跨肺血管机械能的提出与内涵  

Introduction and connotation of transpulmonary vascular mechanical energy

作　　者：张瑞 隆云 Zhang Rui;Long Yun(Department of Critical Care Medicine,Peking Union Medical College Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]中国医学科学院北京协和医学院北京协和医院重症医学科,北京100730

出　　处：《中华重症医学电子杂志》2020年第4期361-364,共4页Chinese Journal Of Critical Care & Intensive Care Medicine(Electronic Edition)

基　　金：北京市科技计划课题(Z201100005520051)。

摘　　要：机械通气是各种原因导致的急性呼吸窘迫综合征(ARDS)的重要治疗方法之一,然而机械通气不仅可能产生呼吸机相关性肺损伤(VILI),也可能造成呼吸机相关性肺血管损伤(VILVI)。VILVI的发生不仅与机械通气产生的气压伤、容积伤、萎陷伤和生物伤相关,并且不恰当的容量、心输出量、血管张力等循环因素也会进一步加重VILVI。因此,我们首次提出跨肺血管机械能的概念,旨在将导致肺血管损伤的机械力及血流动力学合起来,为临床避免VILVI的发生提供重要依据和可行的方法。Mechanical ventilation is an important treatment method of acute respiratory distress syndrome fromvarious causes.However,mechanical ventilation may not only cause ventilator induced lung injury(VILI),but also cause ventilator-induced lung vascular injury(VILVI).VILVI is related to volutrauma,barotrauma,atelectrauma,and biotrauma during mechanical ventilation and is aggravated by circulation factors such as inappropriate blood volume,cardiac output and vascular tensions.Therefore,we propose the concept of mechanical energy across pulmonary vessels for the first time by combining the mechanical stress and hemodynamic stress that lead to pulmonary vascular injury,so as to provide an important basis and a feasible method to avoid VILVI.

关 键 词：机械能 呼吸机相关性肺血管损伤 循环保护通气策略 

分 类 号：R563.8[医药卫生—呼吸系统]