摘要
目的 比较研究双水平气道压力调节通气(BIPAP)、气道压力释放通气(APRV)、反比通气(IRV)和间歇气道正压通气(IPPV)对急性肺损伤犬心肺功能的影响,探讨其应用价值。方法 急性肺损伤犬应用四种通气模式在0、0.5和1kPa呼气末压(EEP)时观察通气、气道压力、气体交换和血流动力学各参数变化。结果 与IPPV比较,BIPAP和APRV均能降低气道峰压(Ppeak)(P<0.05),但仅BIPAP(0.5kPa EEP)能明显降低气道平均压(mPaw)(P<0.05)。随着外源性呼气末正压(1kPa PEEP)的应用,各通气模式均能改善动脉血氧合(P>0.05),以BIPAP和APRV升高动脉血氧分压(PaO_2)的幅度最大(P<0.05),且BIPAP尚伴有混合静脉血氧分压(PvO_2)的改善和肺血管阻力降低(P<0.05)。APRV和IRV的吸气时间均明显延长,但与IPPV比较,无明显的血流动力学变化(P>0.05)。结论 与IPPV比较,BIPAP、APRV和IRV在一定程度上均可降低Ppeak,BIPAP和APRV加1kPa PEEP后,PaO_2分别升高47.1％和52.3％,但仅BIPAP伴有PvO_2升高和肺血管阻力降低。
Objective To compare the cardiopulmonary effects of biphasic positive airway pressure (BIPAP), airway pressure release ventilation (APRV), inverse ratio ventilation (IRV) and intermittent positive pressure ventilation(IPPV)in dogs with acute lung injury.Methods Airway pressure, hemody-namics and blood gases were measured during the four ventilation modalities with 0,0.5 and 1 kPa external end-expiratory pressure (EEP) in dogs with oleic acid-induced lung injury.Results Compared with IPPV, peak airway pressure (Ppeak) in BIPAP and APRV all decreased (P < 0.05), but mean airway pressure(mPaw)decreased markedly only in BIPAP(0.5 kPa EEP,P<0.05) . With the application of PEEP,PaO2 was improved in all ventilation modes,in which PaO2 in BIPAP and APRV was improved more significantly(P< 0.05) .BIPAP can also improved PvO2 and reduced pulmonary vessel resistance (PVR)(P< 0.05) . Although time of inspiration (Tinsp) was greatly prolonged in APRV and IRV, there is no apparent change in hemodynamics parameters(P>0.05) .Conclusion Compared with IPPV,BIPAP.APRV and IRV can all decreased Ppeak. With the application of 1 kPa PEEP,PaO2 in BIPAP and APRV increased by 47.1% and 52.3% .respectively . Only BIPAP could improved PvO2, and reduced PVR.
出处
《中国呼吸与危重监护杂志》
CAS
2002年第1期31-35,共5页
Chinese Journal of Respiratory and Critical Care Medicine
基金
卫生部直属医疗机构临床学科重点建设基金(No.CD96/26)
关键词
机械通气
血注动力学
急性肺损伤
Mechanical ventilation
Hemodynamics
Acute lung injury
