臺灣博碩士論文加值系統

中文摘要
空氣栓塞在高壓氧及海底醫學領域中，是臨床最主要常見治療的適應症之ㄧ。氣泡造成肺部空氣栓塞，最主要會阻塞肺部血流通暢造成缺血及缺氧，另一方面會引發肺損傷。因此，建立一個肺空氣栓塞動物模式，同時探討如何能加速對氣泡的吸收、排除，以降低氣泡對肺部組織的傷害，這是潛水醫學研究中極為重要的課題。本實驗的目的是探討空氣栓塞後肺部通氣及血流分佈的失衡，同時探討給予高濃度氧氣對於空氣栓塞後肺部通氣及血流分佈的失衡。實驗方法是給予兔子靜脈注射空氣0.1mL/min，30分鐘，誘發肺動脈空氣栓塞，利用多重惰性氣體排除技術及螢光微粒分析，分別觀察空氣栓塞前1小時、空氣栓塞時、以及空氣栓塞後2小時，肺部通氣與血流（ A/ ）分佈及肺血流空間分佈的影響。本實驗結果顯示：在給空氣栓塞30分鐘後動脈血壓降低、右心室收縮壓增加，動脈、混合靜脈氧分壓降低、動脈二氧化碳分壓增加。另外在給空氣栓塞後，呼吸無效腔比例增加、 A/ 分佈偏向high A/ 。以上這些變化在停止空氣栓塞2小時後部份恢復。在給空氣栓塞時，肺相對血流之空間分佈有顯著變化，背側血流明顯增加，而腹側減少；另外尾端到頭端或左右肺的相對血流分佈情形，則無顯著差異。在給空氣栓塞時，每塊肺小塊相對血流有重新分佈的現象，相對血流極度增加或減少的肺小塊數目明顯變多，只有少部分肺區的血流能維持不變。這種血流重分佈的情況在停止栓塞後2小時大部份恢復至原來狀態。高濃度氧氣呼吸明顯降低空氣栓塞後動脈血壓及動脈、混合靜脈氧分壓的變化，也使得空氣栓塞後肺通氣灌流失衡的恢復狀況更為完全。但是，高氧呼吸對空氣栓塞時或栓塞後之肺血流空間重分佈並無明顯影響；而每塊肺小塊相對血流的重新分佈及回復狀況，空氣組與高氧組也無顯著差異。本實驗結論：經由靜脈注射空氣可誘發肺空氣栓塞，使得血流向背侧重新分佈，造成通氣血流分佈失衡。這變化大部分可以在兩小時內恢復至正常範圍。呼吸高濃度氧氣對於空氣栓塞後通氣血流分佈失衡及其恢復速度並無顯著影響。

ABSTRACT
Air embolism is one of the main common clinical therapeutically indications in medical undersea and hyperbaric oxygen therapy. The air bubble causes the lung air embolism, blocks lung blood circulate smooth to ischemia and hypoxia, and will cause the lung damage.So, setting up an animal model of pulmonary air embolism, and discussing how to accelerate the absorption of the bubble , to reduce air bubbles inducing lung injury at the same time is an extremely important subject in dive medical research .

The purpose of the experiment is to investigate air embolism-induced ventilation-perfusion mismatch in the lung, and to evaluate the effect of hyperoxia on ventilation – perfusion mismatch in pulmonary air embolism. Pulmonary artery air embolism in rabbits was induced by intravenous injection of air 0.1mL/min, 30 minutes, Multiple inert gas elimination technology and fluorescent microsphere technique, were used to determine the ventilation – perfusion distribution. The result showed that air embolism 30 minutes reduced the arterial pressure, increased right ventricle systolic pressure, reduced artery and mixes vein oxygen partial pressure, and increased artery carbon dioxide partial pressure. Air embolism also caused increase in dead space and high A/ distribution. The above changes partially recovery after stopping air embolism for two hours. During air embolism, the spatial distribution of the relative blood flow of lung shifted from the ventral side to the dorsal side. Besides there is no significance difference in the relative blood flow of caudal to cranial or lift to right distributing. While giving the air embolism, the relative blood flow of each little lung pieces has the phenomenon of redistributed. The relative blood flow of little lung pieces reduced or increased obviously and only some parts of the lung remained unchanged. The redistribution of relative blood flow recover to the original state mostly in 2 hours after stopping the embolism. The hyperoxia breathing obviously reduced changes of arterial pressure and artery and mixing vein oxygen partial pressure after air embolism. It also caused more complete recovery on ventilation – perfusion mismatch after pulmonary air embolism too.

In summary, intravenous injection of air induce the pulmonary air embolism, make the blood flow distribute into dorsal side and cause ventilation – perfusion mismatch. This change majority can recover to the normal range within two hours. Breathing the hyperoxia influence to ventilation – perfusion mismatch and recover the speed not significance difference after the pulmonary air embolism.

正文目錄
「表」目錄
「圖」目錄
中文摘要
英文摘要
中文摘要 5
ABSTRACT 7
第一章 緒論 9
第二章：實驗材料與方法 17
第三章：研究結果 27
第四章 討論 41
第五章 結論 50
表一 、各組空氣栓塞後血液動力學參數 51
表三之一、各組空氣栓塞後之整體MIGET參數 53
表三之二、各組空氣栓塞後之整體MIGET參數 54
表四、各組空氣栓塞後螢光微粒圖形各方向斜率及變異係數比較 55
表五、 控制組不同情況時間點肺小塊相對血流分佈的相關性 56
圖一、空氣組MIGET通氣灌流分佈曲線圖 57
圖二、50% O2組MIGET通氣灌流分佈曲線圖 58
圖三、100% O2組MIGET通氣灌流分佈曲線圖 59
圖四、控制組肺小塊相對血流分佈之離散性 60
圖五、空氣組空氣栓塞與栓塞後2小時肺小塊相對血流分佈離散性 61
圖六、50%O2組空氣栓塞與栓塞後2小時肺小塊相對血流分佈離散性 62
圖七、100%O2組空氣栓塞與栓塞後2小時肺小塊相對血流分佈 63
圖八、各組空氣栓塞後肺背側到腹側肺小塊相對血流分佈狀態 64
圖九、各組空氣栓塞後肺頭側到尾側肺小塊相對血流分佈狀態 65
圖十、控制組所有肺小塊相對血流重新分佈常態分佈圖 66
圖十一、各組空氣栓塞相較於空氣栓塞前肺小塊相對血流 67
圖十二、各組空氣栓塞後2小時相較於空氣栓塞肺小塊相對血流重新分佈比例 68
圖十三、各組空氣栓塞後2小時相較於空氣栓塞前肺小塊相對血流重新分佈比例 69
圖十四、空氣組每塊肺小塊相對血流重新分佈之立體變化 70
圖十五、50% O2組每塊肺小塊相對血流重新分佈之立體變化 71
圖十六、100% O2組每塊肺小塊相對血流重新分佈之立體變化 72
第六章 參考資料： 73

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