4种方法滴定急性呼吸窘迫综合征动物模型最佳呼气末正压效果的比较

doi:10.7694/jldxyxb20130610

吉林大学学报(医学版)

4种方法滴定急性呼吸窘迫综合征动物模型最佳呼气末正压效果的比较

边伟帅¹，晁彦公²，陈炜¹，王兰³，李黎明²，关键²，甄洁¹，盛博¹，刘平¹

（１.首都医科大学附属北京世纪坛医院重症医学科，北京100038；２.清华大学第一附属医院重症医学科，北京100016；３.北京中医药大学东直门医院重症医学科，北京100700）

收稿日期:2013-04-10 发布日期:2013-11-28
通讯作者: 陈炜 E-mail:（Tel：010-63925588，E-mail：hanwa@yahoo.cn）
作者简介:边伟帅（1979-），男，北京市人，主治医师，主要从事急危重症临床工作。 
基金资助:
北京市卫生局重大科研项目资助课题（2005-32）


Comparison of effects between four kinds of methods on setting optimal positive end expiratory pressure in animal models with acute respiratory distress syndrome

BIAN Wei-shuai¹,CHAO Yan-gong²,CHEN Wei¹,WANG Lan³,LI Li-ming²,GUAN Jian²,ZHEN Jie¹,SHENG Bo¹,LIU Ping¹

(1.Department of Critical Care Medicine,Affiliated Beijing Millennium Monument Hospital,Capital Medical University,Beijing 100038,China;2.Department of Critical Care Medicine,First Affiliated Hospital,Tsinghua University,Beijing 100016,China;3.Department of Critical Care Medicine,DongzhimenHospital,Beijing University of Traditional Chinese Medicine,Beijing 100700,China)

Received:2013-04-10 Published:2013-11-28

摘要/Abstract

摘要：

目的：比较不同方法滴定急性呼吸窘迫综合征（ARDS）动物模型中最佳呼气末正压（PEEP）效果的差异，阐明所研究4种方法对确定最佳PEEP的可行性，为临床治疗ARDS提
供依据。方法：油酸静脉注射法复制猪ARDS模型（n=7），应用压力控制法进行肺复张，根据最佳氧分压+二氧化碳分压法(PaO2+PaCO2)、最佳氧合法、静态顺应性(Cst)法和动态顺应性（Cdyn）法4种不同方法确定最佳PEEP。记录在基础状态、ARDS状态和最佳PEEP下， ARDS猪模型的肺内分流（Qs/Qt）、Cst、Cdyn、氧合指数（OI）、动脉血氧饱和度（SaO2）、中心静脉压（CVP）、心排量（CO）、全心舒张末容量(GEDV)、胸腔内血容量(ITBV)和血管外肺水（EVLW）等参数。结果：PaO2+PaCO2、最佳氧合法、Cst和Cdyn法确定的最佳PEEP分别为（13.14±1.35）、（13.43±1.51）、（14.43±4.12）和（14.14±2.91）cmH2O，两两比较差异均无统计学意义（P>0.05）。在ARDS状态下OI、Cst和Cdyn等指标较基础值明显降低（P<0.05），应用最佳PEEP通气后这3个指标较ARDS状态明显升高（P<0.05），但仍不能达到基础状态水平；在ARDS状态下猪的Qs/Qt较基础值明显增加（P<0.05），在ARDS状态下SaO2较基础值明显降低（P<0.05），应用最佳PEEP通气后，猪的Qs/Qt和SaO2能恢复到基础状态水平；在基础状态、ARDS状态和最佳PEEP状态下，心脏的CO、ITBV和GEDV差异均无统计学意义（P>0.05）；ARDS状态下猪的EVLW明显高于基础状态（P<0.05），应用最佳PEEP并未改善EVLW。结论：PaO2+PaCO2、最佳氧合法、Cst和Cdyn 4种不同方法均可以作为滴定最佳PEEP的方法。最佳PEEP可以有效改善呼吸顺应性、提高氧合和降低肺内分流，并对心功能无明显影响。


