呼气末正压对急性呼吸窘迫综合征绵羊血管外肺水的影响-东南大学学报医学版

呼气末正压对急性呼吸窘迫综合征绵羊血管外肺水的影响

单位：1.东南大学附属中大医院危重病医学科,江苏,南京,210009;镇江市第四人民医院,江苏,镇江,212001； 2.东南大学附属中大医院危重病医学科,江苏,南京,210009

分类号：R-332, R332.3, R563.805

出版年·卷·期（页码）：2004·23·第四期（239-243）

摘要：

目的:探讨呼气末正压(PEEP)对急性呼吸窘迫综合征(ARDS)血管外肺水(EVLW)的影响.方法:以内毒素持续静脉注射复制绵羊ARDS模型.根据PEEP水平分成5 cm H2O(7只,1 cm H2O=0.098 kPa)、10 cm H2O(8只)和15 cm H2O(6只)3个组.采用单指示剂热稀释法测定EVLW.应用PEEP前 (0 h)、应用后1 h和2 h测定EVLW,同时监测血流动力学、呼吸力学和肺气体交换.结果:应用PEEP前,10 cm H2O和15 cm H2O组EVLW分别为(16.5±4.7) ml·kg-1和(18.4±6.0) ml·kg-1;应用PEEP 2 h后,EVLW分别为(14.7±4.5) ml·kg-1和(15.3±3.7) ml·kg-1,较应用PEEP前显著减少(P<0.05).应用PEEP前,15 cm H2O组氧合指数(PaO2/FiO2)为(87.3±27.9) mmHg(1 mmHg=0.133 kPa);应用PEEP 2 h后,显著升高至(138.6±41.8) mmHg(P<0.05).应用PEEP前,15 cm H2O组肺静态顺应性为(11.4±1.9) ml·cm H2O-1;应用PEEP 2 h后,显著升高至(14.8±2.3) ml·cm H2O-1(P<0.05).结论:适当水平的PEEP能显著减少ARDS绵羊EVLW.

Objective To determine the effect of positive end-expiratory pressure (PEEP) on extravascular lung water (EVLW) in sheep with acute respiratory distress syndrome (ARDS). Methods Sheeps of ARDS model,induced by intravenous infusion of endotoxin,were separated into three groups according to PEEPs of 5?cm?H 2O(n=7),10?cm?H 2O(n=8) and 15?cm?H 2O(n= 6) and received mechanical ventilation of respective PEEPs for 2 hours. EVLW was measured by single indicator thermodilution technique at 0,1 and 2 hour after PEEP was applied. Hemodynamics, pulmonary mechanics and gas exchange were observed at the same time. Results At 2?h,the EVLWs of 10?cm?H 2O and 15?cm?H 2O group [(14.7±4.5)? ml·kg -1 and (15.3±3.7)?ml·kg -1 respectively] were significantly (P<0.05) less than those of 0?h [(16.5±4.7)?ml·kg -1 and (18.4±6.0)?ml·kg -1 respectively]. At the same time,the PaO 2/FiO 2 of 15?cm?H 2O group increased significantly(P< 0.05) from 0?h(87.3±27.9)?mmHg to (138.6±41.8)?mmHg,so did the pulmonary static compliance from 0?h (11.4± 1.9)?ml·cm?H 2O -1 to (14.8±2.3)?ml·cm?H 2O -1(P<0.05). Conclusion Suitable level of PEEP exerts a significant effect of reducing EVLW in sheep ARDS model.

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