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Arterial Oxygenation was Determined by the Volume Partition of Normal Aeration Region after Sustained Inflation in Acute Respiratory Distress Syndrome
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摘要:
目的 研究急性呼吸窘迫综合征时不同肺复张手法的肺内影像学特征及其与动脉血气的关系。 方法 在10只肺泡灌洗致急性呼吸窘迫综合征的新西兰家兔中, 应用动态肺部CT扫描, 监测并使用Image-J软件分析随气道压力递增和递减时肺内气体容积及分布的变化。然后分别以5种不同开放肺泡的压力和维持肺泡开放的呼气末正压(positive end-expiratory pressure, PEEP)水平进行控制性肺膨胀(sustained inflation, SI), 测量SI后2 min及20 min时的动脉血气。分析不同压力水平下的影像学特征及其与动脉血气的关系。 结果 在使用不同气道压力进行SI后应用相同PEEP水平进行通气时, 发现肺复张后2 min与20 min时的PaO2均随SI压力的增加而明显增加(P < 0.05)。PaO2与不同气道压力下正常通气容积比例呈正相关(r=0.597, P=0.001), 与通气不良容积比例(r=-0.592, P=0.001)和塌陷容积比例(r=-0.475, P=0.012)呈负相关, 而与过度通气容积比例无关(r=0.202, P=0.311)。在使用相同气道压力进行SI后应用不同PEEP进行通气时, 发现肺复张后2 min时的不同PEEP水平下PaO2差异无统计学意义(P>0.05);而在通气20 min时, 高PEEP水平下PaO2明显高于低PEEP水平(P < 0.05)。PaO2与正常通气容积比例呈正相关(r=0.635, P=0.000), 与通气不良容积比例(r=-0.609, P=0.000)和塌陷容积比例(r=-0.544, P=0.002)呈负相关, 而与过度通气容积比例无关(r=0.058, P=0.762)。 结论 完全肺复张需要较高的开放肺泡和维持肺泡开放的气道压力。肺复张后正常通气区域容积比例决定PaO2。 Abstract:Objective To analyze the correlation of arterial blood gas with pulmonary CT scan image after sustained inflation (SI) with the attempt to explore the optimal recruitment maneuvers (RMs) in acute respiratory distress syndrome. Methods Dynamic pulmonary CT scan was performed to monitor the intrapulmonary gas volume and distribution during increment and decrement of airway pressure gradually in 10 warm-saline-lavaged New Zealand rabbits. CT scan was analyzed by Images-J software. In order to explore optimal airway pressure for opening lung and optimal positive end-expiratory pressure (PEEP) for maintaining lung open, five different SIs were implemented individually and randomly, and rabbits' arterial blood gases were measured in 2 and 20 minutes after every SI. Pulmonary CT scan and PaO2 under different airway pressure were combined to be analyzed. Results After different airway pressure of SI and equal PEEP ventilation, PaO2 was increased accompanied with airway pressure of SI both in 2 and 20 minutes after RMs (P < 0.05). When PaO2 was combined with CT images, we found PaO2 was positively correlated with the volume partition of normal aeration region (r=0.597, P=0.001), negatively correlated with the insufficient aeration region (r=-0.592, P=0.001) and nonaeration region (r=-0.475, P=0.012), while not correlated with the overdistension region (r=0.202, P=0.311). While after equal airway pressure of SI and different PEEP ventilation, the difference of PaO2 was not significant in 2 minutes after RMs (P>0.05), and PaO2 was increased accompanied with PEEP in 20 minutes (P < 0.05). In this situation, we found PaO2 was positively correlated with the volume partition of normal aeration region (r=0.635, P=0.000), negatively correlated with the insufficient aeration region (r=-0.609, P=0.000) and nonaeration region (r=-0.544, P=0.002), while not correlated with the overdistension region (r=0.058, P=0.762). Conclusions High airway pressure is needed for opening up the lung and keeping the lung open. Arterial oxygenation is determined by the volume partition of normal aeration region after SI. -
表 1 控制性肺膨胀方法
