Norsted T, Jonzon A, Sedin G
Department of Pediatrics, University Hospital, Uppsala, Sweden.
Acta Anaesthesiol Scand. 1989 Jan;33(1):21-5. doi: 10.1111/j.1399-6576.1989.tb02853.x.
High intrapulmonary pressure is probably an important factor in the development of extra-alveolar air leaks and bronchopulmonary dysplasia during neonatal intermittent positive pressure ventilation (IPPV). Spontaneous breathing, which may be asynchronous with the ventilator as a result of hypoventilation or sometimes of the ventilatory pattern of the ventilator, can be prevented by neuromuscular blockade. During neuromuscular blockade with pancuronium bromide the central inspiratory (phrenic nerve activity) activity could be inhibited during IPPV at all ventilatory frequencies tested, but a lower arterial PCO2 and a higher pH were needed to achieve inhibition at a low frequency (15 bpm). In the present study it was observed that central inspiratory activity in cats was stimulated by intravenous injection of pancuronium bromide. In cats not subjected to neuromuscular blockade the inspiratory activity was inhibited during IPPV at all ventilatory frequencies studied. At the onset of inhibition of this activity, the arterial blood gases and pH in these animals were almost the same at all ventilatory frequencies. When ventilation was administered at a low frequency, higher peak intratracheal pressures were needed to obtain inhibition of central inspiratory activity than when high frequencies were used, both before and after neuromuscular blockade.
在新生儿间歇性正压通气（IPPV）期间，肺内高压可能是肺泡外气体泄漏和支气管肺发育不良发生的一个重要因素。由于通气不足或有时由于呼吸机的通气模式，自主呼吸可能与呼吸机不同步，可通过神经肌肉阻滞来预防。在用潘库溴铵进行神经肌肉阻滞期间，在所有测试的通气频率下，IPPV期间中枢吸气（膈神经活动）活动均可被抑制，但在低频（15次/分钟）时需要较低的动脉PCO2和较高的pH值才能实现抑制。在本研究中观察到，静脉注射潘库溴铵可刺激猫的中枢吸气活动。在未进行神经肌肉阻滞的猫中，在所有研究的通气频率下，IPPV期间吸气活动均被抑制。在这种活动开始抑制时，所有通气频率下这些动物的动脉血气和pH值几乎相同。在神经肌肉阻滞前后，当以低频通气时，与高频通气相比，需要更高的气管内峰值压力才能抑制中枢吸气活动。
