俯卧位通气对急性肺损伤犬肺功能和血流动力学的影响

Influence of prone position to lung function and hemodynamics after acute lung injury in a canine model

目的研究俯卧位通气对犬急性肺损伤(ALI)模型肺功能及血流动力学的影响。方法健康杂种犬28只,充分麻醉后气管插管、机械通气。气管插管内注入盐酸建立ALI后,将实验动物随机分为常规仰卧位通气组与俯卧位通气组,每组各14只。分别采取仰卧位及俯卧位通气240 min,余通气条件相同。测定心率(HR)、气道峰压(PIP)、气道平台压(Pplat)、呼吸系统动态顺应性(Cdyn)、体循环平均压(ABPM)、中心静脉压(CVP)、肺动脉平均压(PAPM)、肺动脉楔压(PAWP)和心输出量(CO)。取外周动脉和肺动脉血进行血气分析,计算肺血分流率(Qs/Qt)。结果①建模成功后,各组pH、PaO2/FiO2、SvO2、HR、ABPM、CO、PIP、Pplat、Cdyn均较健康状态显著下降,Qs/Qt、PAPM、CVP、PAWP均较健康状态显著升高,差异有高度统计学意义(P<0.01)。②60 min时间点时俯卧位通气组PaO2/FiO2、SvO2、Qs/Qt、Cdyn、PAPM等指标优于常规仰卧位通气组,差异均有统计学意义(P<0.01或P<0.05)。120 min时间点时俯卧位通气组pH、PaO2/FiO2、SvO2、Qs/Qt、PIP、Pplat、Cdyn、ABPM、PAPM、PAWP、CVP、CO等指标优于常规仰卧位通气组,差异均有统计学意义(P<0.01或P<0.05)。240 min时间点时俯卧位通气组pH、PaO2/FiO2、SvO2、Qs/Qt、PIP、Pplat、Cdyn、ABPM、PAPM、PAWP、CVP、CO等指标优于常规仰卧位通气组,差异均有统计学意义(P<0.01或P<0.05)。结论俯卧位通气能够明显改善ALI动物的氧合状况,对呼吸力学参数以及血流动力学也有一定的改善作用。

Objective To investigate the effect of prone position to lung function and hemodynamics after acute lung injury （ALI） in a canine model. Methods 28 healthy clogs were anesthetized. After tracheal intubation and mechanical ventilation, hydrochloric acid （HC1） was injected into the trachea to make the ALI model. The animals were divided into supine group and prone group randomly with 14 cases in each group. Supine group was treated with supine position ventilation, prone group was treated with prone position ventilation, the rest of the conditions were the same. Heart rate （HR）, peak airway pressure （PIP）, plat airway pressure （Pplat）, dynamic lung compliance （Cdyn）, mean artery blood pressure （ABPM）, central venous pressure （CVP）, mean pulmonary artery pressure （PAPM）, pulmonary arterial wedge pressure （PAWP） and cardiac output （CO） were measured. Artery and mixture venous blood gas analysis were tested and Qs/Qt was calculated. Results ①pH, PaQ2/FiO2, Sv02, HR, ABPM, CO, PIP, Pplat, Cdyn in each group after the modeling were all 10wer than those in the healthy position, Qs/Qt, PAPM, CVP, PAWP n each group after the modeling were all higher than those in the healthy position, the differences were statistically significant （P 〈 0.01）. ②PaO2/Fi02, Sv02, Qs/Qt, Cdyn, PAPM in prone group at the time point of 60 rain were better than those in supine group, the differenees were statistically significant （P 〈 0.01 or P 〈 0.01）. pH, PaO2/FiO2, SvO2, Qs/Qt, PIP, Pplat, Cdyn, ABPM, PAPM, PAWP, CVP, CO in prone group at the time point of 120 min were better than those in supine group, the differences were statistically significant （P 〈 0.01 or P 〈 0.01）. pH, PaO2/FiO2, SvO2, Qs/Qt, PIP, Pplat, Cdyn, ABPM, PAPM, PAWP, CVP, CO in prone group at the time point of 240 rain were better than those in supine group, the differences were statistically significant （P 〈 0.01 or P 〈 0.01）. Conclusion Prone position ventilation can improve the oxygenation, the lung function and the hemodynamics after ALI in a canine model.