压力调节容量控制通气对肺损伤犬血流动力学、呼吸力学和呼吸功能的影响

目的 探讨压力调节容量控制(PRVC)通气模式对健康及急性肺损伤(ALI)模型犬的血流动力学、呼吸力学和呼吸功能的影响。方法 PRVC和间歇正压通气(IPPV)两种通气模式在呼气末压为0、0．5、1．0和1．5kPa时，分别测定健康犬及油酸诱发ALI犬的血流动力学、呼吸力学及血气参数。结果 健康犬PRVC较IPPV模式下除了在PEEP为0．5kPa时，气道峰压(PIP)、肺动态顺应性(Cdyn)和肺血管阻力(PVR)的影响差异有显著性，对血流动力学、呼吸力学及呼吸功能的影响差异均无显著性。ALI犬PRVC较IPPV模式下各PEEP水平的PIP、平均气道压(mPaw)、Cdyn、动脉血氧分压[pa(O2)]和氧耗(VO2)的影响均有显著意义，但两种通气模式对血流动力学的影响差异无显著性。结论 与IPPV相比，PRVC通气模式能降低PIP，增加Cdyn和提高pa(O2)，两模式对血流动力学的影响差异无显著性，PRVC更适用于ALI／ARDS的治疗。

Effects of Hemodynamics, Respiratory Dynamics and Respiratory Function in Acute Lung Injury Dogs by Pressure Regulated Volume-Controlled Ventilation and Intermittent Positive Pressure Ventilation

Objective To study effects of hamodynamics, respiratory dynamics and respiratory function in acute lung injury(ALI) dogs by pressure regulated volume-controlled ventilation(PRVC) and compared with intermittent positive pressure ventilation(IPPV). Methods Parameters of hamedynamics, respiratory dynamics respiratory function were measured during IPPV and PRVC ventilatory modalities with 0.5, 1.0, 1.5 kPa external end-expiratory pressure in dogs with healthy and oleic acid-induced lung injury. Results For the health dogs, compared to IPPV modality, PRVC modality has no significant difference in hamodynamics, respiratory dynamics and respiratory function but significant difference in peak inspratation pressure(PIP), dynomic compliance(C-{dyn}) and pulmonary vascular resistance(PVR) only when PEEP=0.5 kPa in the ALI dogs was found. PRVC modality has significant difference in PIP, mPaw, C-{dyn}, p-a(O-2) and VO-2 in all sorts of PEEP, but there was no significant difference in hamodynamics between two ventilation modalities. Conclusion Compared to IPPV, PRVC modality can decrease P peak and increase pulmonary compliance and p-a(O-2), but there was no significant difference in hamodynamics. Therefore, PRVC serves to treat ALI/ARDS better than IPPV.;