对肺 perfusion 分布和肺内穿在猪一个肺通风期间的阳性终端呼吸压力的影响:一个随机交叉研究
Jakob Wittenstein1, Martin Scharffenberg1, Jonathan Fröhlich1
1Department of Anesthesiology and Intensive Care Medicine, Pulmonary Engineering Group, University Hospital Carl Gustav Carus Dresden at Technische Universität Dresden, Dresden, Germany.
Anesthesiology
|April 16, 2024
概括
在单肺通风 (OLV) 过程中,较高的阳性末尾呼气压力 (PEEP) 并没有将肺 perfusion 从通风的肺部转移. 这项研究在实验模型中没有发现高PEEP水平的肺内冲路增加.
科学领域:
- 麻醉学 麻醉学
- 胸部外科手术 胸部外科手术
- 呼吸系统生理学 呼吸系统生理学
背景情况:
- 一个肺通风 (OLV) 对于胸部手术至关重要.
- 在OLV期间的阳性末尾呼气压 (PEEP) 可能会改善通风,但可能会导致过度膨胀和分流.
- 该研究调查了PEEP在OLV期间对肺 perfusion 分布和肺内分流的影响.
研究的目的:
- 为了测试假设,OLV期间更高的PEEP将肺 perfusion 从通风到非通风的肺重定向.
- 为了确定PEEP水平和OLV期间的肺内分流之间的关系.
- 评估PEEP在OLV期间对气体交换和血液动力学的影响.
主要方法:
- 麻醉后的猪在诱导炎症反应后接受了不同PEEP水平 (0,5,定位,15厘米H2O) 的OLV.
- 使用光微球来评估肺 perfusion 的分布.
- 通过计算机断层扫描确定了通风分布;测量了呼吸,血液动力和气体交换变量.
主要成果:
- 驾驶压力随着OLV而增加,无论PEEP如何.
- 心脏输出在PEEP (15厘米H2O) 的最高值下降.
- 肺内转移在0厘米H2OPEEP时最高,在定位PEEP时最低,但PEEP时对通风肺的相对 perfusion 并没有显著变化.
结论:
- 与假设相反,在这个模型中,更高的PEEP并没有将输液从通风到非通风的肺部转移.
- 在OLV期间,升高的PEEP并没有增加肺内分流.
- PEEP影响透气肺内的输液和通风分布,转移到较高水平的背部和尾部区域.
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