肺血流调节：正压通气的影响

Pulmonary blood flow regulation: influence of positive pressure ventilation.

作者信息

Theissen J L, Fischer S R, Traber L D, Traber D L

机构信息

Department of Anesthesiology and Intensive Care Medicine, Wesfalische Wilhelms-Universitat, Munster, Germany.

出版信息

Respir Physiol. 1995 Dec;102(2-3):251-60. doi: 10.1016/0034-5687(95)00049-6.

DOI:10.1016/0034-5687(95)00049-6

PMID:8904016

Abstract

Positive pressure ventilation with PEEP has been reported to reduce hypoxic pulmonary vasoconstriction (HPV) and thus increase venous admixture. This effect was investigated in six chronically instrumented unanesthetized healthy sheep. The change in left pulmonary arterial blood flow (Qlpa, ultrasonic transit time) in response to unilateral lung hypoxia (10 min of N2 alternately to the left (LLH) and right lung (RLH) was evaluated during mechanical ventilation with and without PEEP of 10 cm H2O in comparison to spontaneous breathing. In the spontaneously breathing animal and during mechanical ventilation without PEEP, Qlpa decreased during LLH from 30% to 16% of cardiac index, during RLH it increased to 51%. With 10 cm H2O of PEEP, Qlpa showed an identical reaction to hypoxia both in the left and right lung. It is concluded that mechanical ventilation and PEEP up to 10 cm H2O does not interfere with pulmonary blood flow regulation to hypoxia.

摘要

据报道，使用呼气末正压（PEEP）的正压通气会降低缺氧性肺血管收缩（HPV），从而增加静脉血掺杂。在六只长期植入仪器的未麻醉健康绵羊身上对这种效应进行了研究。与自主呼吸相比，在有和没有10 cm H₂O PEEP的机械通气期间，评估了单侧肺缺氧（向左肺（LLH）和右肺（RLH）交替给予10分钟N₂）时左肺动脉血流量（Qlpa，超声渡越时间）的变化。在自主呼吸的动物以及没有PEEP的机械通气期间，LLH期间Qlpa从心指数的30%降至16%，RLH期间则增至51%。使用10 cm H₂O的PEEP时，左肺和右肺的Qlpa对缺氧均表现出相同的反应。得出的结论是，机械通气和高达10 cm H₂O的PEEP不会干扰对缺氧的肺血流调节。