肺复张术中频率和吸气平台压对急性肺损伤患者肺及远端器官的影响
Effects of frequency and inspiratory plateau pressure during recruitment manoeuvres on lung and distal organs in acute lung injury.
作者信息
Steimback Paula W, Oliveira Gisele P, Rzezinski Andréia F, Silva Pedro L, Garcia Cristiane S N B, Rangel Graziela, Morales Marcelo M, Lapa E Silva José R, Capelozzi Vera L, Pelosi Paolo, Rocco Patricia R M
机构信息
Laboratory of Pulmonary Investigation, Instituto de Biofísica Carlos Chagas Filho, C.C.S., Universidade Federal do Rio de Janeiro, Ilha do Fundão, Rio de Janeiro, RJ 21941-902, Brazil.
出版信息
Intensive Care Med. 2009 Jun;35(6):1120-8. doi: 10.1007/s00134-009-1439-y. Epub 2009 Feb 17.
PURPOSE
To evaluate the effects of frequency and inspiratory plateau pressure (Pplat) during recruitment manoeuvres (RMs) on lung and distal organs in acute lung injury (ALI).
METHODS
We studied paraquat-induced ALI rats. At 24 h, rats were anesthetized and RMs were applied using continuous positive airway pressure (CPAP, 40 cmH(2)O/40 s) or three-different sigh strategies: (a) 180 sighs/h and Pplat = 40 cmH(2)O (S180/40), (b) 10 sighs/h and Pplat = 40 cmH(2)O (S10/40), and (c) 10 sighs/h and Pplat = 20 cmH(2)O (S10/20).
RESULTS
S180/40 yielded alveolar hyperinflation and increased lung and kidney epithelial cell apoptosis as well as type III procollagen (PCIII) mRNA expression. S10/40 resulted in a reduction in epithelial cell apoptosis and PCIII expression. Static elastance and alveolar collapse were higher in S10/20 than S10/40.
CONCLUSIONS
The reduction in sigh frequency led to a protective effect on lung and distal organs, while the combination with reduced Pplat worsened lung mechanics and histology.
目的
评估急性肺损伤（ALI）患者在肺复张手法（RMs）过程中频率和吸气平台压（Pplat）对肺及远端器官的影响。
方法
我们研究了百草枯诱导的ALI大鼠。在24小时时，将大鼠麻醉，并使用持续气道正压通气（CPAP，40 cmH₂O/40秒）或三种不同的叹息策略进行RMs：（a）每小时180次叹息，Pplat = 40 cmH₂O（S180/40），（b）每小时10次叹息，Pplat = 40 cmH₂O（S10/40），以及（c）每小时10次叹息，Pplat = 20 cmH₂O（S10/20）。
结果
S180/40导致肺泡过度充气，肺和肾上皮细胞凋亡增加以及III型前胶原（PCIII）mRNA表达增加。S10/40导致上皮细胞凋亡和PCIII表达减少。S10/20组的静态弹性和肺泡萎陷高于S10/40组。
结论
叹息频率降低对肺和远端器官具有保护作用，而与降低的Pplat相结合则会使肺力学和组织学恶化。
Zotero 插件