俯卧位通气联合肺复张对ARDS氧合及肺复张容积的影响
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Effects of prone position ventilation combined with recruitment maneuvers on oxygenation and lung recruited volume in canines with acute respiratory distress syndrome
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    摘要:

    目的:探讨俯卧位通气联合肺复张对急性呼吸窘迫综合征(ARDS)氧合及肺复张容积的影响-方法:健康杂种犬24只,油酸静脉注射复制ARDS模型,再随机分为4组,每组6只,分别应用仰卧位常规机械通气(SC组)-仰卧位联合控制性肺膨胀(SI) (SS组) -俯卧位通气(PC组)-俯卧位通气联合SI(PS组)-各组观察5 h,记录氧合及肺复张容积等指标的变化-结果:①与SC组相比,SS组PaO2/FiO2仅在成模后2 h显著增高(P < 0.05),而PC组和PS组PaO2/FiO2在成模后2 h及5 h均高于SC组(P均< 0.05)-成模2 h及5 h,PS组PaO2/FiO2明显高于SC组-PC组-SS组(P均<0.05);②成模0 h,4组的肺复张容积差异无统计学意义(P均> 0.05)-成模2 h,SS组-PC组-PS组肺复张容积较SC组明显增加(P均< 0.05)-成模5 h,与SC组相比,SS组肺复张容积呈减少趋势,PC组-PS组肺复张容积呈增高趋势-结论:俯卧位通气联合SI较单应用俯卧位通气及单应用SI能更好的改善ARDS氧合,肺复张容积的显著增加可能是主要机制之一-

    Abstract:

    Objective:To evaluate the effects of prone position ventilation combined with recruitment maneuvers(RM) on oxygenation and lung recruited volume(RV) in oleic acid-induced acute respiratory distress syndrome in canines. Methods:Twenty-four healthy canines were randomly divided into four groups after oleic acid-induced lung injury:supine position group(SC),supine position+RM group(SS),prone position group(PC) and prone position+RM group(PS). Oxygenation index and RV were measured for five hours after ARDS was reproduced. Results:(1)Compared to the SC group,oxygenation index in SS group was increased only at 2 h after onset of ARDS(P < 0.05),while that of PC and PS group improved both at 2 h and 5 h after onset of ARDS(all P < 0.05). Compared to the SC,SS,and PC group,PS group oxygenation index was much higher at 2 h and 5 h after onset of ARDS(all P < 0.05). (2)There was no significant difference of RV among the four group at 0 h after onset of ARDS(all P > 0.05). Compared to the SC group,RV in SS,PC and PS group was much higher at 2 h after onset of ARDS(all P < 0.05). At 5 h after onset of ARDS,the RV of the SS group had a tendency to decrease while the RV of the PC and PS group had a tendency to increase. Conclusion:Prone position ventilation combined with RM improved oxygenation significantly. The increase of RV may be one of the most important mechanisms of its positire effect.

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严〓正,许红阳,梁锋鸣,陈秋华,金〓科,衡军锋,严〓洁,邱海波.俯卧位通气联合肺复张对ARDS氧合及肺复张容积的影响[J].南京医科大学学报(自然科学版),2010,(4):450-453571

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  • 收稿日期:2009-11-21
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