection PEEP ( P >0.05). The pulmonary vascular resistance index (PVRI) was significantly higher ( P <0.05) and the mean airway pressure and peak inspiratory pressure increased significantly ( P <0.01). Conclusion In the treatment of early ARDS, the PEEP needed may be lower than the “optimal PEEP” determined by obtaining the maximal static compliance. The application of point inflection PEEP determined at inspiratory static pressure volume curve was appropriate as the best PEEP.
出处
《中华医学杂志》
CAS
CSCD
北大核心
1998年第6期409-412,共4页
National Medical Journal of China
关键词
急性
呼吸窘迫综合征
正压呼吸
PEEP
治疗
Sheep Acute respiratory distress syndrome positive pressure respiration
