Shinozaki M, Muteki T, Kaku N, Tsuda H
Critical Care Center, Kurume University Hospital, Japan.
Crit Care Med. 1988 Feb;16(2):144-7. doi: 10.1097/00003246-198802000-00010.
The hemodynamic relationship between renal venous pressure (RVP) and renal blood flow (RBF) during PEEP was investigated using adult mongrel dogs. When continuous mechanical ventilation (CMV) with 10 cm H2O of PEEP was applied to dogs previously on CMV with zero PEEP, RVP increased from 6.6 to 8.7 mm Hg (p less than .01), and left RBF decreased from 66 to 57 ml/min (p less than .05). RBF recovered by 49% of the difference as soon as PEEP was discontinued when the RVP elevation was maintained at the level observed during 10 cm H2O of PEEP. With 20 cm H2O of PEEP, RVP increased further to 10 mm Hg (p less than .01) and left RBF decreased to 48 ml/min (p less than .05). When the left renal vein was occluded and the RVP was maintained at the level seen during 20 cm H2O of PEEP, left RBF recovered only 50% of the difference from the flow during zero PEEP. We conclude that the reduction in RBF with PEEP application is caused by several factors; however, RVP elevation during CMV with PEEP is influential in decreasing RBF.
利用成年杂种犬研究了呼气末正压通气（PEEP）期间肾静脉压（RVP）与肾血流量（RBF）之间的血流动力学关系。当对先前接受零PEEP的持续机械通气（CMV）的犬应用10 cm H₂O PEEP的CMV时，RVP从6.6 mmHg升高至8.7 mmHg（p＜0.01），左肾血流量从66 ml/min降至57 ml/min（p＜0.05）。当RVP升高维持在10 cm H₂O PEEP期间观察到的水平时，一旦停止PEEP，肾血流量恢复了差异的49%。使用20 cm H₂O PEEP时，RVP进一步升高至10 mmHg（p＜0.01），左肾血流量降至48 ml/min（p＜0.05）。当左肾静脉被阻断且RVP维持在20 cm H₂O PEEP期间观察到的水平时，左肾血流量仅从零PEEP时的血流量恢复了差异的50%。我们得出结论，应用PEEP时肾血流量减少是由多种因素引起的；然而，PEEP的CMV期间RVP升高对肾血流量减少有影响。
