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[高频通气。作用机制研究]

[High frequency ventilation. Study of the mechanisms of action].

作者信息

Theissen J L, Lunkenheimer P P, Mersch F J, Frieling G, Redmann K, Lawin P

机构信息

Clinique et Policlinique d'Anesthésie et de Réanimation Chirurgicale, Université Wilhelm, Münster, Westphalie, RFA.

出版信息

Ann Fr Anesth Reanim. 1988;7(3):233-8. doi: 10.1016/s0750-7658(88)80117-5.

Abstract

Dried lungs and isolated bronchial trees dissected from large animals were submitted to high-frequency oscillation and jet-ventilation. The pattern of intrapulmonary pressure distribution and CO2 diffusion were measured through transalveolar chambers fixed to the perforated pleural surfaces and through airbags pasted on the isolated bronchial trees. Under oscillating conditions, the pressure profiles in different lung and bronchial compartments were inhomogeneous and frequency dependent; the pressure-wave amplitude was proportional to the oscillation frequency. On the other hand, the inhomogeneities found with jet-ventilation were mostly dependent on the airflow direction and position of the intratracheal cannula. Since these inhomogeneities were similar on dissected lungs as well as on isolated bronchial trees, it was concluded that they were essentially dependent on endobronchial aerodynamic effects. But the absence of the in vivo pulmonary and bronchial elastic recoil certainly modified the effects of these ventilation modes with respect to accepted clinical findings. Also results were shown to vary between individuals and within individuals, probably explaining the divergent results obtained by different authors.

摘要

取自大型动物的干燥肺脏和分离出的支气管树被用于高频振荡通气和喷射通气。通过固定在有孔胸膜表面的跨肺泡腔室以及粘贴在分离出的支气管树上的气囊来测量肺内压力分布模式和二氧化碳扩散情况。在振荡条件下,不同肺和支气管区域的压力分布不均匀且与频率相关;压力波振幅与振荡频率成正比。另一方面,喷射通气时发现的不均匀性大多取决于气流方向和气管插管的位置。由于这些不均匀性在解剖后的肺脏以及分离出的支气管树上都相似,所以得出结论,它们本质上取决于支气管内空气动力学效应。但是体内肺和支气管弹性回缩的缺失肯定改变了这些通气模式相对于公认临床发现的效果。而且结果显示个体之间以及个体内部都存在差异,这可能解释了不同作者得到的不同结果。

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