急性呼吸窘迫综合征时PEEP设置:从氧合顺应性到EIT局部呼吸生理指标  

PEEP titration in ARDS:from oxygenation and compliance to EIT-guided regional respiratory physiology parameters

作　　者：袁思依 何怀武[1] 隆云[1] Siyi Yuan;Huaiwu He;Yun Long(Department of Critical Care Medicine,State Key Laboratory of Critical Care and Rare Diseases,Peking Union Medical College,Peking Union Medical College,Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]中国医学科学院北京协和医学院,北京协和医院,疑难重症及罕见病国家重点实验室,重症医学科,北京100730

出　　处：《中华重症医学电子杂志》2024年第2期102-107,共6页Chinese Journal Of Critical Care & Intensive Care Medicine(Electronic Edition)

基　　金：国家重点研发计划课题(2022YFC2404805);首都医学科技创新成果转化优促计划赋能项目(YC202301QX0024);国家自然科学基金面上项目(82272249)。

摘　　要：在急性呼吸窘迫综合征(ARDS)治疗中,关于最佳呼气末正压(PEEP)设置方法一直存在争议。近来越来越多的证据提示目前临床常用的氧合法和最大顺应性法滴定最佳PEEP存在一定局限性,并不能有效地反映区域肺泡复张和过度膨胀。本文主要阐述关于氧合法和顺应性法滴定PEEP局限性的认识进展,进一步提出基于电阻抗成像(EIT)局部呼吸生理指标的“CODP”全流程PEEP管理策略,以期为临床实践提供参考。There has been debate on the optimal approach for determining the appropriate positive end-expiratory pressure(PEEP)setting in the treatment of acute respiratory distress syndrome(ARDS).Recently,more and more evidence suggests that the currently used oxygenation and maximum compliance methods for titrating optimal PEEP have certain limitations and cannot effectively reflect regional alveolar recruitment and overexpansion.This article mainly elaborates on the potential misunderstandings of oxygenation and compliance methods for titrating PEEP,and proposes a PEEP setting"CODP"whole strategy based on electrical impedance tomography local respiratory physiology parameters,serving as a guide for clinical practice.

关 键 词：电阻抗成像 呼气末正压滴定 氧合法 顺应性法 

分 类 号：R563.8[医药卫生—呼吸系统]