Ventilation of Injured Lung-肺损伤的机械通气.ppt

Ventilation of Injured Lung肺损伤的机械通气Younsuck Koh, MD. Department of Pulmonary and Critical Care Medicine Asan Medical Center University of Ulsan College of Medicine Tongji Mechanical Ventilation Forum Mechanical ventilation (MV) is the way to let the ARF patients to be survived. 机械通气是挽救急性肾衰竭病人的方法之一。Why Do We Care for Protective Ventilation? 为什么我们需要关注保护性肺通气？ MV can induce or aggravate lung injury. 机械通气会导致或加重肺损伤。Mechanical Force to the Alveoli during Ventilation 机械通气过程中对肺泡的机械力Stress: Transpulmonary pressure 压力：跨肺压 (airway pr-pl pr, ΔPL) Strain (ΔV/FRC) 牵张（Ratio of volume change(ΔV) to the FRC） （肺容量的变化量与肺功能残气量的比值） Average stress–strain relationship computed from the fitting of individual recordings, available in 22 pigs. Protti A, et al. Am J Respir Crit Care Med 2011;183:1354 Safe Threshold between Strain and Stress in Healthy Pigs 在健康猪的实验中得出的牵张力与压力关系的安全阈值Normal 正常的肺泡ALI急性肺损伤的肺泡 Alveolar Volume Effective Pressure = Applied Pressure X Atelectatic Volume 肺泡容量有效压力= 设定压力X 肺塌陷容量Example（例如）: 140 cm H2O = 30 cm H2O X 102/3 Mead J. et al : Stress distribution in lungs : A model of pulmonary elasticity. J Appl Physiol 28:596-608, 1970 Amplification of Wall Stress by Heterogeneous Expansion 不均匀扩张导致的肺泡壁压力的扩增High transalveolar pressure increases transmicrovascular forces, which could lead to capillary stress fracture*. West JB, JAP, 1991;70;1731* Pelosi P et al. Am J Respir Crit Care Med 1994;149:8-13 by the Courtesy of Gattinoni L Gravity Effect on Alveoli in Supine 仰卧位时重力对肺泡的影响Alveolar Area Pressure Curve for each of the Three Alveolar Types 三类肺泡的压力曲线Nieman GF, et al. Crit Care Med 2003;31:1126 Alveolar size change with lung inflation: Tween lavage pigs, in vivo microscopy Observation 予以表面活性剂肺泡灌洗猪的体内实验，镜下：肺膨胀时肺泡容量的改变Adopted from Tremblay LN, et al. Ventilator-induced lung injury. In: Physiological basis of ventilator support. Marcel De