Abstract
目的 探讨早期应用控制性高浓度氧疗、持续气道内正压(CPAP)、双水平气道内正压(BiPAP)等不同的干预措施对犬急性肺损伤(ALI)早期中枢驱动和呼吸应答的影响.方法 24只杂种犬在制作油酸急性肺损伤模型成功后(PaO2/FiO2≤300mm Hg),保持自主呼吸,随机分为控制性高浓度氧疗组(n=8)、CPAP组(n=8)、BiPAP组(n=8).连续记录并计算正常、ALI早期、干预后1～4h内中枢驱动和呼吸应答的各项生理指标.结果 在降低呼吸频率上,BiPAP组效果最明显(P＜0.001),其次是CPAP组和氧疗组(P＜0.05).三组对分钟通气量的影响不大(P＞0.05),维持在ALI或急性呼吸窘迫综合征(ARDS)发生后的通气水平.在潮气量、吸气流量峰值、平均吸气流量指标的改善上,BiPAP组效果最显著,其次是CPAP组和氧疗组.在跨膈压峰值、膈肌肌电电压最大均方根上,BiPAP组降低最明显,其次是CPAP组.结论 BiPAP和CPAP对于缓解呼吸窘迫、降低呼吸中枢驱动、改善呼吸应答均具有积极作用,显著延缓了ALI/ARDS的病情恶化,其中BiPAP效果更为显著。
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