重症新型冠状病毒肺炎的病理生理和基于心肺功能保护的呼吸支持策略  

Pathophysiology of severe COVID-19 pneumonia and respiratory support based on cardiopulmonary function protection

作　　者：蔡书翰[1] 杨晓[1] 张婧[1] 胡波[1] 彭志勇[1] Cai Shuhan;Yang Xiao;Zhang Jing;Hu Bo;Peng Zhiyong(Department of Critical Care Medicine,Central South Hospital Affiliated to Wuhan University,Wuhan 430071,China)

机构地区：[1]武汉大学中南医院重症医学科,武汉430071

出　　处：《中华重症医学电子杂志》2020年第4期393-397,共5页Chinese Journal Of Critical Care & Intensive Care Medicine(Electronic Edition)

基　　金：重大新药创制科技重大专项课题(2020ZX09201007)。

摘　　要：SARS-Cov-2引起肺泡上皮细胞损害,导致炎症细胞浸润,并继发内皮细胞损害导致毛细血管渗漏增加从而加重肺水肿。患者表现为缺氧,呼吸窘迫,严重者出现肺动脉高压,急性肺心病,右心室扩大并压迫左心室,左心室射血能力随之下降,最终导致休克。机械通气可以改善氧合,但不恰当的机械通气会导致肺损伤,也可能加重急性肺心病。所以,有效的呼吸支持需要在基于心肺功能保护的基础上进行,经保护性机械通气呼吸支持效果不佳的新型冠状病毒肺炎(COVID-19)患者应尽早接受ECMO支持从而减轻心肺及其他重要器官损害。我们推荐了一个详细的基于心肺功能保护的呼吸支持流程。The SARS-Cov-2 insults lung epithelial cells and causes inflammatory cell infiltration initially.The secondary injury of endothelial cells induces microvascular leakage which aggravates pulmonary edema.The clinical manifestations of COVID-19 pneumonia include hypoxemia,dyspnea,and subsequent pulmonary hypertension and acute core pulmonale in severe cases.The ejection of left ventricle is comprised by enlarged right ventricle which could induce the low cardiac output and shock.These progresses can be revised by improving oxygenation with mechanical ventilation.However,improper mechanical ventilation will induce lung injury and deteriorate the acute cor pulmonale.Thus,the ideal approach of mechanic ventilation should be based on cardiopulmonary protection.Patients should receive extracorporeal membrane oxygenation(ECMO)if no response to protective mechanical ventilation to decrease the organ injury.Here we recommend a flowchart for mechanic ventilation based on cardiopulmonary protection.

关 键 词：新型冠状病毒肺炎 机械通气 肺保护 

分 类 号：R563.1[医药卫生—呼吸系统]