Fujita Y
Department of Anesthesiology, Kawasaki Medical School, Kurashiki, Japan.
Acta Anaesthesiol Scand. 1993 May;37(4):427-31. doi: 10.1111/j.1399-6576.1993.tb03742.x.
The effects of intermittent positive pressure ventilation with PEEP on splanchnic circulation and hepatic oxygen supply were studied in six beagles. PEEP of 0, 0.5 and 1.0 kPa (0, 5, 10 cmH2O, PEEP0, PEEP5 and PEEP10, respectively) of 30 min duration was applied in a random sequence. Hepatic arterial blood flow and portal venous blood flow were measured by electromagnetic flow meters. Blood volume changes in the splanchnic area were assessed from hepatic and splenic dimensions determined by sonomicrometry. PEEP5 and PEEP10 were associated with proportional decreases in both hepatic blood flow and cardiac output, while mean arterial pressure remained unchanged. Reflecting the decrease in hepatic blood flow, the hepatic oxygen supply decreased with the level of PEEP, and hepatic venous hemoglobin oxygen saturation was significantly less during PEEP10 (55.1 +/- 14.3%) than during PEEP5 (62.6 +/- 17.4%) and PEEP0 (62.3 +/- 11.9%). Hepatic venous and portal venous pressure increased with the level of PEEP. Hepatic dimensions increased by 7-8% and 16-19% during PEEP5 and PEEP10, respectively, but no significant changes in splenic dimension were observed. We conclude that PEEP5 and PEEP10 are accompanied by a decrease in hepatic blood flow and oxygen supply along with hepatic congestion.
在六只比格犬身上研究了带呼气末正压（PEEP）的间歇性正压通气对内脏循环和肝脏氧供的影响。分别以随机顺序施加持续30分钟、压力为0、0.5和1.0 kPa（分别为0、5、10 cmH₂O，即PEEP0、PEEP5和PEEP10）的PEEP。通过电磁流量计测量肝动脉血流量和门静脉血流量。根据超声测微法测定的肝脏和脾脏尺寸评估内脏区域的血容量变化。PEEP5和PEEP10与肝血流量和心输出量成比例下降相关，而平均动脉压保持不变。反映肝血流量的减少，肝脏氧供随PEEP水平降低，并且在PEEP10期间肝静脉血红蛋白氧饱和度（55.1±14.3%）显著低于PEEP5期间（62.6±17.4%）和PEEP0期间（62.3±11.9%）。肝静脉压和门静脉压随PEEP水平升高。在PEEP5和PEEP10期间肝脏尺寸分别增加7 - 8%和16 - 19%，但未观察到脾脏尺寸有显著变化。我们得出结论，PEEP5和PEEP10伴随着肝血流量和氧供的减少以及肝脏充血。