关键词: 急性呼吸窘迫综合征, 最佳呼气末正压, 静态顺应性, 动态顺应性

Abstract:

To compare the differences of effects between   four kinds methods on setting t
he optimal positive end expiratory pressure （PEEP）in animal models with acute respiratory distress syndrome(ARDS),and to clarify the feasibility of these methods to confirm the optimal PEPP and to provide basis for ARDS treatment in clinic.
Methods The ARDS pig models were induced by intravenously infusing oleic acid(n=7).The optimal PEEP level was determined by four kinds of methods after lun
g recruitment:such as optimal PaO2 + PaCO2 method,optimal oxygenation method,optimal static compliance（Cst） method,and optimal dynamic compliance (Cdyn) method. Intrapulmonary shunt fraction（Qs/Qt）,plateau airway pressure (Pplat),Cst,dynamic compliance(Cdyn),oxygen index（OI）,central venous pressure（CVP）,cardiac output(CO), global end-diastolic volume(GEDV), intra-thoracic blood volume(ITBV),extravascular lung water（EVLW） of ARDS pigs were recorded before infusing oleic acid，after s
tabilization of ARDS model and at optimal PEEP level. Results The optimal PEEP
（cmH2O） eleterminated by optimal PaO2 + PaCO2 method(13.14±1.35),optimal oxygenation method( 13.43±1.51),optimal Cst method( 14.43±4.12 )and optimal cdyn method(14.14±2.91) had no significant differences (P>0.05).The values of OI,Cst,Cdyn and arterial oxygen saturation(SaO2) in ARDS model were significantly lower than those at the baseline level (P<0.05).Compared with ARDS model，the values of OI,Cst,Cdyn and SaO2 were significantly improved after using optimal PEEP(P<0.05).The value of Qs/Qt was increased in   ARDS model compared with the baseline level(P<0.05);and the value of
SaO2 was decreased(P<0.05).The values of Qs/Qt and SaO2 were   decreased to the baseline level after using optimal PEEP.The values of CO,GEDV,and ITBV showed no significant differences(P>0.05) between the baseline level，ARDS model and optimal PEEP level；the value of EVLW in ARDS m
odel was significantly higher than that at the baseline level (P<0.05)，but the optimal PEEP did not change EVLW. Conclusion The four kinds of methods can identify the optimal PEEP.The optimal PEEP can improve lung compliance and oxygenation，and decrease the intrapulmonary shunt，but has no effect on heart function.

Key words: acute respiratory distress syndrome, positive end expiratory pressure, static compliance, dynamic compliance

中图分类号:

R363

边伟帅，晁彦公，陈炜，王兰，李黎明，关键，甄洁，盛博，刘平. 4种方法滴定急性呼吸窘迫综合征动物模型最佳呼气末正压效果的比较[J]. 吉林大学学报(医学版), 2013, 39(6): 1132-1137.

BIAN Wei-shuai,CHAO Yan-gong,CHEN Wei,WANG Lan,LI Li-ming,GUAN JianZHEN Jie,SHENG Bo,LIU Ping. 
Comparison of effects between four kinds of methods on setting optimal positive end expiratory pressure in animal models with acute respiratory distress syndrome[J]. Journal of Jilin University Medicine Edition, 2013, 39(6): 1132-1137.

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4种方法滴定急性呼吸窘迫综合征动物模型最佳呼气末正压效果的比较

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Comparison of effects between four kinds of methods on setting optimal positive end expiratory pressure in animal models with acute respiratory distress syndrome

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4种方法滴定急性呼吸窘迫综合征动物模型最佳呼气末正压效果的比较

 Comparison of effects between four kinds of methods on setting optimal positive end expiratory pressure in animal models with acute respiratory distress syndrome

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Comparison of effects between four kinds of methods on setting optimal positive end expiratory pressure in animal models with acute respiratory distress syndrome