肺保护性通气策略在非ARDS患者的临床应用  

Clinical application of lung protective ventilation strategy in non-ARDS patients

作　　者：瞿海龙[1] 周英莲[1] 张红强 彭广军[1] JU Hailong;ZHOU Yinglian;ZHANG Hongqiang;PENG Guangjun(Emergency Department,Affiliated Hospital of Hebei University,Baoding 071000,China)

机构地区：[1]河北大学附属医院急诊医学科

出　　处：《医学研究与教育》2019年第5期7-11,共5页Medical Research and Education

摘　　要：随着机械通气治疗的发展,有创通气在危重患者的抢救及全麻患者手术中得到广泛应用,然而其亦有双面性。机械通气作为一种侵入性治疗,可直接导致肺组织损伤,即呼吸机相关肺损伤(ventilator-induced lung injury,VILI)。在急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)患者的治疗过程中,为预防VILI的发生,肺保护性通气策略被提出并应用于临床。近年研究显示保护性通气对非ARDS患者也具有明显效应,从小潮气量通气中亦可获益。低水平驱动压通气正受到大家推荐,而对高水平呼气末正压(positive end-expiratory pressure,PEEP)是否获益尚不能确定。With the development of mechanical ventilation,invasive ventilation is a life-saving strategy in critically ill patients and an indispensable tool in patients under general anesthesia for surgery,it also acts as a double-edged sword.Ventilation as a potentially dangerous intrusion that has the potential to harm lungs,in a condition known as ‘ventilator-induced lung injury (VILI).In order to prevent the occurrence of VILI,so-called ‘lung-protective ventilator settings were used to improve outcomes in patients with ARDS.Since the last few years,there has been increasing interest in possible benefit of lung-protective ventilation in patients under ventilation for reasons other than ARDS.Patients without ARDS could benefit from tidal volume reduction during mechanical ventilation.Low driving pressures during ventilation is recommended,however,it is uncertain whether higher levels of positive end-expiratory pressure could benefit these patients as well.

关 键 词：肺保护通气 呼吸机相关肺损伤 急性呼吸窘迫综合征 

分 类 号：R56[医药卫生—呼吸系统]