控制性肺膨胀对急性呼吸窘迫综合征绵羊肺力学和肺损伤的影响

Effects of sustained inflation on pulmonary mechanics and lung injury in sheep with acute respiratory distress syndrome

目的 :探讨控制性肺膨胀 ( SI)与肺保护性通气策略联合应用时 ,对急性呼吸窘迫综合征 ( ARDS)的肺泡复张作用及其安全性。方法 :利用内毒素诱导的绵羊 ARDS模型 ,观察实施 SI〔2 .94k Pa( 1 k Pa=1 0 .2 0 cm H2 O) ,屏气时间 2 0秒〕后绵羊的肺力学和组织病理学改变。结果 :实施 SI后 ,绵羊的动态肺顺应性和肺容积显著增加 ,气道峰值压、平台压和平均气道压均显著降低 ( P均 <0 .0 5) ,并可维持 3～ 4小时。与未应用SI的绵羊比较 ,实施 SI后的绵羊肺损伤减轻 ,肺不张改善。结论 :SI具有肺复张和肺保护作用 。

Objective:To determine the safety of sustained inflation (SI) combined with lung protective strategy for alveolar recruitment in sheep with acute respiratory distress syndrome (ARDS).Methods:ARDS sheep model was induced by intravenous infusion of endotoxin,and SI was applied at a pressure of 2 94 kPa (1 kPa=10 20 cmH 2O) for 20 seconds.Pulmonary mechanics was determined and histologic examination were done.Results:Dynamic pulmonary compliance and lung volume significantly increased after SI,while mean airway pressure,peak inspiratory pressure and airway plateau pressure markedly decreased (all P <0 05);all these parameters were able to maintain for 3~4 hours.Compared with ventilation without SI,lung injury was abated after SI.Conclusions:SI is a lung recruitment and lung protective approach,which might become an important supplement of lung protective strategy.