体外生命支持下超保护性肺通气的实施  

Ultra-lung-protective ventilation strategies under extracorporeal life support

作　　者：李敏[1] 詹庆元[1] LI Min;ZHAN Qing-yuan(Department of Pulmonary and Critical Care Medicine,Center of Respiratory Medicine,China-Japan Friendship Hospital,National Center for Respiratory Medicine,Institute of Respiratory Medicine,Chinese Academy of Medical Sciences,National Clinical Research Center for Respiratory Diseases,WHO Collaborating Centre for Tobacco Cessation and Respiratory Diseases Prevention,Beijing100029,China)

机构地区：[1]中日友好医院呼吸中心呼吸与危重症医学科、国家呼吸医学中心、中国医学科学院呼吸病学研究院、国家呼吸疾病临床医学研究、中心世界卫生组织戒烟与呼吸疾病预防合作中心,北京100029

出　　处：《中国实用内科杂志》2024年第3期177-181,共5页Chinese Journal of Practical Internal Medicine

基　　金：重大呼吸系统疾病关键诊疗技术的临床研究和成果转化(2022-NHLHCRF-LX-01)。

摘　　要：肺保护性通气策略是目前急性呼吸窘迫综合征患者的标准治疗措施之一,旨在提供足够的通气需求,同时最大限度降低呼吸机相关性肺损伤。随着对呼吸机相关肺损伤的深入认识,目前更多关注驱动压、应变、跨肺压、机械能等指标变化。超保护性肺通气能达到更低的潮气量和气道压力,达到更好的肺保护。由于超保护性肺通气的应用往往受到呼吸性酸中毒的限制,因此以体外膜肺氧合和体外二氧化碳清除技术为代表的体外生命支持是保证超保护性肺通气实施的关键。文章简要阐述体外生命支持下超保护性肺通气的可行性和有效性,总结其实施要点及目前存在问题,旨在提高对超保护性肺通气的认识,并提出未来的研究领域。Lung-protective ventilation strategies are currently one of the standard treatments for patients with acute respiratory distress syndrome in an effort to provide adequate ventilatory requirements while minimizing ventilator-induced lung injury. With the in-depth understanding of ventilator-induced lung injury,more attention has been paid to the changes in the indicators of driving pressure,strain,transpulmonary pressure,mechanical power and in other indicators. Ultralung-protective ventilation can achieve lower tidal volume and airway pressure but better lung protection. Because application of ultra-lung-protective ventilation is often limited by respiratory acidosis,extracorporeal life support,represented by extracorporeal membrane oxygenation and extracorporeal carbon dioxide removal technology,is the key to ensuring the implementation of ultra-lung-protective ventilation. This article briefly describes the feasibility and effectiveness of ultra-lung-protective ventilation under extracorporeal life support and summarizes the main points of its implementation and existing problems,aiming to enhance our understanding of ultra-lung-protective ventilation and propose areas of future research.

关 键 词：体外生命支持 体外膜肺氧合 体外二氧化碳清除 超保护性肺通气 呼吸机相关性肺损伤 

分 类 号：R563[医药卫生—呼吸系统]