国际麻醉学与复苏杂志
國際痳醉學與複囌雜誌
국제마취학여복소잡지
INTERNATIONAL JOURNAL OF ANESTHESIOLOGY AND RESUSCITATION
2014年
5期
453-457
,共5页
急性呼吸窘迫综合征%治疗%机械通气
急性呼吸窘迫綜閤徵%治療%機械通氣
급성호흡군박종합정%치료%궤계통기
Acute respiratory distress syndrome%Therapy%Mechanical ventilation
背景 急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)在重症监护病房的发生率为7％～10％,死亡率约36％～44％.ARDS的机械通气治疗仍然是治疗的研究热点. 目的 旨在综述ARDS近年的机械通气策略进展. 内容 肺保护性通气策略包括小潮气量(4 ml/kg～7 ml/kg理想体重)、控制气道平台压＜28 cmH2O～32 cmH2O(1 cmH2O=0.098 kPa)、允许性高碳酸血症和最佳呼气末正压的设定.氧合法、肺的力学指标和影像学研究都为临床医师选择适宜的最佳呼气末正压提供了参考.肺复张是肺保护性通气中肺开放策略的必要补充,对于顽固性低氧血症患者,可考虑严密监测下使用,但首先要对患者肺的可复张性进行判断.肺复张的效果受病因及病程早晚等因素的影响.与仰卧位比较,俯卧位通气能降低重症ARDS患者的病死率,建议用于常规机械通气治疗无效的重度ARDS患者.肺影像学、ARDS病程及低氧血症的严重程度等可帮助预测ARDS患者对俯卧位通气的反应. 趋向 体外膜肺氧合今后可能成为重症ARDS(对常规治疗无效)患者呼吸支持的一线选择.
揹景 急性呼吸窘迫綜閤徵(acute respiratory distress syndrome,ARDS)在重癥鑑護病房的髮生率為7％～10％,死亡率約36％～44％.ARDS的機械通氣治療仍然是治療的研究熱點. 目的 旨在綜述ARDS近年的機械通氣策略進展. 內容 肺保護性通氣策略包括小潮氣量(4 ml/kg～7 ml/kg理想體重)、控製氣道平檯壓＜28 cmH2O～32 cmH2O(1 cmH2O=0.098 kPa)、允許性高碳痠血癥和最佳呼氣末正壓的設定.氧閤法、肺的力學指標和影像學研究都為臨床醫師選擇適宜的最佳呼氣末正壓提供瞭參攷.肺複張是肺保護性通氣中肺開放策略的必要補充,對于頑固性低氧血癥患者,可攷慮嚴密鑑測下使用,但首先要對患者肺的可複張性進行判斷.肺複張的效果受病因及病程早晚等因素的影響.與仰臥位比較,俯臥位通氣能降低重癥ARDS患者的病死率,建議用于常規機械通氣治療無效的重度ARDS患者.肺影像學、ARDS病程及低氧血癥的嚴重程度等可幫助預測ARDS患者對俯臥位通氣的反應. 趨嚮 體外膜肺氧閤今後可能成為重癥ARDS(對常規治療無效)患者呼吸支持的一線選擇.
배경 급성호흡군박종합정(acute respiratory distress syndrome,ARDS)재중증감호병방적발생솔위7％～10％,사망솔약36％～44％.ARDS적궤계통기치료잉연시치료적연구열점. 목적 지재종술ARDS근년적궤계통기책략진전. 내용 폐보호성통기책략포괄소조기량(4 ml/kg～7 ml/kg이상체중)、공제기도평태압＜28 cmH2O～32 cmH2O(1 cmH2O=0.098 kPa)、윤허성고탄산혈증화최가호기말정압적설정.양합법、폐적역학지표화영상학연구도위림상의사선택괄의적최가호기말정압제공료삼고.폐복장시폐보호성통기중폐개방책략적필요보충,대우완고성저양혈증환자,가고필엄밀감측하사용,단수선요대환자폐적가복장성진행판단.폐복장적효과수병인급병정조만등인소적영향.여앙와위비교,부와위통기능강저중증ARDS환자적병사솔,건의용우상규궤계통기치료무효적중도ARDS환자.폐영상학、ARDS병정급저양혈증적엄중정도등가방조예측ARDS환자대부와위통기적반응. 추향 체외막폐양합금후가능성위중증ARDS(대상규치료무효)환자호흡지지적일선선택.
Background In the ICU setting,the incidence of acute respiratory distress syndrome (ARDS) is 7％-10％.Reported mortality rate is still high,ranged from 36％-44％.Ventilation strategies for ARDS is the prime focus in management.Objective This review emphasizes progress of mechanical ventilation strategy for ARDS.Content Lung protective ventilation strategies for ARDS includs low tidal volums (4 ml/kg-7 ml/kg),low plateau pressures [＜28 cmH2O-32 cmH2O (1 cmH2O=0.098 kPa)],permissive hypercapnia and the optimal level of positive end expiratory pressure.Oxygenation,pulmonary mechanical characteristics and study of lung imaging can help clinicians titrate positive end expiratory pressure better,although the optimal level of positive end expiratory pressure when ventilating patients with ARDS remains unclear.Lung recruitment maneuver is a necessary complement to open lung strategy of lung protective ventilation methods for ARDS patients with refractory hypoxemia,but the pulmonary recruitability must be assessed.The effect of lung recruitment maneuver influenced by etiology and the course of ARDS.Recent study support the existence of a survival benefit with prone positioning ventilation in severely hypoxemia ARDS patients.The pulmonary inaging,the course of ARDS and the severity hypoxemia can help predict the reaction to prone positioning ventilation.Trend In the future,extracorporealmembrane oxygenation may be the first-line choice for respiratory support to severe patients with ARDS who are unsuitable for conventional therapy.
