自主呼吸条件下双相气道正压通气与持续性气管内吹气联合运用的 …

目的 探讨在自主呼吸间隙存在时应用持续性气管内吹气（ＣＴＧＩ）的可能性。方法 油酸所致急性肺伤犬模型８号，随机予双相气道正压通气（ＢＩＰＡＰ）及ＢＩＰＡＰ加用ＣＴＧＩ（流速分别为３、６、９Ｌ／ｍｉｎ，简称Ｔ３、Ｔ６、Ｔ９组），调节ＢＩＰＡＰ压力水平使ＰａＣＯ２在各组间相等，达到稳态后测定各通气方式下的气体交换、呼吸力学、血流动力学和氧动力学指标。结果 在保证ＰａＣＯ２相同，即通气效果相同的前提下，

Effects of continuous tracheal gas insufflation during biphasicinterm ittent positive airway pressure ventilation on canine model of acute lung injury with spontaneous breathing

OBJECTIVE: To study the possibility of using continuous tracheal gas insufflation (CTGI) in dogs with spontaneous breathing. METHODS: Eight canine with oleic acid induced lung injury which had spontaneous breathing were ventilated by Evita 2 (Drager Inc). The setting parameters were FiO(2) (60%), I/E (1:1), RR (20) and PEEP (5 cm H(2)O) in four different conditions: BIPAP (BIPAP group) and BIPAP with different CTGI flow rates (3, 6 and 9 L/min, T3, T6 and T9 group). Gas exchange, lung mechanics and hemodynamic status were monitored at the same level of PaCO(2) obtained by adjusting the high pressure (P high) of BIPAP. RESULTS: The peak inspiratory pressures in the T6 group (14 cm H(2)O +/- 4 cm H(2)O) and T9 group (11 cm H(2)O +/- 3 cm H(2)O) were significantly lower than that of BIPAP group (20 cm H(2)O +/- 5 cm H(2)O, P < 0.01), but significant differences were not found neither among T3, T6 and T9 groups, nor between T3 and BIPAP groups. PaO(2), hemodynamics and oxygenation remained unchanged in the four different conditions. CONCLUSION: BIPAP combined with CTGI in canine with spontaneous breathing could significantly decrease the airway pressure, with no influence on hemodynamics and oxygenation. Thus BIPAP with CTGI may be a useful support technique, especially for cases whose airway pressure should be limited.