BIPAP与IPPV对健康和急性肺损伤猪心肺功能的影响

Cardiopulmonary effection of two modes of mechanical ventilation in pigs with or without acute lung injury: comparison pressure regulated biphasic positive airway pressure ventilation and volume control ventilation

目的比较双水平压力调节(BIPAP)通气与容量控制通气(IPPV)对健康及急性肺损伤(ALI)猪心肺功能的影响。方法健康猪麻醉后气管切开,分别给予IPPV及BIPAP两种模式通气,IPPV时潮气量:12～15ml/kg,BIPAP时吸气压参照IPPV时的平台压设定,测定不同通气模式下的呼吸力学指标。从颈内静脉置入Swag-Ganz导管,从股动脉置入动脉导管,测定不同通气模式下的血气分析、血流动力学和氧代谢参数。以油酸诱发急性肺损伤猪模型,重复测定两种通气模式下的上列参数。结果不论有无ALI,BIPAP通气时呼吸频率(RR)较快,气道峰压(PIP)较低(2者均P<0.05)。在ALI状态下,BIPAP与IPPV比,PaO2,PvO2和PaO2/FiO2较高(3者P<0.05),mPAP较低(P<0.05),CO较高(P<0.05),DO2较高(P<0.05),Qs/Qt较低(P<0.05)。结论与IPPV相比,BIPAP有利于开放自主呼吸,降低PIP,改善肺部气体交换,降低肺内分流,提高DO2,对血流动力学影响较小。

Objective To compare the cardiopulmonary effect of pressure regulated biphasic positive airway pressure ventilation and volume control ventilation. Methods Respiration dynamics, haemodynamics and blood gases were measured during two different mechanical ventilatory modalities pigs with or without oleic-induced acute lung injury. Results In spite of ALI, the BIPAP had higher RR and lower PIP. In the ALI condition, compared with IPPV, BIPAP had lower mPAP (P<0.05), higher CO (P<0.05), higher DO2 (P<0.05) and lower Qs/Qt (P<0.05). Conclusion Compared with IPPV, BIPAP is in favor of spontaneous breathing, decreases the PIP, improves the gas exchange, decreases the Qs/Qt, elevates the DO2 and has fewer effect to hemodynamics.