肺总顺应性的容量反应性研究

Volumetric responsiveness of total lung compliance

目的探讨肺总顺应性(C)的容量反应性以及高血压对其反应能力的影响。方法选择广东省广州市红十字会医院行择期平卧位手术的患者65例为研究对象,记录患者机械通气后不同时点[5 min(t_(1))、10 min(t_(2))、15 min(t_(3))、20 min(t_(4))、25 min(t_(5))、30 min(t_(6))]的C、气道平台压(p_(plat))、气道峰压(p_(peak))、心率(HR)、平均动脉压(MAP)、心排血量(CO)、每搏量变异度(SVV)、每搏输出量(SV)。计算不同时间段[T_(1)(5~10 min)、T_(2)(>10~15 min)、T_(3)(>15~20 min)、T_(4)(>20~25 min)、T_(5)(>25~30 min)]患者C、SV、SVV的变化量(△C、△SV、△SVV)。采用日本科林动脉硬化检测仪采集高血压及非高血压者的肱踝脉搏波传导速度(BaPWV)。结果t_(1)至t_(6)时点,患者HR、MAP、SVV、SV、CO、p_(plat)、p_(peak)、C比较,差异无统计学意义(P>0.05)。受试者分层相关性分析结果显示,T_(1)至T_(5)5个时间段,所有受试者的△C与△SVV的相关系数(r)分别为-0.626、-0.650、-0.676、-0.588、-0.518,△C与△SV的r分别为0.744、0.772、0.785、0.698、0.681;T_(1)至T_(5)5个时间段,△C与△SVV以及△C与△SV的相关性在非高血压受试者中增强,在高血压受试者中减弱,并在T_(3)时间段高血压及非高血压受试者的△C与△SVV以及△C与△SV的相关性最强。高血压与非高血压者的BaPWV比较,差异有统计学意义(P<0.05)。结论C具有容量反应能力,高血压能够影响其反应能力。

Objective To investigate the volumetric responsiveness of lung total compliance(C)and the effect of hypertension on its responsiveness.Methods Sixty-five patients who underwent elective recumbent surgery in Red Cross Hospital of Guangzhou in Guangdong Province were selected as study subjects.C,airway plateau pressure(p_(plat)),peak airway pressure(p_(peak)),heart rate(HR),mean arterial pressure(MAP),cardiac output(CO),stroke volume variability(SVV)and stroke volume(SV)of patients were recorded at different time points[5 min(t_(1)),10 min(t_(2)),15 min(t_(3)),20 min(t_(4)),25 min(t_(5)),30 min(t_(6))]of 30 min after mechanical ventilation.The change of C,SV,SVV(△C,△SV,△SVV)of patients in time periods of T_(1)(5 to 10 min),T_(2)(>10 to 15 min),T_(3)(>15 to 20 min),T_(4)(>20 to 25min)and T_(5)(>25 to 30 min)were recorded.The brachial and ankle pulse wave conduction velocity(BaPWV)of hypertensive and non-hypertensive patients was collected by Japanese Kelin arteriosclerosis detector.Results There were no significant differences in HR,MAP,SVV,SV,CO,p_(plat),p_(peak) and C from t_(1) to t_(6) time points(P>0.05).The correlation coefficients(r)between△C and△SVV were-0.626,-0.650,-0.676,-0.588,-0.518,respectively,were 0.744,0.772,0.785,0.698 and 0.681,respectively between△C and△SV in all subjects during T_(1) to T_(5);during T_(1) to T_(5),the correlations between△C and△SVV,between△C and△SV increased in non-hypertensive subjects,but decreased in hypertensive subjects,the correlations between△C and△SVV or△C and△SV were the strongest during T_(3) in both hypertensive and non-hypertensive subjects.BaPWV of hypertensive and non-hypertensive patients showed significant difference(P<0.05).Conclusion C has capacity response and hypertension can affect its responsiveness.