急性呼吸窘迫综合征顽固性低氧的挽救治疗策略  

Salvage strategies for acute respiratory distress syndrome with refractory hypoxia

作　　者：张红强 张冰[1] 瞿海龙[1] ZHANG Hongqiang;ZHANG Bing;JU Hailong(Emergency Department,Affiliated Hospital of Hebei University,Baoding 07100,China)

机构地区：[1]河北大学附属医院急诊医学科,河北保定071000

出　　处：《医学研究与教育》2023年第4期31-36,共6页Medical Research and Education

基　　金：保定市科学技术研究与发展计划项目(2141ZF302)。

摘　　要：急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)病因多样,以急性低氧、顺应性降低、非心源性肺水肿、双肺弥漫性渗出为特点。保护性通气策略已被临床广泛实施,然而仍有10%~15%患者死于顽固性低氧。目前对于这些患者多采取挽救性治疗,如俯卧位通气、早期应用肌肉松弛剂、各种肺复张、实施非常规通气模式、吸入肺血管活性药物、体外膜肺氧合等。这些挽救策略可改善患者氧合,但是否降低病死率、改善预后却备受争议。而且不同方法各有利弊,需根据患者个体情况采取相应治疗策略。Acute respiratory distress syndrome is a condition of varied etiology characterized by the acute onset of hypoxemia,reduced lung compliance,noncardiogenic pulmonary edema and diffuse exudative lesions of both lungs.Although protective ventilation strategy has been implemented in clinical practice,an estimated 10%-15%of the deaths in ARDS are caused due to refractory hypoxemia.In these cases,clinicians may resort to“salvage therapies”.These include prone position ventilation,application of early neuromuscular blockers,various recruitment maneuvers,unconventional ventilation modes,inhaled pulmonary vasodilators,and extracorporeal membrane oxygenation.All the salvage therapies have been associated with improved oxygenation,but whether to reduce mortality and improve prognosis is controversial.Each of the salvage therapiesis associated with its own risks and benefits,specific treatment strategies should be adopted according to the individual situation of patients.

关 键 词：急性呼吸窘迫综合征 低氧血症 机械通气 呼吸机相关肺损伤 

分 类 号：R56[医药卫生—呼吸系统]