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[新生儿常规呼吸机的高频通气策略。气体交换、血流动力学状态及肺损伤评估]

[High frequency ventilation strategies with neonatal conventional ventilator. Assessment of gas exchange, hemodynamic status and lung injury].

作者信息

Herrera N, Regnicoli R, Begnis M S, Solari M, Magliaro N, Scrigna J

机构信息

Servicio de Neonatología, Hospital Italiano Garibaldi, Rosario, Argentina.

出版信息

Medicina (B Aires). 1997;57(4):402-8.

PMID:9674261
Abstract

Experiments were performed to consider the use of conventional neonatal ventilators with assisted expiratory mechanism using ventilatory high frequency strategies. Gas exchange, hemodynamic state, and lung injury were also assessed. Twenty Albino Wistar rats, undergoing and acute lung lesion through physiological solution wash of the lungs were studied. Afterward, they were distributed into four groups according to the different ventilator strategies, based on the different pressure changes and the tidal volume, the baseline lung volume and the respiratory frequency. Group I, High Frequency Ventilation, with high baseline lung volumes (HFVh); group II, Conventional Mechanical Ventilation, with high baseline lung volume (CMVh), group III, High Frequency Ventilation, with low baseline lung volume (HFV1) and group IV Conventional Mechanical Ventilation, with low baseline lung volume (CMV1). Significant differences were found between group I (HFVh) and groups II (CMVh), III (HFV1) and IV (CMV1) as regards pO2, Artery/Alveolar relation to O2 (a/A), pCO2, arterial blood pressure and histopathologic lung lesion. The hypothesis concerning the decisive role of the baseline lung volume maintainence to minimize progressive damage caused by mechanical ventilation on a previously injured lung while attending ventilatory strategies that generate little pressure and volume cyclical changes was confirmed. We conclude that, high frequency mechanical ventilation is possible through conventional neonatal respirators with assisted expiratory mechanism.

摘要

进行了实验,以探讨使用具有辅助呼气机制的传统新生儿呼吸机并采用高频通气策略的情况。还评估了气体交换、血流动力学状态和肺损伤。研究了20只通过肺生理盐水冲洗造成急性肺损伤的白化Wistar大鼠。之后,根据不同的通气策略,基于不同的压力变化、潮气量、基线肺容量和呼吸频率,将它们分为四组。第一组,高频通气,基线肺容量高(HFVh);第二组,传统机械通气,基线肺容量高(CMVh),第三组,高频通气,基线肺容量低(HFV1),第四组,传统机械通气,基线肺容量低(CMV1)。在I组(HFVh)与II组(CMVh)、III组(HFV1)和IV组(CMV1)之间,在动脉血氧分压(pO2)、动脉血氧分压与肺泡氧分压之比(a/A)、二氧化碳分压(pCO2)、动脉血压和肺组织病理学损伤方面发现了显著差异。关于在采用产生小压力和容量周期性变化的通气策略时,维持基线肺容量对最小化机械通气对先前受损肺造成的进行性损伤的决定性作用的假设得到了证实。我们得出结论,通过具有辅助呼气机制的传统新生儿呼吸机进行高频机械通气是可行的。

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