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作者采用拟合法、多次阻断技术,压力-容积环(PV环)测量等观察麻醉犬油酸呼吸窘迫综合征(RDS)模型在0～4h的肺力学改变。结果:(1)顺应性降低,吸气相及呼气相的肺顺应性分别由对照值0.9942±0.3773,1.1706±0.4466降至0.4120±0.0714,0.3365±0.0398 L·kPa;跨肺压(Ptp)、气道压(Pao)升高;功能残气量(FRC)减少等改变主要发生于0～2h,其后2～4h期间的变化缓慢,且多未达显著水平。(2)拟合法测得呼气相的气流阻力显著升高,肺阻力及呼吸系统阻力分别由对照值-0.06±0.13,0.32±0.05增至4h时0.42±0.05,0.67±0.08kPa·L·s。(3)肺以及整个呼吸系统的压力-容积环(PV环)的变化趋势基本相同,主要有充气支出现拐点,位于0.98kPa处;环的滞后程度加大,注入油酸后4h,跨肺压-容积环及气道压-容积环的“半容积宽度”分别由注入前的0.36及0.69增为0.81及1.05kPa;环向下方移位。我们认为,在成人呼吸窘迫综合征(ARDS)通气支持治疗过程中,以选用拟合法结合PV环测量,根据Pao、呼吸流率等生理变化,实行肺力学变化的实时监测为宜。
The authors observed the change of pulmonary mechanics of anesthetized dog oleic acid respiratory distress syndrome (RDS) model at 0 ~ 4h by fitting method, multiple blocking technique and pressure-volume ring (PV ring) measurement. Results: (1) Compliance decreased, pulmonary compliance of inspiratory and expiratory phases decreased from 0.9942 ± 0.3773,1.1706 ± 0.4466 to 0.4120 ± 0.0714,0.3365 ± 0.0398 L · kPa, respectively; , And Pao increased. The decrease of functional residual capacity (FRC) occurred mainly in 0 ~ 2h, and then changed slowly from 2h to 4h. (2) The airflow resistance of the expiratory phase was significantly increased by fitting test. The lung resistance and respiratory resistance increased from -0.06 ± 0.13,0.32 ± 0.05 to 0.42 ± 0.05,0.67 ± 0.08kPa · L · S. (3) The pressure-volume ring (PV ring) of the lung and the whole respiratory system showed the same tendency of change, mainly inflatable branch appeared inflection point located at 0.98kPa; ring lag increased, injection of oleic acid 4h, The “half volumetric width” of the pressure-volume ring and the airway pressure-volume ring increased from 0.36 and 0.69 before injection to 0.81 and 1.05 kPa, respectively; and the ring shifted downward. We believe that in the treatment of adult respiratory distress syndrome (ARDS) ventilation support, the selection of fitting method combined with PV loop measurement, according to Pao, respiratory rate and other physiological changes, the implementation of real-time monitoring of pulmonary changes is appropriate.