Venus B, Jacobs H K, Mathru M
Crit Care Med. 1980 Nov;8(11):620-7. doi: 10.1097/00003246-198011000-00005.
Hemodynamic function during spontaneous breathing (SB), IMV, IPPV, continuous positive airway pressure with 10 torr PEEP (CPAP10), IMV with 10 torr PEEP (IMV10), and continuous positive pressure ventilation with 10 torr PEEP (CPPV10) were studied in 13 normovolemic anesthetized dogs. Hemodynamic function was also studied during each type of ventilation after inducing acid aspiration with 0.1 molar HCl, 5 ml/kg, in these animals. In normal dogs, hemodynamic function during IMV and IPPV did not differ significantly from that observed in spontaneously breathing dogs. CPAP10 had no effect on the hemodynamic function. IMV10 decreased cardiac index, increased arterial-mixed venous O2 content difference (avDO2) compared to SB and decreased stroke index compared to SB, IMV, and CPAP10. CPPV10 significantly decreased cardiac and stroke indicies compared to SB, IMV, IPPV and CPAP10, and increased avDO2 compared to SB. After acid aspiration, IMV did not affect the hemodynamic function, but IPPV caused a significant decrease in stroke index compared to SB. Again, CPAP10 had no significant effect on the hemodynamic function. IMV10 decreased cardiac index and increased systemic vascular resistance compared to SB and decreased stroke index compared to SB and IMV. CPPV10 increased pulmonary vascular resistance and avDO2 compared to SB, decreased cardiac index compared to SB and IMV, decreased stroke index compared to SB, IMV, and CPAP10 and increased systemic vascular resistance compared to SB, IMV, IPPV, and CPAP10. Comparing percentage change of cardiac and stroke indices before and after aspiration indicated that the decrease in lung compliance caused by acid aspiration did not prevent the hemodynamic effects of different types of ventilation. Among different types of mechanical ventilation with PEEP, CPAP10 caused the least cardiovascular depression.
在13只血容量正常的麻醉犬中，研究了自主呼吸（SB）、间歇指令通气（IMV）、间歇正压通气（IPPV）、10厘米水柱呼气末正压的持续气道正压通气（CPAP10）、10厘米水柱呼气末正压的间歇指令通气（IMV10）以及10厘米水柱呼气末正压的持续正压通气（CPPV10）期间的血流动力学功能。还在这些动物中用0.1摩尔/升盐酸、5毫升/千克诱发酸误吸后，研究了每种通气类型期间的血流动力学功能。在正常犬中，IMV和IPPV期间的血流动力学功能与自主呼吸犬中观察到的情况相比无显著差异。CPAP10对血流动力学功能无影响。与SB相比，IMV10降低了心脏指数，增加了动脉-混合静脉血氧含量差（avDO2），与SB、IMV和CPAP10相比降低了每搏输出指数。与SB、IMV、IPPV和CPAP10相比，CPPV10显著降低了心脏和每搏输出指数，与SB相比增加了avDO2。酸误吸后，IMV不影响血流动力学功能，但与SB相比，IPPV导致每搏输出指数显著降低。同样，CPAP10对血流动力学功能无显著影响。与SB相比，IMV10降低了心脏指数并增加了全身血管阻力，与SB和IMV相比降低了每搏输出指数。与SB相比，CPPV10增加了肺血管阻力和avDO2，与SB和IMV相比降低了心脏指数，与SB、IMV、CPAP10相比降低了每搏输出指数，与SB、IMV、IPPV和CPAP10相比增加了全身血管阻力。比较误吸前后心脏和每搏输出指数的百分比变化表明，酸误吸引起的肺顺应性降低并未阻止不同类型通气的血流动力学效应。在不同类型的呼气末正压机械通气中，CPAP10引起的心血管抑制最小。
