RELATIONSHIPS BETWEEN LUNG COMPUTED TOMOGRAPHIC DENSITY, GAS-EXCHANGE, AND PEEP IN ACUTE RESPIRATORY-FAILURE
RELATIONSHIPS BETWEEN LUNG COMPUTED TOMOGRAPHIC DENSITY, GAS-EXCHANGE, AND PEEP IN ACUTE RESPIRATORY-FAILURE
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DOI：
10.1097/00000542-198812000-00005
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发表时间：
1988-12-01
期刊：
影响因子：
8.8
通讯作者：
TORRESIN, A
中科院分区：
文献类型：
--
作者：
GATTINONI, L;PESENTI, A;TORRESIN, A
22例急性呼吸衰竭患者在5、10和15 cm H2O呼气末正压（PEEP）下进行肺部计算机断层扫描（CT）和生理测量，以研究形态学与功能之间的关系。肺密度主要集中在依赖区。根据CT值（水和肺之间的X射线衰减差异）和肺气体体积测量值的频率分布，作者获得了正常充气、充气不良和非充气肺组织重量的定量估计值。估计的平均肺重量比正常增加两倍，并且多余的肺重量与平均肺动脉压相关（P < 0.01）。静脉混合物与未膨胀组织块相关（P < 0.01）。增加PEEP导致放射学密度逐渐清除，并增加正常膨胀组织的质量（解剖募集），同时减少静脉混合。增加PEEP后，心脏指数下降，而氧气输送量不变。作者得出结论，CT扫描肺密度和氧交换效率是相关的;增加PEEP的主要作用是恢复先前塌陷的灌注肺泡单位。
Twenty-two patients with acute respiratory failure underwent lung computed tomography (CT) and physiological measurements at 5, 10, and 15 cm H2O positive end-expiratory pressure (PEEP) to investigate the relationship between morphology and function. Lung densities were primarily concentrated in the dependent regions. From the frequency distribution of CT numbers (difference in x-ray attenuation between water and lung) and lung gas volume measurements the authors obtained a quantitative estimate of normally inflated, poorly inflated, and non-inflated lung tissue weight. This estimated average lung weight was increased twofold above normal and excess lung weight correlated with the mean pulmonary artery pressure (P < 0.01). Venous admixture correlated with the non-inflated tissue mass (P < 0.01). Increasing PEEP caused progressive clearing of radiographic densities and increased the mass of normally inflated tissue (anatomic recruitment), while reducing venous admixture. The cardiac index decreased after increasing PEEP while oxygen delivery was unchanged. The authors conclude that CT scan lung density and oxygen exchange efficiency are correlated; the main effect of augmenting PEEP is to recruit perfused alveolar units that were previously collapsed.