摘要
目的评价通过监测食道压设定呼吸机参数，对重症急性胰腺炎腹高压模型猪血流动力学和氧代谢的影响。方法采用自身对照研究，将6只家猪进行麻醉、气管插管后接呼吸机辅助呼吸，使用含5％牛磺胆酸钠和0．5％胰蛋白酶生理盐水1ml／kg胰管内注射制作重症急性胰腺炎模型，呼吸机参数为容量控制10mt／kg，Fi0240％，PEEP5cmH20（常规机械通气）（1cmH20=0．098kPa）。置入动脉导管和Swan-Ganz导管测定心率（HR）、平均动脉压（MAP）、心指数（CI）、中心静脉压（CVP）、肺动脉嵌压（PAWP）及气道峰压（Ppeak）、平台压（Pplat）、胸内压（Pes）、肺顺应性（Cstat）并行血气分析检查。3h后通过腹腔内注入氮气法制作25mmHg（1mmHg=0．133kPa）腹高压模型，呼吸机参数不变，持续3h观察上述指标的变化；随后置入食道测压管，调整PEEP使呼气末跨肺压为正值（跨肺压导向机械通气），其余呼吸机参数不变，持续3h观察上述指标的变化。结果6只家猪均制模成功，无一发生气压伤。常规机械通气时，腹高压1h、3h与胰腺炎相比HR增快；MAP、CVP和PAWP上升；CI下降。Ppeak、Pplat、Pes上升；Csat下降。PaO2和氧输送（DO2）等氧代谢指标下降（均P〈0．05）；跨肺压导向机械通气与常规机械通气相比，模型猪的PaO2以及Cstat明显改善，Pplat升高，CI下降，血乳酸降低（均P〈0．05）；PaCO2、HR、MAP、CVP、PAWP差异无统计学意义（均P〉0．05）。结论通过食道压监测设定呼吸机参数能改善重症急性胰腺炎腹高压模型猪的氧分压及肺顺应性，对血流动力学指标影响较小。
Objective To study the effect of mechanical ventilation guided by esophageal pressure on hemodynamics and oxygen metabolism of severe acute pancreatitis （SAP） swine model with intra-abdominal hypertension （IAH） Methods By self-controlled study, SAP model was made by infusing sodium taurocholate （5%） into the pancreatic duct in 6 domestic swine. Mechanical ventilator mode was volume- assist control with tidal volume l0 ml/kg ; FiO2 40% and PEEP 5 cm H20 （routine ventilation） given to SAP model swine. After 3 h ventilation, pneumo-peritoneum was made with N2 gas to increase the intra- abdominal pressure （IAP） to 25 mm Hg in SAP swine. Three more hours later, PEEP was adjusted as the measurement of esophageal pressure （ Pes guided ventilation） to such a level that trans-pulmonary pressure stayed above 0 cm H20 during end-expiratory occlusion. During the investigation period, heart rate （HR） , cardiac output index （CI）, central venous pressure （CVP）, mean arterial pressure （MAP） and pulmonary arterial wedge pressure （PAWP） were continuously recorded with the aid of Swan-Ganz catheter and ECG monitor, and oxygen partial pressure of artery （ PaO2 ） and carbon dioxide partial pressure of artery （ PaCO2 ）were measured by blood-gas analysis. In addition, systemic oxygen delivery （DO2 ） and systemic oxygen consumption （VO2） were calculated by using the data of blood-gas analysis of arterial and central venous blood. Results No swine model was subjected to barotrauma. After routine mechanical ventilation, there were significant differences in HR, CI, MAP, CVP, PAWP, Ppeak, Polar, Pes, pulmonary compliance （Cstat）, PaO2, and DO2 between SAP and IAH in swine （all P 〈 0. 05）. Compared with routine ventilation, however, PaO2 and Cstat improved significantly with lower CI and increased Pplat after PEEP adjusted according to measurements of esophageal pressure （all P 〈 0. 05 ）. The lactate decreased significantly after esophageal pressure guided ventilati
出处
《中华急诊医学杂志》
CAS
CSCD
北大核心
2013年第5期487-490,共4页
Chinese Journal of Emergency Medicine
基金
全军医药卫生科研基金（06G041）
关键词
腹高压
猪模型
食道压
血流动力学
氧代谢
Intra-abdominal hypertension
Porcine model
Esophageal pressure
Hemodynamics
Oxygen metabolism
