双相气道正压通气模式对急性肺损伤动物模型心肺功能的影响

Cardiorespiratory effects of biphasic positive airway pressure ventilation in an acute lung injury model

目的：研究双相气道正压通气模式（ＢｉＰＡＰ）对急性肺损伤（ＡＬＩ）动物模型心肺功能的影响。方法：１１只犬麻醉后，用油酸造成ＡＬＩ模型。采用自身对照法比较其在ＢｉＰＡＰ、压力控制反比通气（ＰＣＩＲＶ）和容量控制反比通气（ＶＣＩＲＶ）３种通气模式中的呼吸、循环参数的变化。结果：在保持相同每分通气量和平均气道压的情况下，ＢｉＰＡＰ和ＰＣＩＲＶ模式的气道峰压均分别低于相同条件下ＶＣＩＲＶ模式的气道峰压，Ｐ均＜０．０５；在平均气道压相同情况下，ＢｉＰＡＰ和ＰＣＩＲＶ模式每分通气量分别为（４．４２±０．４３）Ｌ／ｍｉｎ和（４．４３±０．３９）Ｌ／ｍｉｎ，均大于ＶＣＩＲＶ模式的（３．８４±０．２０）Ｌ／ｍｉｎ和（３．７６±０．２３）Ｌ／ｍｉｎ，Ｐ均＜０．０５；ＢｉＰＡＰ模式时，肺泡死腔和肺内分流分别为（２０．２４±２．３６）和（１５．８０±２．６２），均较ＶＣＩＲＶ模式的（２４．９６±１．８７）和（２１．３６±２．２７）低（Ｐ均＜０．０５）；但ＰＣＩＲＶ模式时，上述两个指标与ＶＣＩＲＶ模式无显著性差异。结论：ＢｉＰＡＰ将压力控制通气和自主呼吸合为一体，是一种较好的治疗ＡＬＩ的通气模式。

Abstract Objective:To study the cardiorespiratory effects of biphasic positive airway pressure (BiPAP) ventilation in dogs with acute lung injury (ALI).Methods:After being anesthetized,11 dogs were subjected to oleic acidinduced ALI and then were supported by mechanical ventilation in 3 modes.The changes in ventilation,gas exchange and hemodynamic parameters were compared during BiPAP ,pressure control inverse ratio ventilation (PCIRV) and volume control inverse ratio ventilation (VCIRV).Results:Keeping the same minute ventilation volume and mean airway pressure,the peak airway pressure of BiPAP and PCIRV were lower than that of VCIRV respectively (all P <0 05).At the same mean airway pressure,the minute ventilation volume of BiPAP and PCIRV were (4 42±0 43)L/min and (4 43±0 39) L/min respectively,which were all higher than that of VCIRV (3 84±0 20)L/min and (3 76±0 23)L/min,both P <0 05 .In the mode of BiPAP,V D/V T and [AKQ·5〗s/t were 20 24±2 36 and 15 80±2 62 respectively,which were all lower than that of VCIRV