Alfery D D, Zamost B G, Benumof J L
Anesthesiology. 1981 Oct;55(4):376-80.
The authors attempted to favorably manipulate the distribution of pulmonary blood flow during unilateral atelectasis and during unilateral lung lavage by nonocclusive inflation of an ipsilateral pulmonary artery catheter balloon (PAB). Six mongrel dogs were anesthetized, intubated with a double-lumen endotracheal tube, and following a thoracotomy, pulmonary artery and left lung blood flows (Qt and QLL/Qt, respectively) were measured electromagnetically; right lung blood flows (QRL/Qt) were derived by difference. A PAB was positioned in the right main pulmonary artery. The experimental sequence consisted of seven steps: 1) both lungs ventilated; 2) ventilation of the left lung (LL vent), right lung (RL) atelectatic, PAB deflated; 3) LL vent, RL atelectatic, PAB inflated; 4) LL vent, RL lavaged, PAB deflated; 5) LL vent, RL lavaged, PAB inflated; 6) LL vent, RL drained, PAB deflated; and 7) LL vent, RL drained, PAB inflated. At each step the shunt fraction (Qs/Qt) was determined. Inflation of the PAB during LL vent and RL atelectatic (step 3) caused QRL/Qt and Qs/Qt to decrease and QLL/Qt and PaO2 to increase significantly (compared to step 2). There were no significant differences in QRL/Qt, QLL/Qt, Qs/Qt, and PaO2 during RL lavage with the PAB deflated (step 4) compared to RL lavage with the PAB inflated (step 5). Inflation of the PAB during RL drainage (step 7) caused QRL/Qt to decreased and QLL/Qt to increase significantly compared to their values during periods of RL drainage with the PAB deflated (step 6). This resulted in a significant increase in PaO2 and decrease in Qs/Qt. These results demonstrate that the distribution of pulmonary blood flow in dogs can be favorably manipulated by nonocclusive ipsilateral PAB inflation and support a trial of use in selected patients during one-lung anesthesia and ventilation.
作者试图通过同侧肺动脉导管球囊（PAB）的非阻塞性充气，在单侧肺不张和单侧肺灌洗期间，对肺血流分布进行有利的调控。6只杂种犬麻醉后，用双腔气管内导管插管，开胸后，用电磁法测量肺动脉和左肺血流（分别为Qt和QLL/Qt）；右肺血流（QRL/Qt）通过差值得出。将一个PAB置于右主肺动脉。实验步骤包括七个步骤：1）双肺通气；2）左肺通气（LL通气），右肺（RL）肺不张，PAB放气；3）LL通气，RL肺不张，PAB充气；4）LL通气，RL灌洗，PAB放气；5）LL通气，RL灌洗，PAB充气；6）LL通气，RL引流，PAB放气；7）LL通气，RL引流，PAB充气。在每个步骤中测定分流分数（Qs/Qt）。在LL通气和RL肺不张期间（步骤3）PAB充气，导致QRL/Qt和Qs/Qt降低，QLL/Qt和PaO2显著升高（与步骤2相比）。与PAB充气时的RL灌洗（步骤5）相比，PAB放气时的RL灌洗（步骤4）期间，QRL/Qt、QLL/Qt、Qs/Qt和PaO2没有显著差异。与PAB放气时的RL引流期间（步骤6）相比，RL引流期间（步骤7）PAB充气导致QRL/Qt降低，QLL/Qt显著升高。这导致PaO2显著升高，Qs/Qt降低。这些结果表明，通过同侧PAB非阻塞性充气可以有利地调控犬的肺血流分布，并支持在单肺麻醉和通气期间对选定患者进行试用。
