Lakshminarayan S, Agostoni P G, Kirk W
Department of Medicine, University of Washington, Seattle.
Respiration. 1990;57(2):85-9. doi: 10.1159/000195826.
Positive end-expiratory pressure (PEEP) reduces systemic to pulmonary bronchial blood flow [Qbr(s-p)] presumably because it increases bronchial vascular resistance. Since PEEP increases lung volume and thus could stimulate pulmonary stretch receptors, we investigated the hypothesis that the PEEP-related decrease in bronchial blood flow was due to a reflex mediated by the vagus. In open-chest dogs the left lower lobe (LLL) was isolated, independently ventilated, perfused in situ with a closed pulmonary vascular circuit and weighed continuously. Qbr(s-p) was measured as LLL vascular circuit overflow and changes in LLL weight. When LLL PEEP was increased from 5 to 15 cm H2O in a group of 11 dogs Qbr(s-p) was reduced by half from 60.8 +/- 10.5 to 31.6 +/- 6.1 ml/min/100 g dry lobe weight. In another group of 7 dogs Qbr(s-p) was 46.5 +/- 6.9 with PEEP = 5 cm H2O; it decreased to 28.3 +/- 6.8 with bilateral cervical vagal cooling (0-1.5 degrees C) and did not decrease further after increasing PEEP to 15 cm H2O. We conclude that the effect of resting vagal tone is to increase Qbr(s-p) and that the effect of PEEP on Qbr(s-p) may be mediated at least partially by vagal influences.
呼气末正压(PEEP)可减少体循环至肺的支气管血流[Qbr(s-p)],这可能是因为它增加了支气管血管阻力。由于PEEP会增加肺容积,进而可能刺激肺牵张感受器,我们研究了这样一个假设,即PEEP相关的支气管血流减少是由迷走神经介导的反射所致。在开胸犬中,左下叶(LLL)被分离出来,独立进行通气,通过闭合的肺血管回路进行原位灌注,并持续称重。Qbr(s-p)通过LLL血管回路溢出量和LLL重量变化来测量。在一组11只犬中,当LLL的PEEP从5 cm H₂O增加到15 cm H₂O时,Qbr(s-p)从60.8±10.5降至31.6±6.1 ml/min/100 g干叶重,减少了一半。在另一组7只犬中,PEEP = 5 cm H₂O时Qbr(s-p)为46.5±6.9;双侧颈迷走神经冷却(0 - 1.5℃)后降至28.3±6.8,将PEEP增加到15 cm H₂O后未进一步降低。我们得出结论,静息迷走神经张力的作用是增加Qbr(s-p),并且PEEP对Qbr(s-p)的影响可能至少部分由迷走神经影响介导。