摘要
目的观察经气管插管(ETT)壁内导管引导气管内吹气(TGI)联合压力控制通气(PCV)对实施允许性高碳酸血症(PHC)的急性呼吸窘迫综合征(ARDS)模型的疗效,并探讨其作用机制。方法16只新西兰兔气道内滴入内毒素诱发ARDS模型后,随机分为:①TGI组,实施PHC后经TGI专用ETT引导持续TGI气流(流量0·5L/min)治疗4h;②常规机械通气(CMV)组。每30min记录动脉血气(pH、PaCO2、PaO2)、吸气压力(PIP)、潮气量(VT)、生理死腔(VD/VT)、动态胸肺顺应性(Cdyn)。调节PIP,以最小VT维持正常PaCO2。实验结束后测定肺髓过氧化物酶(MPO)、白细胞介素-8(IL-8)、肺组织含气容积密度(VV)、支气管肺泡灌洗液中总蛋白(TP)、肺表面活性物质总磷脂(TPL)、大小聚集体比值(SA/LA)和最小表面张力(γmin)。结果TGI组吹气后PaCO2和VD/VT分别较吹气前下降46%和53%(P均<0·01);PIP、VT和VD/VT分别较同期CMV组下降32%、38%和30%(P均<0·01)。TGI组PaO2、Cdyn、MPO、IL-8、VV、TPL/TP、SA/LA和γmin均明显优于CMV组(P<0·05或P<0·01)。结论经TGI专用ETT壁内导管吹气联合PCV可显著降低实施PHC的ARDS模型VD/VT,缓解CO2潴留,降低机械通气时PIP和VT,对ARDS肺脏具有保护作用。
Objective To evaluate the effects of tracheal gas insufflation（TGI） introduced through six capillaries embedded in the wall of a novel Vygon endotracheal tube（ETT） on the washout of excessive CO2, reduction of peak inspiratory pressure（PIP） and tidal volume（VT） while maintaining eucapnia, and therefore its protective effect against ventilator-induced lung injury（VILI） in a rabbit model of acute respiratory distress syndrome（ARDS） with permissive hypercapnia （PHC）. Methods ARDS was induced by intratracheal administration of lipopolysaccharide in 16 anesthetized, pressure control ventilated（PCV） healthy adult rabbits which were then randomly assigned to TGI group（ after initiation of PHC with PaCO2 between 60 to 80 mm Hg, continuous TGI flow at a rate ofO.5 L/min was introduced） or conventional mechanical ventilation（CMV） group （ n = 8 for each） ,and subsequently ventilated with minimized PIP and VT to maintain eucapnia for 4 h. Values of arterial blood gas analysis, PIP, VT, Physiological dead space to VT ratio （ VD/VT ）, and dynamic respiratory compliance（Cdr,） were recorded every 30 rain. After the period of ventilation, myeloperoxidase（MPO） content, interleukin8 （ IL-8 ） levels, alveolar volume density （ Vv ）, total proteins （ TP ）, pulmonary surfactant total phospholipids（TPL）, small to large surfactant aggregates ratio（ SA/LA）, and minimum surface tension（7min） of bmnchoalveolar lavage fluid（ BALF）were assayed. Results TGI resulted in 46% and 53 % decrease（ all P 〈 0.01） in PaCO2 and VD/VT, respectively as compared with baseline, and 32%, 38% and 30% decrease（ all P 〈 0.01） in PIP, VT and VD/VT, respectively as compared with CMV during 4 hours＇ treatment time. Furthermore, the TGI group showed more favorable pulmonary function（ PaO2 and Cdyn ）, less lung inflammatory markers（ myeloperoxidase and IL-8）, better alveolar expansion（Vv） and better pulmonary surfactant composition and function（TPL/TP,SA/LA and γmin） than those in CMV group.Conclusions TGI delivered through Vygon ETT during PCV can effectively washout excessive CO2 under PHC condition, allows animal ventilated with lower PIP and VT while maintaining eucapnia, therefore, protects against VILI in this animal model of ARDS.
出处
《中国呼吸与危重监护杂志》
CAS
2006年第6期418-422,共5页
Chinese Journal of Respiratory and Critical Care Medicine
基金
教育部留学回国人员科研启动基金资助项目
关键词
气管内吹气
允许性高碳酸血症
急性呼吸窘迫综合征
机械通气
呼吸机
所致肺损伤
Tracheal gas insufflation
Permissive hypercapnia
Acute respiratory distress syndrome
Mechanical ventilation
Ventilator-induced lung injury
