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目的研究持续气道正压(CPAP)通气对急性心源性肺水肿(ACPE)犬呼吸及循环功能的影响。方法分别监测10条犬健康状态及ACPE发生后自主呼吸、5cmH2O(1cmH2O=0.098kPa)、10cmH2O、15cmH2OCPAP时的胸腔负压(Pt)、中心静脉压(CVP)、心输出量(CO)、平均动脉压(BPm)、肺动脉楔压(PAWP)。结果与健康状态相比,ACPE犬呼吸增强、增快,Pt由-(4.90±0.09)cmH2O上升至-(10.90±0.75)cmH2O,CVP由(10.1±0.4)mmHg下降至(8.0±0.7)mmHg,CO由(1.52±0.13)L/min下降至(0.85±0.09)L/min,PAWP升高(P均<0.05)。CVP与Pt变化呈正相关(r=0.78,P<0.01)。5及10cmH2OCPAP时Pt值恢复至-(6.53±0.11)cmH2O和-(5.14±0.25)cmH2O,呼吸形式基本恢复正常,CVP升至(11.6±0.7)mmHg和(14.2±0.2)mmHg,CO增加至(1.45±0.11)L/min和(1.24±0.11)L/min,其中5cmH2OCPAP组PAWP下降(P均<0.05)。15cmH2OCPAP时,呼吸浅快,Pt为-(0.82±0.37)cmH2O,CO为(0.82±0.07)L/min,其他血流动力学指标皆恶化(P均<0.05)。结论犬ACPE发生时,呼吸运动显著增强,Pt升高,并导致CVP和CO的下降;适当CPAP通过改善呼吸功能,调节Pt改善ACPE犬的心功能。
Objective To investigate the effects of continuous positive airway pressure (CPAP) ventilation on respiration and circulatory function in dogs with acute cardiogenic pulmonary edema (ACPE). Methods The health status of 10 dogs and the negative pressure (Pt), central venous pressure (CVP), cardiac output (CO), spontaneous breathing after spontaneous ACPE, Arterial pressure (BPm), Pulmonary artery wedge pressure (PAWP). Results Compared with healthy controls, ACPE dogs showed increased respiration and increased Pt levels from - (4.90 ± 0.09) cmH2O to - (10.90 ± 0.75) cmH2O. CVP decreased from (10.1 ± 0.4) mmHg to (8.0 ± 0.7) mmHg , CO decreased from (1.52 ± 0.13) L / min to (0.85 ± 0.09) L / min and PAWP increased (all P <0.05). There was a positive correlation between CVP and Pt (r = 0.78, P <0.01). (P <0.05). The Pt value recovered to (6.53 ± 0.11) cmH2O and - (5.14 ± 0.25) cmH2O at 5 and 10cmH2OCPAP, resumed to normal in respiration form, and the CVP increased to (11.6 ± 0.7) mmHg and (14.2 ± 0.2) mmHg (1.45 ± 0.11) L / min and (1.24 ± 0.11) L / min, respectively. PAWP in 5cmH2OCPAP group decreased (all P <0.05). At 15cmH2OCPAP, respiration was shallow, Pt was (0.82 ± 0.37) cmH2O, and CO was (0.82 ± 0.07) L / min, all other hemodynamic parameters were worsened (all P <0.05). Conclusions When ACPE occurs, the respiratory activity is significantly increased and Pt is increased, which leads to the decrease of CVP and CO. Appropriate CPAP can improve heart function of ACPE canine by improving respiratory function and regulating Pt.