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目的 探讨在自主呼吸存在时应用持续性气管内吹气 (CTGI)的可能性。方法 油酸所致急性肺损伤犬模型 8只 ,保持一定程度的自主呼吸 ,随机予双相气道正压通气 (BIPAP)及BIPAP加用CTGI(流速分别为 3,6,9L/min ,简称T3,T6,T9组 ) ,BIPAP的参数均为呼吸频率 2 0次 /分 ,吸呼比 1∶1,PEEP(呼气末正压 ) 5cmH2 O。每种模式均通过调节BIPAP压力水平使PaCO2 在各组间相等 ,达到稳态后测定各通气方式下的外周动脉血和混合静脉血血气、呼吸力学、体循环和肺循环血流动力学指标 ,并推算氧运输量 (DO2 )和氧消耗量 (VO2 )。结果 在保证PaCO2 相同 ,即通气效果在各组间相同的前提下 ,吸气峰压在T6组 ( 14± 4cmH2 O)和T9组 ( 11± 3cmH2 O)均显著低于BIPAP组 ( 2 0± 5cmH2 O) ,T3组 ( 16± 4cmH2 O)、T6组与T9组相比及BIPAP组与T3组相比无显著差异 ,PaO2 、体循环平均压 (ABPM)、肺动脉平均压 (PAPM )、肺动脉楔压 (PCWP)、心输出量 (CO) ,DO2 和VO2在各组间无显著性差异。结论 CTGI与BIPAP联合运用时不会增加自主呼吸与呼吸机之间的不协调性 ,能有效地降低死腔通气 ,在降低气道压的同时 ,对血流动力学和氧动力学无显著影响。
Objective To explore the possibility of using continuous endotracheal insufflation (CTGI) in the presence of spontaneous breathing. Methods Eight dogs with acute lung injury induced by oleic acid were treated with BIPAP and BIPAP plus CTGI (flow rates were 3, 6 and 9 L / min, respectively) while maintaining a certain degree of spontaneous breathing. T3, T6 and T9). The parameters of BIPAP were respiratory rate 20 times / min, respiration rate 1: 1, PEEP (positive end expiratory pressure) 5cmH2O. In each mode, PaCO2 was equal between the groups by adjusting the pressure level of BIPAP. After steady state was reached, the peripheral arterial blood and mixed venous blood gas, respiration mechanics, systemic circulation and pulmonary circulation hemodynamics were measured and calculated Oxygen transport (DO2) and oxygen consumption (VO2). Results The inspiratory peak pressure was significantly lower in T6 group (14 ± 4cmH2O) and T9 group (11 ± 3cmH2O) than in BIPAP group (20 ± There was no significant difference between T6 group and T9 group and between BIPAP group and T3 group (P> 0.05). PaO2, mean arterial pressure (ABPM), mean pulmonary artery pressure (PAPM), pulmonary artery wedge Pressure (PCWP), cardiac output (CO), DO2 and VO2 did not differ significantly among the groups. Conclusions CTGI combined with BIPAP does not increase the incompatibility between spontaneous respiration and ventilator, and can effectively reduce dead space ventilation. While reducing airway pressure, CTGI has no significant effect on hemodynamics and oxygen dynamics .