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目的 探讨反比通气 (IRV)对急性呼吸窘迫综合征 (ARDS)绵羊血流动力学及氧代谢的影响。方法 总呼气末正压 (PEEPt)相同条件下 ,观察压力控制 (PC) /容量控制 (VC)正比和反比通气 (IRV)对血流动力学及氧代谢的影响。结果 与VC及VC IRV比较 ,PC及PC IRV时的气道峰值压力明显降低。但IRV时的平均气道压力明显高于正比通气 (P <0 0 5 )。VC IRV与VC及PC IRV与PC比较 ,血流动力学及氧代谢均无明显差异。实施PC IRV时 ,内源性呼气末正压为 (3 0± 1 0 )cmH2 O ,显著高于VC (2 1± 0 8)cmH2 O(P <0 0 5 )。PEEPt相同的前提下 ,PC IRV时动脉血氧饱和度 (SaO2 )为 90 % ,显著低于VC(96 % ) (P <0 0 5 )。结论 在PEEPt相同的前提下 ,无论是VC IRV还是PC IRV ,均不优于常规正比通气。PEEPt是影响氧合的主要因素
Objective To investigate the effects of inverse-proportion ventilation (IRV) on hemodynamics and oxygen metabolism in sheep with acute respiratory distress syndrome (ARDS). Methods Under the same conditions of total positive expiratory pressure (PEEPt), the effects of propofol / volume control (VC) proportional and inverse ratio ventilation (IRV) on hemodynamics and oxygen metabolism were observed. Results Compared with VC and VC IRV, peak pressure of airway in PC and PC IRV significantly decreased. However, the mean airway pressure was significantly higher at IRV than at proportional ventilation (P <0.05). There was no significant difference in hemodynamics and oxygen metabolism between VC IRV, VC, PC IRV and PC. The endogenous positive end expiratory pressure was (3 0 ± 1 0) cmH 2 O when PC IRV was administered, which was significantly higher than that of VC (2 1 ± 0 8) cmH 2 O (P 0 05). Under the same conditions of PEEPt, the arterial oxygen saturation (SaO2) at PC IRV was 90%, significantly lower than that of VC (96%) (P <0.05). Conclusion In the same premise of PEEPt, neither VC IRV nor PC IRV is superior to conventional proportional ventilation. PEEPt is the main factor affecting oxygenation