Goto K, Goto H, Benson K T, Unruh G K, Arakawa K
Department of Anesthesiology, University of Kansas Medical Center, Kansas City 66103.
Anesth Analg. 1990 Apr;70(4):375-81. doi: 10.1213/00000539-199004000-00006.
To evaluate the effects of high-frequency jet ventilation (HFJV) (f = 60, 120 breaths/min) and conventional mechanical ventilation (CMV) (f = 10, 20) during equivalent conditions of cardiac tamponade, stroke index (SI), intrapericardial pressure (IPP), airway pressure (P(aw)), and cardiac pressures were measured in anesthetized, paralyzed, chest-closed dogs with the same levels of PaCO2. Cardiac tamponade was produced by infusing normal saline into the intrapericardial space to increase IPP to either 8 mm Hg (group 1, n = 8) or 12 mm Hg (group 2, n = 8). Stroke index in group 1 was 7.3 +/- 0.8 during CMV (f = 10), 8.1 +/- 0.7 during CMV (f = 20), 10.9 +/- 1.4 during HFJV (f = 60), and 10.7 +/- 1.2 (mL.beat-1.m-2) during HFJV (f = 120). Stroke index in group 2 was 4.1 +/- 0.7, 5.1 +/- 0.5, 7.2 +/- 0.5, and 6.7 +/- 0.5 (mL.beat-1.m-2), respectively. In both IPP groups, stroke index values during HFJV were significantly higher than during CMV; however, there were no significant differences in mean left and right atrial transmural pressures between HFJV and CMV. Peak IPP, mean P(aw), and peak P(aw) during HFJV were significantly lower than those during CMV. The results indicate that HFJV with lower mean and peak Paw, and with lower mean and peak IPP, can result in higher cardiac output than CMV in cardiac tamponade. Thus, HFJV may be superior to CMV in the clinical management of cardiac tamponade.
为评估在心脏压塞等效条件下高频喷射通气（HFJV）（频率f = 60、120次/分钟）和传统机械通气（CMV）（频率f = 10、20次/分钟）的效果，在麻醉、麻痹、胸部闭合且具有相同PaCO2水平的犬中测量了心指数（SI）、心包内压（IPP）、气道压力（P(aw)）和心脏压力。通过向心包腔内注入生理盐水使IPP升高至8 mmHg（第1组，n = 8）或12 mmHg（第2组，n = 8）来造成心脏压塞。第1组在心指数为10次/分钟的CMV期间心指数为7.3±0.8，在CMV（频率f = 20）期间为8.1±0.7，在HFJV（频率f = 60）期间为10.9±1.4，在HFJV（频率f = 120）期间为10.7±1.2（mL·beat-1·m-2）。第2组的心指数分别为4.1±0.7、5.1±0.5、7.2±0.5和6.7±0.5（mL·beat-1·m-2）。在两个IPP组中，HFJV期间的心指数值均显著高于CMV期间；然而，HFJV和CMV之间的平均左、右心房跨壁压无显著差异。HFJV期间的IPP峰值、平均P(aw)和P(aw)峰值均显著低于CMV期间。结果表明，在心脏压塞中，具有较低平均和峰值Paw以及较低平均和峰值IPP的HFJV可导致比CMV更高的心输出量。因此，在心脏压塞的临床管理中，HFJV可能优于CMV。
