Effect of positive end-expiratory pressure ventidation on organ blood volumes

呼气末正压通气对器官血容量的影响

• 批准号: 04454397
• 负责人: TAKAORI Masuhiko
• 金额: $ 3.46万
• 依托单位: Kawasaki Medical School
• 依托单位国家: 日本
• 项目类别: Grant-in-Aid for General Scientific Research (B)
• 财政年份: 1992
• 资助国家: 日本
• 起止时间: 1992 至 1994
• 项目状态: 已结题
• 来源: https://kaken.nii.ac.jp/en/grant/KAKENHI-PROJECT-04454397/
• 关键词: positive end-expiratory pressure ventilation; organ blood volume; distribution of circulating blood; cardiac output; isotope labelled red cells; intraabdominal pressure; vasoactive drug; 循環血液量; 胸腔内圧; 呼気終末陽圧呼吸; 赤血球分布; 連続的血液量測定

At initiation of positive end-expiratory pressure ventilation (PEEP), some decreases in cardiac out are usually observed in practice. However its mechanism remains still obscure. A hypothesis, that the PEEP may move the circulating blood from the central area, such as the heart and lung, to peripheral vessels and thus the PEEP may decrease the venous return, has been supported mostly consistently. We intended to confirm this hypothesis in this study and to find the peripheral area where the blood pooling would occur most intensively. Further we attempted to observe how long the pooling would be continued after the PEEP and to adopt how we could prevent the pooling.Experiments were carried out in beagles which were anesthetized with ketamine-N_2O-O_2 and fully paralyzed with vecuronium. Tow mililiters of autologous packed red cells which were labelled with ^<99m>Tc (2 mCi) were injected intravenously and density of the red cells was determined in the brain, thoracic organs (mainly the h … More eart and lungs), liver, splen, adductor muscles in the hind limb and one of the femoral vein with the fixed lumen by gamma ray detectors, respectively, and then blood volumes were calculated with the counted radioactivities and hematocrit value for the blood in the organ.While zero, 5,10,15, and 20 cmH_2O PEEP were loaded randomly, decreases in the circulating blood volume and thoracic organ blood volume were observed inversely with the changes in PEEP.On the hand, the blood volumes in the liver, spleen and skeletal muscle increased paralleling with the changes in PEEP.Cardiac output measured with thermodilution technique decreased paralleling with the changes in PEEP.In the second experimented series, the lower part of abdomen was compressed by an air tourniquet and the intraabdominal pressure was elevated to 10 and 20 cmH_2O randomly for each PEEP.By this procedure, all changes in the organ blood volume described above were attenuated and, particularly, both decrease in the circulating blood volume and increase in the skeletal muscle blood volume disappeared. However the decrease in cardiac output had still persisted.In the third series, effects of dopamine (5 mug, kg^<-1>, min^<-1>) or isosorbid dinitrate (2 mug, kg^<-1>, min^<-1>) on the changes in organ blood volume and cardiac output were observed under 15 cmH_2O PEEP with or without 20 cmH_2O intraabdominal pressure. None of definite change was noted in the organ blood volumes either with the infusion of dopamine or isosorbide dinitrate. However the decrease in cardiac output recovered during the infusion of dopamine but not isosorbide dinitrate.From the results obtained above, we presumed that the decrease in cardiac output under PEEP is caused by not sole factor but by complexes of many factors. In the future it seems to need more substantial study, particularly with endocrinological approch. Less

在开始呼气末正压通气（PEEP）时，在实践中通常会观察到心输出量的一些减少。但其机制仍不清楚。PEEP可将循环血液从中心区域（例如心脏和肺）移动到外周血管，并且因此PEEP可减少静脉回流的假设已得到大多数一致的支持。我们打算在这项研究中证实这一假设，并找到血液汇集最集中的外周区域。实验在氯胺酮-N_2 O-O_2麻醉、维库溴铵完全麻痹的比格犬上进行。用~（13）Tc（2 mCi）标记的自体浓缩红细胞2 <99m>ml经静脉注射，测定脑、胸器官（主要是心脏）的红细胞密度。 ...更多信息 用γ射线探测器分别对大鼠后肢（心、肺）、肝脏、脾脏、内收肌和一侧固定管腔的股静脉进行放射性计数和红细胞压积测定，计算血容量，并随机加载0、5、10、15和20 cmH_2O PEEP，观察到循环血容量和胸腔器官血容量的减少与PEEP的变化成反比。另一方面，肝脏中的血容量，脾、骨骼肌随PEEP的变化而增加，热稀释法测心输出量随PEEP的变化而减少，第二组用空气止血带压迫下腹部，每次PEEP随机将腹内压升高至10和20cmH_2O，上述器官血容量的变化均减弱，尤其是循环血容量的减少和骨骼肌血容量的增加均消失。第三组在15 cm H_2O呼气末正压（PEEP）和20 cm H_2O腹内压下，观察多巴胺（5 μ g，kg<-1>·min ~（-1<-1>））或硝酸异山梨酯（2 μ g，kg<-1>·min ~（-1<-1>））对器官血容量和心输出量的影响。无论是输注多巴胺还是硝酸异山梨酯，器官血容量都没有明显变化。但在输注多巴胺后，心输出量的减少得到恢复，而在输注硝酸异山梨酯后，心输出量的减少没有恢复，由此推测PEEP下心输出量的减少不是单一因素引起的，而是多种因素综合作用的结果。在未来，它似乎需要更多的实质性研究，特别是与内分泌的方法。少

项目成果

Takaori,M.,Fukui,A.,Kimura,K.,Fujita,Y.: "The effect of positive end-expiratory pressure on the cardiac output and organ blood volumes accompanied with increases in intraabdominal pressure." Pathophysiology. 2:Suppl.1. 356 (1994)

Takaori,M.、Fukui,A.、Kimura,K.、Fujita,Y.：“呼气末正压对心输出量和器官血容量的影响伴随着腹内压的增加。”

福井 明,高折益彦,木村健一,藤田善久: "終末呼気陽圧(PEEP)人工呼吸の臓器血液量に及ぼす影響" 循環制御. 14. 537-543 (1993)

Akira Fukui、Masahiko Takaori、Kenichi Kimura、Yoshihisa Fujita：“呼气末正压 (PEEP) 机械通气对器官血量的影响”循环控制。 14. 537-543 (1993)

福井 明,高折益彦,木村健一,藤田善久: "終末呼気陽圧人工呼吸の臓器血液量に及ぼす影響-腹腔内圧と血管作動薬の影響" 循環制御. 15(掲載許可済). (1995)

Akira Fukui、Masahiko Takaori、Kenichi Kimura、Yoshihisa Fujita：“呼气末正压通气对器官血容量的影响 - 腹内压和血管活性药物的影响”循环控制 15（允许出版）。

福井 明、高折益彦,木村健一、藤田喜久: "終末呼気陽圧呼吸の臓器血液量におよぼす影響-腹腔内圧の影響" 循環制御. 15,2号. (1994)

Akira Fukui、Masahiko Takaori、Kenichi Kimura、Yoshihisa Fujita：“呼气末正压呼吸对器官血容量的影响 - 腹内压的影响”循环控制 15，第 2 期。

Fukui, A., Takaori, M., Kimure, K., Fujita, Y.: "Effect of positive end-expiratory positive pressure ventilation on organ organ blood volumes -Effect of increased intraabdominal pressure" Circuration Control. 15 (2). 249-257 (1994)

Fukui, A.、Takaori, M.、Kimure, K.、Fujita, Y.：“呼气末正压通气对器官血容量的影响 - 腹内压增加的影响”循环控制。