静脉‑静脉体外膜肺氧合支持下急性呼吸窘迫综合征患者的机械通气策略  

Mechanical ventilation strategy for acute respiratory distress syndrome patients supported by veno‑venous extracorporeal membrane oxygenation

作　　者：桑岭[1] 黎毅敏[1] Sang Ling;Li Yimin(Department of Critical Care Medicine,the First Affiliated Hospital of Guangzhou Medical University,Guangzhou Institute of Respiratory Health,Guangzhou 510120,China)

机构地区：[1]广州医科大学附属第一医院重症医学科广州呼吸健康研究院,广州510120

出　　处：《中华医学杂志》2022年第25期1895-1898,共4页National Medical Journal of China

基　　金：广州实验室应急攻关项目(EKPG21‑17);广东省科技厅项目(2020B1111340016);广州医科大学附属第一医院成果转化培育项目(ZH201805);广州呼吸健康研究院自主项目(2019GIRHQ05)。

摘　　要：急性呼吸窘迫综合征(ARDS)患者病死率很高,静脉-静脉体外膜肺氧合(VV-ECMO)支持目前已被证明可以改善这类患者预后,但这种获益的最大化需要依靠合适的机械通气策略;随着新的研究证据不断出现,学者针对VV-ECMO支持下的ARDS患者如何实施机械通气尽管有了一定的共识,但仍存在众多争议。本文基于目前的循证研究结果与临床体会,分析这类患者的机械通气策略热点问题,如早期“超保护”通气策略的实施、是否允许自主呼吸、俯卧位通气与呼吸机的撤离,为同道提供参考。The mortality of acute respiratory distress syndrome(ARDS)patients is very high,veno-venous extracorporeal membrane oxygenation(VV-ECMO)has been proved to improve the prognosis of these patients,but the maximization of this benefit relies on the appropriate mechanical ventilation strategy;with the new research evidence arise,scholars have reached a certain consensus on how to implement mechanical ventilation in ARDS patients supported by VV-ECMO,but there are still many controversies.Based on the evidences of current researches and clinical experiences,this article analyzes the hot issues of mechanical ventilation strategy for these patients,including the implementation of early′overprotective′ventilation strategy,whether spontaneous breathing allowed,prone ventilation and ventilator weaning.

关 键 词：体外膜氧合作用 呼吸窘迫综合征 机械通气 策略 

分 类 号：R563.8[医药卫生—呼吸系统]