Veddeng O J, Myhre E S, Risøe C, Smiseth O A
Department of Anesthesia, University Hospital, Rikshospitalet, Oslo, Norway.
J Appl Physiol (1985). 1992 Nov;73(5):2016-20. doi: 10.1152/jappl.1992.73.5.2016.
Effects of differential ventilation with general vs. selective right (R) and left (L) positive end-expiratory pressure (PEEP) on left (LV) and right ventricular (RV) end-diastolic dimensions were compared in seven pentobarbital-anesthetized dogs. All three modes of PEEP reduced LV cross-sectional area: general PEEP more than RPEEP and RPEEP more than LPEEP. General PEEP and, to a lesser degree, RPEEP decreased both the LV anteroposterior diameter and LV septum-free wall diameter, whereas LPEEP reduced the LV septum-free wall diameter only. Cardiac output was unaffected by LPEEP, whereas general PEEP (20 cmH2O) reduced cardiac output by 48%, and RPEEP (20 cmH2O) reduced it by 23%. RV septum-free wall diameter was not changed by any mode of PEEP. In conclusion, cardiac output was better maintained with selective PEEP than with general PEEP because LV filling was less impeded with selective PEEP. During LPEEP LV assumed a different configuration than during RPEEP and general PEEP, probably reflecting a different pattern of heart-lung interaction.
在七只戊巴比妥麻醉的犬中，比较了采用常规与选择性右（R）侧和左（L）侧呼气末正压（PEEP）进行差异通气对左心室（LV）和右心室（RV）舒张末期内径的影响。所有三种PEEP模式均减小了LV横截面积：常规PEEP的作用大于RPEEP，RPEEP的作用大于LPEEP。常规PEEP以及在较小程度上RPEEP均减小了LV前后径和LV室间隔-游离壁直径，而LPEEP仅减小了LV室间隔-游离壁直径。心输出量不受LPEEP影响，而常规PEEP（20 cmH₂O）使心输出量降低48%，RPEEP（20 cmH₂O）使其降低23%。任何PEEP模式均未改变RV室间隔-游离壁直径。总之，与常规PEEP相比，选择性PEEP能更好地维持心输出量，因为选择性PEEP对LV充盈的阻碍较小。在LPEEP期间，LV呈现出与RPEEP和常规PEEP期间不同的形态，这可能反映了心肺相互作用的不同模式。
