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目的探讨早期应用控制性高浓度氧疗、持续气道内正压(CPAP)、双水平气道内正压(BiPAP)等不同的干预措施对犬急性肺损伤(ALI)早期中枢驱动和呼吸应答的影响。方法24只杂种犬在制作油酸急性肺损伤模型成功后(PaO_2/FiO_2≤300 mm Hg),保持自主呼吸,随机分为控制性高浓度氧疗组(n=8)、CPAP组(n=8)、BiPAP组(n=8)。连续记录并计算正常、ALI早期、干预后1～4 h内中枢驱动和呼吸应答的各项生理指标。结果在降低呼吸频率上,BiPAP组效果最明显(P<0.001),其次是CPAP组和氧疗组(P<0.05)。三组对分钟通气量的影响不大(P>0.05),维持在ALI或急性呼吸窘迫综合征(ARDS)发生后的通气水平。在潮气量、吸气流量峰值、平均吸气流量指标的改善上,BiPAP组效果最显著,其次是CPAP组和氧疗组。在跨膈压峰值、膈肌肌电电压最大均方根上,BiPAP组降低最明显,其次是CPAP组。结论BiPAP和CPAP对于缓解呼吸窘迫、降低呼吸中枢驱动、改善呼吸应答均具有积极作用,显著延缓了ALI/ARDS的病情恶化,其中BiPAP效果更为显著。
Objective To investigate the effects of early interventional therapy such as controlled high-concentration oxygen therapy, continuous positive airway pressure (CPAP), and bi-level positive airway pressure (BiPAP) on central drive and respiratory response in early acute lung injury (ALI) . Methods 24 dogs were randomly divided into control high concentration oxygen therapy group (n = 8) and CPAP group (n = 8) after successful model of oleic acid induced acute lung injury (PaO 2 / FiO 2 ≤ 300 mm Hg) 8), BiPAP group (n = 8). Continuous recording and calculation of normal, ALI early, 1 ~ 4 h after intervention within the central drive and respiratory response to various physiological indicators. Results The BiPAP group was the most effective in reducing respiratory rate (P <0.001), followed by CPAP group and oxygen therapy group (P <0.05). The three groups had insignificant effect on minute ventilation (P> 0.05), maintaining the level of ventilation after ALI or acute respiratory distress syndrome (ARDS). In the tidal volume, inspiratory flow peak, the average inspiratory flow indicators improve, BiPAP group the most significant effect, followed by CPAP group and oxygen therapy group. In the diastolic diaphragms, diaphragmatic EMG maximum root mean square, BiPAP group decreased the most obvious, followed by the CPAP group. Conclusion BiPAP and CPAP have a positive effect on alleviating respiratory distress, lowering respiratory center drive and improving respiratory response, and significantly delay the progression of ALI / ARDS. BiPAP is more effective.