Claussen D, Klein U, Gottschild D, Langbein T, Schubert H, Dahinten H
Abteilung Anästhesiologie und Intensivtherapie, Friedrich-Schiller-Universität Jena.
Anaesthesiol Reanim. 1990;15(6):377-87.
In a controlled study, functional-scintigraphic investigations into perfusion and ventilation were performed on 10 dogs with non-damaged and extremely severely damaged lungs. The pulmonary damage was produced by injecting oleic acid (OA) into the right atrium of the heart under controlled ventilation (IPPV). The scintigraphic examinations were carried out using 133Xenon. The study compared HFJV (HFJV100, HFJV300) with IPPV in the non-damaged lung as well as HFJV300 with IPPV and CPPV (PEEP 1 kPa) after damage by OA. With the aid of the present radionuclide investigations, new insights can be gained into the largely unclear regional conditions of the gas exchange under HFJV in both the healthy and the damaged lung. Results from controlled studies on the distribution of ventilation and perfusion under HFJV have not been reported to date. The functional-scintigraphic examination with 133Xe on dogs shows, based on specific conditions of the gas exchange and special anatomic conditions of the lungs, a ventilation distribution that differs fundamentally from all other forms of ventilation, including HFOV, preference being given to apical pulmonary segments. This refers to the normal and the damaged lungs alike. However, ventilation-specific changes in pulmonary perfusion do not occur. The resulting deviating regional VA/Q relationship are obviously not of crucial influence upon the gas exchange. Rather, it is influenced and determined by damage-induced intraregional functional-structural alterations in the lung.
在一项对照研究中,对10只肺未受损和严重受损的犬进行了灌注和通气的功能闪烁扫描检查。通过在控制通气(IPPV)下将油酸(OA)注入心脏右心房来造成肺损伤。使用133氙进行闪烁扫描检查。该研究比较了在未受损肺中高频喷射通气(HFJV100、HFJV300)与IPPV,以及在OA损伤后HFJV300与IPPV和持续气道正压通气(CPPV,呼气末正压1 kPa)的情况。借助当前的放射性核素研究,可以对高频喷射通气下健康肺和受损肺中气体交换的区域状况在很大程度上仍不清楚的情况获得新的认识。迄今为止,尚未报道关于高频喷射通气下通气和灌注分布的对照研究结果。对犬进行的133氙功能闪烁扫描检查显示,基于气体交换的特定条件和肺的特殊解剖条件,通气分布与包括高频振荡通气(HFOV)在内的所有其他通气形式有根本不同,优先分布于肺尖段。这同样适用于正常肺和受损肺。然而,肺灌注并未出现与通气相关的变化。由此产生的区域通气/血流比值关系的偏差显然对气体交换没有关键影响。相反,它受肺内损伤引起的区域内功能结构改变的影响和决定。