急性呼吸窘迫综合征患者不当呼吸驱动导致肺损伤的监测与治疗  

Monitoring and treatment of lung injury in patients with acute respiratory distress syndrome caused by inappropriate respiratory drive

作　　者：郝泽宇 王明星 刘景仑[1] HAO Ze-yu;WANG Ming-xing;LIU Jing-lun(Department of Critical Medicine,The First Affiliated Hospital of Chongqing Medical University,Chongqing 400010,China)

机构地区：[1]重庆医科大学附属第一医院重症医学科,重庆400010

出　　处：《实用医院临床杂志》2024年第4期39-43,共5页Practical Journal of Clinical Medicine

基　　金：重庆市自然科学基金(编号:CSTB2022NSCQ-MSX0912);重庆市科卫联合医学科研项目(编号:2022GDRC020)。

摘　　要：患者自戕式肺损伤和呼吸机导致肺损伤是急性呼吸窘迫综合征肺损伤主要原因,本文对目前常用监测指标包括临床体征、气道闭合压、跨肺压、驱动压、膈肌功能、呼吸功率等指标进行综述,描述上述指标在不当呼吸驱动和呼吸机导致肺损伤等临床场景应用情况,并介绍了包括自主管理、合理设置呼气末正压以避免肺过度膨胀和塌陷、俯卧位体位管理、二氧化碳清除/体外膜氧合技术等基于防治自戕式肺损伤和呼吸机导致肺损伤的肺保护策略措施。Patient-self-inflincted lung injury(P-SILI)and ventilator induced lung injury(VILI)are the main causes of lung injury in acute respiratory distress syndrome(ARDS).This article reviews the currently commonly used monitoring indicators.The indicators include clinical signs,airway closure pressure,transpulmonary pressure,driving pressure,diaphragm function,respiratory power and others.The application of the above indicators in clinical situations of lung injury caused by improper respiratory drive and ventilators is described.The lung protection strategies and measures such as self-management,reasonable setting of positive end-expiratory pressure to avoid excessive lung expansion and collapse,prone position management,and carbon dioxide removal/extracorporeal membrane oxygenation technology are also introduced in this article.

关 键 词：急性呼吸窘迫综合征 自戕式肺损伤 呼吸机导致肺损伤 

分 类 号：R563.8[医药卫生—呼吸系统]