| 引用本文： |
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李从烨,Kyle Burk,王启星,等.肺应力和应变在肺损伤家猪机械通气中的作用[J].同济大学学报（医学版）,2015,36(2):33-36, 40. [点击复制]
- LI Cong-ye,Kyle Burk,WANG Qi-xing,et al.Role of lung stress and strain in acute lung injury swine model during mechanical ventilation[J].同济大学学报（医学版）,2015,36(2):33-36, 40. [点击复制]
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| 摘要: |
| 目的 研究不同平台压参数设置下,急性肺损伤(acute lung injury, ALI)家猪的跨肺压(transpulmonary pressure)等呼吸力学参数,明确平台压30cmH2O能否全面准确反应ARDS呼吸力学情况。方法 将6只健康家猪麻醉、进行外科手术后,按照以下不同实验状态进行机械通气: A组平台压＜30cmH2O、B组平台压＞30cmH2O伴腹内高压(intra-abdominal hypertension, IAH)。观察不同分组通气参数设置下,肺应力、平台压等呼吸力学标。结果呼吸力学: A组肺应力为(15.07±1.47)cmH2O高于 B组(10.92±1.28)cmH2O；B组胸壁弹性阻力与呼吸系统弹性阻力之比(Ecw/Ers)为(0.36±0.06)高于A组(0.24±0.05)；B组肺顺应性(Cdyn)为(13.38±2.79)ml/cmH2O,明显高于A组(10.26±1.18)ml/cmH2O ；差异均有统计学意义(P<0.01)。B组胸壁顺应性(Ccw)为(43.12±8.00)ml/cmH2O,低于A组(63.28±36.71)ml/cmH2O,差异均有统计学意义(P<0.01)。结论 单纯以平台压30cmH2O作为机械通气的标准,不能准确地反映ARDS患者肺部的呼吸力学。腹内高压时,需要更高的平台压来改善氧合状况。肺应力和应变是真正反应ARDS肺呼吸力学的指标,将肺应力和应变理论引入临床,有利于为ARDS患者制定更加安全、合理的通气策略。 |
| 关键词: 急性呼吸窘迫综合征 肺应力 肺应变 平台压 |
| DOI：10.16118/j.1008-0392.2015.02.008 |
| 投稿时间：2014-09-02 |
| 基金项目: |
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| Role of lung stress and strain in acute lung injury swine model during mechanical ventilation |
| LI Cong-ye,Kyle Burk,WANG Qi-xing,YIN Ying-jie,ZHANG Xiang-yu,ZHANG Shou-qin |
| (Dept.of Critical Care, Tenth People's Hospital, Tongji University, Shanghai 200072, China;Dept.of Bioegineering, University of Utah, Salt Lake City 84112, USA) |
| Abstract: |
| Objective To investigate the respiratory mechanics including lung stress and lung strain of the pigs with acute lung injury (ALI) under different plateau pressures. Methods ALI was induced in 6 pigs under anesthesia, and mechanical ventilation was performed after surgery. Respiratory mechanics including lung stress and plateau pressure were measured under two experimental conditions:the plateau pressure was <30cmH2O in group A, while the plateau pressure >30cmH2O with a intra-abdominal hypertension (IAH) at the same time in group B. Results The lung stress of group A was higher than that of group B [(19.68±1.74)cmH2O vs(12.91±1.90)cmH2O, P<0.01]. The ratio between chest wall elastance and respiratory system elastance (Ecw/Ers) of group B was higher than that of group A (0.36±0.06 vs 0.24±0.05, P<0.01). The lung compliance (Cdyn)of group B was higher than group A [(13.38±2.79)ml/cmH2O vs(10.26±1.1)ml/cmH2O, P<0.01]；while the chest wall compliance (Ccw)of group A was higher than group B [(63.28±36.71)ml/cmH2O vs(43.12±8.00)ml/cmH2O, P<0.01]. Conclusion Plateau pressure 30cmH2O may not reflect the global respiratory mechanics; patients with IAH need elevated plateau pressure to improve oxygen condition. Lung stress and strain should be used as physiological indicators to establish a more reasonable and safe strategy for mechanical ventilation. |
| Key words: acute respiratory distress syndrome lung stress lung strain plateau pressure |