方法 SI压力(cmH2O) 维持PEEP(cmH2O) 1 20 12 2 28 12 3 36 12 4 36 16 5 36 8 1 cmH2O=0.098 kPa；SI：控制性肺膨胀；PEEP：呼气末正压 
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表 2 不同气道压力SI后使用12 cmH2O PEEP通气的PaO2和PaCO2(mmHg，x ±s)
SI压力(cmH2O) SI后2 min SI后20 min PaO2 PaCO2 PaO2 PaCO2 20 245.7±80.8 49.4±7.8 221±74.7* 49.6±6.7 28 443.3±73.3† 46.7±5.2 328.4±76.1*† 44.3±5.5† 36 489.3±49.9‡ 50.5±4.6 357.9±90.4*‡ 45.1±3.3† SI、PEEP:同表 1；1 mmHg=0.133 kP；与SI后2 min时比较，*P＜0.05；与20 cmH2O SI比较，†P＜0.05；与28 cmH2O SI比较，‡P＜0.05
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表 3 36 cm H2O气道压力SI后使用不同PEEP通气的PaO2或PaCO2（mm Hg, x±s)
PEEP(cmH2O) SI后2 min SI后20 min PaO2 PaCO2 PaO2 PaCO2 8 477.4±48.3 54.4±5.2 142.7±59.5* 52.8±5.0 12 489.3±49.9 50.5±4.6 357.9±90.4*† 45.1±3.3† 16 485.7±62.6 47.6±3.9 377.8±97.0*‡ 45.8±4.9 SI、PEEP:同表 1；1 mmHg=0.133 kP；与SI后2 min时比较，*P＜0.05；与20 cmH2O SI比较，†P＜0.05；与28 cmH2O SI比较，‡P＜0.05
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[1] Lachmann B. Open up the lung and keep the lung open[J]. Intensive Care Med, 1992, 18:319-321. doi: 10.1007/BF01694358 [2] Pesenti A, Tagliabue P, Patroniti N, et al. Computerised tomography scan imaging in acute respiratory distress syndrome[J]. Intensive Care Med, 2001, 27:631-639. doi: 10.1007/s001340100877 [3] Gattinoni L, Bombino M, Pelosi P, et al. Inflammatory pulmonary edema and positive end-expiratory pressure:correlations between imaging and physiologic studies[J]. J Thorac Imaging, 1988, 3:59-64. http://europepmc.org/abstract/MED/3292784 [4] NIH network. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. The Acute Respiratory Distress Syndrome Network[J]. N Engl J Med, 2000, 342:1301-1308. doi: 10.1056/NEJM200005043421801 [5] Rouby JJ, Lu Q, Goldstein I. Selecting the right level of positive end-expiratory pressure in patients with acute respiratory distress syndrome[J]. Am J Respir Crit Care Med, 2002, 165:1182-1186. doi: 10.1164/ajrccm.165.8.2105122 [6] Meade MO, Cook DJ, Guyatt GH, et al. Ventilation strategy using low tidal volumes, recruitment maneuvers, and high positive end-expiratory pressure for acute lung injury and acute respiratory distress syndrome:a randomized controlled trial[J]. JAMA, 2008, 299:637-645. doi: 10.1001/jama.299.6.637 [7] Mercat A, Richard JC, Vielle B, et al. Positive end-expiratory pressure setting in adults with acute lung injury and acute respiratory distress syndrome:a randomized controlled trial[J]. JAMA, 2008, 299:646-655. doi: 10.1001/jama.299.6.646 [8] Medoff BD, Harris RS, Kesselman H, et al. Use of recruitment maneuvers and high positive end-expiratory pressure in a patient with acute respiratory distress syndrome[J]. Crit Care Med, 2000, 28:1210-1216. doi: 10.1097/00003246-200004000-00051 [9] Borges JB, Okamoto VN, Matos GF, et al. Reversibility of lung collapse and hypoxemia in early acute respiratory distress syndrome[J]. Am J Respir Crit Care Med, 2006, 174:268-278. doi: 10.1164/rccm.200506-976OC [10] Morán I, Blanch L, Fernández R, et al. Acute physiologic effects of a stepwise recruitment maneuver in acute respiratory distress syndrome[J]. Minerva Anestesiol, 2011, 77:1167-1175. http://www.ncbi.nlm.nih.gov/pubmed/21623343 -
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