不同辅助比例时PAV对急性肺损伤犬心肺功能影响比较.docVIP

不同辅助比例时PAV对急性肺损伤犬心肺功能影响比较 　 作者：方智野，钮善福，朱蕾，王健，张敏 【摘要】 目的：观察比例辅助通气（PAV）时不同辅助比例对急性肺损伤（ALI）犬呼吸、循环功能影响，为PAV临床广泛应用奠定基础。方法：对10条ALI犬先用间歇正压通气(IPPV)模式通气，同时计算弹性阻力(Ers)和粘性阻力(Rrs)，然后将模式改为PAV，随机设置辅助比例80％、60％、40％、20％，观察通气期间呼吸力学、血气和血流动力学的变化。结果：随着辅助比例的增加气道峰压(Ppeak)、气道平均压(mPaw)、潮气量(VT)、呼吸机呼吸功(WOBv)均增加，犬呼吸功(WOBp)减少。Ppeak、WOBp各比例间均差异显著，PAV40%和PAV20%的VT、WOBp与PAV80%相比，差异显著，PAV20%时mPaw、血氧分压(PaO2)、WOBv与PAV80%相比差异显著，PAV20%时WOBp、WOBv与PAV40%相比，差异显著。随辅助比例增加，PAV80%、PAV60%、PAV40%间血气分析结果差异不显著，PAV20%时PaCO2、PaO2与PAV80%相比差异显著。随着辅助比例的增加血压(mBP)、中心静脉压(CVP)、肺毛细血管楔压(PCWP)、平均肺动脉压(mPAP)均有增加趋势，心输出量(CO)有降低趋势，其中PAV20%的CVP与其余辅助比例相比，差异显著，余指标间差异不显著。结论：在ALI犬中，不同的辅助比例对气道压力和呼吸功影响较大，对血流动力学影响较小。 【关键词】 比例辅助通气； 急性肺损伤； 心肺功能 　　Influence on Cardiac-pulmonary Function of Acute Lung Injury (ALI) Dogs by Different Assist Ratio of Proportional Assist Ventilation 　　Abstract： Objective： Comparing the influence on cardiac-pulmonary function of acute lung injury (ALI) dogs by different assist ratio of proportional assist ventilation (PAV). Method： Use intermittent positive pressure ventilation (IPPV) mode in ALI dogs, calculate Elastance (Ers) and Resistance(Rrs), then change to PAV, set the assist ratio 80％、60％、40％、20％randomly, Observe the changes of respiratory mechanics、blood gas analysis and hemodynamics during mechanical ventilation. Result： With the increase of assist ratio, peak pressure(Ppeak)、mean airway pressure(mPaw)、tidal volume(VT)、work of breath of ventilator(WOBv) were all increased, work of breath of Patient(WOBp) decreased， the difference of Ppeak and mPaw between the every two assist ratios were notable. During PAV80%, VT and WOBp were different from that of PAV20% and PAV40%，the difference was notable. with the increase of assist ratio, mean blood pressure(mBP)、central venous pressure(CVP)、pulmonary capillary wedge pressure(PCWP)、mean pulmonary artery pressure(mPAP) increased, cardiac output(CO) decreased. During PAV20%, CVP were markedly different from that of the other assist ratios, the difference was notab