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目的:比较以跨肺压(PL)为导向的肺保护通气策略(控制PL)和传统肺保护通气策略(控制Pplat)分别在机控通气和保留自主呼吸模式下对犬急性呼吸窘迫综合征(ARDS)模型呼吸生理的影响,并探讨其机制。方法:18只比格犬采用静注油酸复制ARDS模型,随机分为3组,每组6只:A组(镇静组):充分镇静肌松,呼吸机控制通气,控制Pplat=30cmH_2O(即相当于控制吸气末PL=20cmH2O);B组(控制PL组):保留自主呼吸,控制吸气末PL=20cmH_2O;C组(控制Pplat组):保留自主呼吸,控制Pplat=30cmH_2O。观察动物基础状态(成模前)及肺保护通气前后的氧合功能、呼吸力学指标变化,胸活检取肺组织,HE染色进行病理学评分。结果:与A、B两组相比,C组动态肺顺应性(CL-dyn)、静态肺顺应性(CL-stat)明显低于A组和B组(P<0.05),潮气量(VT)高于A组和B组(P<0.05);C组氧输送(DO_2)明显低于A组和B组,肺内分流比例(Qs/Qt)高于A组和B组(P<0.05);C组的肺损伤总分高于A组和B组(P<0.05);肺损伤分类评分中,C组中性白细胞浸润评分和间质水肿高于A组和B组(P<0.05),C组肺不张评分均低于A组和B组(P<0.05);结论:监控PL无论在自主呼吸或机控呼吸状态下,均能够有效地调控肺容量,改善肺顺应性和氧输送,减轻呼吸机相关性肺损伤(VILI);在保留自主呼吸时,单纯监控Pplat不能有效的调控肺容量,可加重VILI。
OBJECTIVE: To compare the effects of lung protection ventilation strategy (controlled PL) and traditional lung protection ventilation strategy (control Pplat) guided by transplanted pulmonary pressure (PL) in the treatment of acute respiratory distress syndrome ARDS) model of respiratory physiology and explore its mechanism. Methods: Eighteen Beagle dogs were randomly divided into 3 groups with 6 rats in each group: A group (sedation group): the rats were treated with muscle relaxant and ventilator controlled ventilation to control Pplat = 30cmH2O (Control PL group): Retained spontaneous breathing, control inspiratory end of PL = 20cmH_2O; C group (control Pplat group): to maintain spontaneous breathing control Pplat = 30cmH_2O. Observed the basic state of animals (pre-mold) and oxygenation before and after lung protection ventilation function, changes in respiratory mechanics, lung biopsy specimens were taken for pathological score. Results: Compared with A and B groups, CL-dyn and CL-stat of group C were significantly lower than those of group A and B (P <0.05) and tidal volume of VT ) Were higher than those in group A and group B (P <0.05). The oxygen transport (DO_2) in group C was significantly lower than that in group A and B, and the ratio of pulmonary shunt (Qs / Qt) ). The total score of lung injury in group C was higher than those in group A and group B (P <0.05). In the classification of lung injury, the neutrophil infiltration score and interstitial edema in group C were higher than those in group A and B ), C group atelectasis scores were lower than those in A and B groups (P <0.05) .Conclusion: Monitoring PL can effectively regulate lung capacity and improve lung compliance in spontaneous breathing or mechanically controlled breathing Oxygen transport, reduce ventilator-associated lung injury (VILI); while maintaining spontaneous breathing, simply monitoring Pplat can not effectively regulate lung volume, can increase VILI.