Theissen J, Lunkenheimer P P, Niederer P, Bush E, Frieling G, Lawin P
Klinik für Anaesthesiologie und Operative Intensivmedizin, Universität und Eidgenössische Technischen Hochschule, Zürich.
Anaesthesist. 1987 Sep;36(9):480-5.
The pattern of intrapulmonary pressure distribution was studied during high-frequency ventilation in order to explain the inconsistent results reported in the literature. Methods. Pressure and flow velocity (hot-wire anemometry) were measured in different lung compartments: 1. In transalveolar chambers sealed to the perforated pleural surfaces of dried pig lungs; 2. In emphysema-simulating airbags sealed to the isolated bronchial trees of dried pig lungs; and 3. In transalveolar chambers sealed to the perforated pleural surfaces of freshly excised pig lungs. Results. 1. The pressure amplitudes change from one area to another and depending on the exciting frequency. 2. High-frequency oscillation is associated with an increase in pressure amplitude when the exciting frequency rises, whereas with conventional high-frequency jet ventilation the pressure amplitude is more likely to decrease with frequency. 3. During high-frequency jet ventilation the local pressure amplitude changes with the position of the tube in the trachea rather than with the exciting frequency. 4. When the volume of the measuring chamber is doubled the resulting pressure amplitude falls to half the control value. 5. The pressure amplitude and mean pressure measured in the transalveolar chamber vary more or less independently from the peak flow velocity. High-frequency ventilation is thus seen to be a frequency-dependant, inhomogeneous mode of ventilation that can essentially be homogenized by systematically changing the exciting frequency. The frequency-dependant response to different lung areas to excitation is likely to result from an intrabronchially-localized aerodynamic effect rather than the mechanical properties of the lung parenchyma.
为了解释文献中报道的不一致结果,对高频通气期间肺内压力分布模式进行了研究。方法。在不同的肺腔室中测量压力和流速(热线风速仪):1. 在密封于干燥猪肺穿孔胸膜表面的跨肺泡腔室中;2. 在密封于干燥猪肺分离支气管树的模拟肺气肿气囊中;3. 在密封于新鲜切除猪肺穿孔胸膜表面的跨肺泡腔室中。结果。1. 压力幅度在不同区域之间变化,并取决于激发频率。2. 当激发频率升高时,高频振荡与压力幅度增加相关,而在传统高频喷射通气中,压力幅度更可能随频率降低。3. 在高频喷射通气期间,局部压力幅度随气管中导管位置而变化,而非随激发频率变化。4. 当测量腔室体积加倍时,产生的压力幅度降至对照值的一半。5. 在跨肺泡腔室中测量的压力幅度和平均压力与峰值流速或多或少独立变化。因此,高频通气被视为一种依赖频率的、不均匀的通气模式,通过系统地改变激发频率基本上可以使其均匀化。对不同肺区域激发的频率依赖性反应可能是由支气管内局部空气动力学效应而非肺实质的机械特性引起的。