控制性肺膨胀对急性呼吸窘迫综合征绵羊肺力学和肺损伤的影响

目的：探讨控制性肺膨胀（SI）与肺保护性通气策略联合应用时,对急性呼吸窘迫综合征（ARDS）的肺泡复张作用及其安全性。方法：利用内毒秀导的绵羊ARDS模型,观察实施SI[2.94kPa(1kPa=10.20cmH2O),屏气时间20秒]后绵羊的肺力学和组织病理学改变。结果：实施SI后,绵羊的动态肺顺应性和肺容积显著增加,气道峰值压、平台压和平均气道压均显著降低（P均＜0．05）,并可维持3－4小时。与未应用SI的绵羊比较,实施SI后的绵羊肺损伤减轻,肺不张改善。结论：SI具有肺复张和肺保护作用,是肺保护性通气策略的重要补充。

Effects of sustained inflation on pulmonary mechanics and lung injury in sheep w ith acute respiratory distress syndrome

Objective:To determine the safety of sustained inflation (SI) combined with lung protective strategy for alveolar recruitment in sheep with acute respiratory distress syndrome (ARDS).Methods:ARDS sheep model was induced by intravenous infusion of endotoxin,and SI was applied at a pressure of 2 94 kPa (1 kPa=10 20 cmH 2O) for 20 seconds.Pulmonary mechanics was determined and histologic examination were done.Results:Dynamic pulmonary compliance and lung volume significantly increased after SI,while mean airway pressure,peak inspiratory pressure and airway plateau pressure markedly decreased (all P <0 05);all these parameters were able to maintain for 3~4 hours.Compared with ventilation without SI,lung injury was abated after SI.Conclusions:SI is a lung recruitment and lung protective approach,which might become an important supplement of lung protective strategy.