摘要
目的：探讨气管内吹气（ＴＧＩ）对机械通气相关性急性肺损伤（ＡＬＩ）家兔实施容许性高碳酸血症（ＰＨＣ）时二氧化碳清除效果及其在维持二氧化碳分压（ＰａＣＯ２ ）大致正常时降低潮气量（ＶＴ）、气道峰压（Ｐｐｅａｋ ）和平台压（Ｐｐｌａｔｅ）的作用。方法：用自行设计的ＴＧＩ装置对常规机械通气（ＣＭＶ）组和小ＶＴ 机械通气致ＰＨＣ时ＡＬＩ家兔行ＴＧＩ，观察２ 组动物在不同吹气流量（０．２ Ｌ／ｍ ｉｎ 和０．４ Ｌ／ｍ ｉｎ）时呼气末二氧化碳分压（ＰｅｔＣＯ２ ）、血气与呼吸力学等指标的变化，并分别同单纯ＣＭＶ时ＡＬＩ家兔（病理对照组）比较。结果：①ＴＧＩ可明显降低ＣＭＶ组和ＰＨＣ组家兔的ＰａＣＯ２ 水平，促进ＣＯ２ 清除，并能在ＶＴ 降低３０％ 的情况下维持ＰａＣＯ２ 在正常范围，ＴＧＩ降低ＰａＣＯ２ 的作用呈流量依赖性；②ＴＧＩ使２ 组动物的气道压力明显增高，但ＰＨＣ组Ｐｐｅａｋ、Ｐｐｌａｔｅ水平均显著低于ＣＭＶ组；③ＴＧＩ无加重肺组织病理改变作用，ＴＧＩ与ＰＨＣ结合能显著减轻非病变区肺泡的扩张程度。结论：ＴＧＩ是一种简便实用的机械通气的辅助手段，它能有效地降低ＰａＣＯ２，在ＰＨＣ状态下抑制或减缓ＰａＣＯ２的上升速度。
Objective:To evaluate the effects of tracheal gas insufflation (TGI) on the elimination of CO 2 and the reduction of tidal volume (V T),airway peak pressure (P peak ),airway pause pressure(P plate ) while maintaining PaCO 2 in the normal range in acute lung injury (ALI) rabbits with permissive hypercapnia.Methods:Using selfdesigned TGI device,we have determined changes in PaCO 2,P peak ,P plate and end expiratory carbon dioxide pressure (PetCO 2) in two groups of conventional mechanical ventilation (CMV) and permissive hypercapnia (PHC) by applying two different TGI flow (0 2 L/min and 0 4 L/min).We have also studied the pathological changes of the two groups and compared with a group of rabbits receiving CMV treatment only.Results:TGI can significantly decrease the PaCO 2 level,enhance CO 2 elimination and maintain PaCO 2 in the normal range,while decreasing V T by 30%,and the reduction effects of CO 2 are flow dependent.TGI can elevate airway pressure in both animal groups,but the levels of P peak 、P plate in PHC group are significantly lower than those of CMV group.PetCO 2 levels are significantly decreased after TGI.Combined TGI with PHC strategy can protect the lung from over distention and thus avoid the incidence of ventilation induced lung injury.Conclusions:Our results reveal that TGI is a simple and practical adjunct to mechanical ventilation,it can effectively decrease PaCO 2,impede rise of PaCO 2 under PHC condition,and maintain low airway pressure.Furthermore it avoids over distention of the diseased lung and has protective effects from ventilator induced lung injury.
出处
《中国危重病急救医学》
CAS
CSCD
2000年第1期42-47,共6页
Chinese Critical Care Medicine
关键词
气管内吹气
肺损伤
急性
机械通气
PHC
treacheal gas insufflation
permissive hypercapnia
acute lung injury
mechanical ventilation
