监控跨肺压的肺保护通气策略对犬ARDS模型肺损伤的影响

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摘要目的比较监控跨肺压（PL）的肺保护通气策略（控制PL）和传统肺保护通气策略（控制Pplat）分别在机控通气和保留自主呼吸模式下对犬ARDS模型肺损伤的影响。方法18只比格犬采用静注油酸复制ARDS模型，随机分为A组、B组、C组。肺保护通气4 h后通过全肺CT扫描，根据三组的CT值判断过度通气区、正常通气区、通气不足区和闭合区，计算各充气区的容积以及其占总肺容积的比例；胸活检取肺组织，HE染色进行病理学评分。结果C组的过度充气区所占比例显著高于A组和B组，肺损伤总分高于A组和B组，差异有统计学意义（P＜0.05）。C组的中性白细胞浸润和间质水肿评分高于A组和B组，肺不张评分低于A组和B组，差异有统计学意义（P＜0.05）。结论监控PL无论在自主呼吸还是机控呼吸状态下，均能够有效调控肺容量，减轻VILI。在保留自主呼吸时，单纯监控Pplat不能有效调控肺容量，可导致肺组织过度充气，加重肺损伤。

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	温德良
	肖锐
	熊旭明

关键词 ：急性呼吸窘迫综合征, 肺保护通气策略, 平台压, 病理学, 呼吸机相关性肺损伤

Abstract：Objective To compare the influence of lung protective ventilation strategy　（LPVS）guided by PLand traditional LPVS on lung injury in a canine model of ARDS under the mode of controlled mechanical ventilation and spontaneous breath.Methods 18 beagle dogs were recruited to induct ARDS models by venous injection of oleic acid and were divided into group A，group B and group C.After 4 hours LPVS，CT scanning among the three groups was performed，and the regions of hyperventilation，normal ventilation，hypoventilation and closure were judged according to CT value，then the volume of each aerated region and its proportion to the total LV were calculated.Lung tissues were obtained by thoracotomy，HE staining was performed for pathological score.Results The proportion of hyperventilation region in group C was higher than that in group A and group B，the total score of lung injury in group C was higher than that in group A and group B，with significant difference（P＜0.05）.The score of neutrophil infiltration and interstitial edema in group C was higher than that in group A and group B，the atelectasis score in group C were lower than those in group A and group B，with significant difference　（P＜0.05）.Conclusion Monitoring of PLin both autonomous breathing and respiratory control，can effectively control the lung capacity，reduce VILI.In the retention of spontaneous breathing，simply monitoring Pplatcan not effectively control the lung capacity，which can lead to excessive inflation of the lung tissue and increase the lung injury.

Key words： Acute respiratory distress syndrome Lung protective ventilation strategy Plateau pressure Pathology Ventilation-induced lung injury

基金资助:广东省自筹经费类科技计划项目；广东省医学科研基金（B2015007）

作者简介: 温德良（1974-），男，医学博士，副主任医师，主要从事危重症临床研究

引用本文:

温德良;肖锐;熊旭明. 监控跨肺压的肺保护通气策略对犬ARDS模型肺损伤的影响[J]. 中国当代医药, 2016, 23(19): 4-8.
WEN De-liang;XIAO Rui;XIONG Xu-ming. Influence of lung protective ventilation strategy guided by transpulmonary pressure on lung injury in a canine model of ARDS. 中国当代医药, 2016, 23(19): 4-8.

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［1］	Slutsky AS，Tremblay LN.Multiple system organ failure.Is mechanical ventilation a contributing factor？［J］.Am J Respir Crit Care Med，1998，157（6）：1721-1725.
［2］	Sarge T，Talmor D.Targeting transpulmonary pressure to prevent ventilator lung injury［J］.Minerva Anestesiol，2009，75（9）：293-299.
［3］	Talmor D，Sarge T，Malhotra A，et al.Mechanical ventilation guided by esophageal pressure in acute lung injury［J］.N Engl J Med，2008，389（11）：2095-2014.
［4］	熊旭明，温德良，温艺超等.肺复张对肺内/外源性ARDS模型犬氧代谢和血流动力学的影响［J］.中国病理生理杂志，2011，27（4）：759-762.
［5］	Talmor D，Sarge T，O′Donnell CR，et al.Esophageal and transpulmonary pressures in acute respiratory failure［J］.Crit Care Med，2006，34（5）：1389-1394.
［6］	Gattinoni L，Pesenti A，Bombino M，et al.Relationships between lung computed tomographic density，gas exchange， and PEEP in acute respiratory failure［J］.Anesthesiology，1988，69（10）：824-832.
［7］	Smith KM，Mrozek JD，Simonton SC，et al.Prolonged partial liquid ventilationusing conventional and high-frequency ventilatory techniques：gas exchange and lung pathology in animalmodelofrespiratorydistresssyndrome［J］.CritCareMed，1997，25（11）：1888-1897.
［8］	Suki B，Hubmayr R.Epithelial and endothelial damage induced by mechanical ventilation modes［J］.Curr Opin Crit Care，2014，2011（11）：17-24.
［9］	Gattinoni L，Carlesso E，Cadringher P，et al.Physical and biological triggers of ventilator-induced lung injury and its prevention［J］.Eur Respir J，2003，47（9）：15-25.
［10］	Gattinoni L，Bombino M，Pelosi P，et al.Inflammatory pulmonary edema and positive end-expiratory pressure：cortelations between imaging and physiologic studies［J］.J Thorac Imaging，1988，3（3）：59-64.
［11］	Crotti S，Mascheroni D，Cairomi P，et al.Recruitment and derecruimentduring　acute　respiratoryfailure：aclinical study［J］.Am J Respir Crit Care Med，2001，164（10）：131-140.
［12］	Luecke T，Meinhardt JP，Herrmann P，et al.Oleic acid vs saline solution lung lavage-induced lung injury：effects on lung morphology，pressure-volume relationships，and response to positiveend-expiratory pressure［J］.Chest，2006，130（8）：392-401.
［13］	Chiumello D，Cressoni M，Colombo A，et al.The assessment of transpulmonary pressure in mechanically ventilated ARDS patients［J］.Intensive Care Med，2014，40（11）：1670-1678.
［14］	Blennerhasset JB.Shock lung and diffuse alveolar damage：pathological and pathogenetic considerations［J］.Pathology，1985，17（8）：239-247.