Takeuchi C, Nakazawa K, Yokoyama K, Matsuzawa Y, Makita K
Department of Anesthesiology and Critical Care Medicine, Tokyo Medical and Dental University, Tokyo 113-8519.
Masui. 2001 Feb;50(2):116-21.
The efficacy of gas exchange during partial liquid ventilation (PLV) may be affected by positive end-expiratory pressure (PEEP), tidal volume (TV) and perflubron (PFOB) dose. The purpose of the present study was to clarify which factors were important for improving gas exchange during PLV. Fourteen rabbits were anesthetized and tracheostomized. Lung was introduced with intravenous oleic acid combined with saline lung lavage. After obtaining control data, PFOB 7.5 ml.kg-1 was instilled into the trachea, and ventilation settings were changed sequentially [1. TV: 10 ml.kg-1 (mTV), 2. mTV with PEEP, 3. TV: 15 ml.kg-1 (hTV), 4. hTV with PEEP]. PEEP level was set to the lower inflection point. The PFOB dose was increased to 15 ml.kg-1 and measurements were repeated under each ventilation setting. PEEP increased PaO2 in all ventilation settings. In hTV ventilation settings, incremental dose of PFOB significantly increased PaO2. The PaO2 values of all hTV ventilation settings were significantly higher than those of corresponding ventilation setting of mTV. Pulmonary compliance was significantly decreased with PEEP in hTV ventilation in addition to 15 ml.kg-1 PFOB. The results suggested that adequate gas tidal volume was the most important factor for improving gas exchange during PLV. However, PEEP or larger dose of PFOB should be avoided because they may decrease pulmonary compliance.
部分液体通气（PLV）期间的气体交换效率可能受到呼气末正压（PEEP）、潮气量（TV）和全氟溴辛烷（PFOB）剂量的影响。本研究的目的是阐明哪些因素对改善PLV期间的气体交换很重要。14只兔子被麻醉并进行气管切开术。通过静脉注射油酸联合生理盐水肺灌洗来处理肺脏。在获得对照数据后，将7.5 ml.kg-1的PFOB注入气管，并依次改变通气设置[1. TV：10 ml.kg-1（mTV），2. 带有PEEP的mTV，3. TV：15 ml.kg-1（hTV），4. 带有PEEP的hTV]。PEEP水平设定为下拐点。将PFOB剂量增加到15 ml.kg-1，并在每个通气设置下重复测量。在所有通气设置中，PEEP均提高了动脉血氧分压（PaO2）。在hTV通气设置中，PFOB的递增剂量显著提高了PaO2。所有hTV通气设置的PaO2值均显著高于相应mTV通气设置的值。除了15 ml.kg-1的PFOB外，在hTV通气中，PEEP还显著降低了肺顺应性。结果表明，足够的气体潮气量是改善PLV期间气体交换的最重要因素。然而，应避免使用PEEP或更大剂量的PFOB，因为它们可能会降低肺顺应性。
