呼吸治疗肺保护施丽萍解析.ppt

呼吸机治疗的肺保护策略 浙江大学医学院附属儿童医院 施丽萍 呼吸机相关性肺损伤 acute parenchymal lung injury and an acute inflammatory response in the lung. cytokines →alveoli and the systemic circulation →multiple organ dysfunction mortality↑ 呼吸机相关性肺损伤ventilator-induced lung injury 容量性损伤 Volutrauma（large gas volumes ） 压力性损伤 Barotrauma（high airway pressure ） 不张性损伤 Atelectotrauma（alveolar collapse and re-expansion） 生物性损伤 Biotrauma（increased inflammation ） 肺 损 伤 病 理 alveolar structural damage pulmonary edema、 inflammation、 fibrosis surfactant dysfunction other organ dysfunction exacerbate the disturbance of lung development Semin Neonatol. 2002 Oct;7(5):353-60. Approaches in the management of acute respiratory failure in children protective ventilatory and potential protective ventilatory modes lower tidal volume and PEEP permissive hypercapnia high-frequency oscillatory ventilation airway pressure release ventilation partial liquid ventilation improve oxygenation recruitment maneuvers prone positioning kinetic therapy reduce FiO2 and facilitate gas exchange inhaled nitric oxide and surfactant Curr Opin Pediatr. 2004 Jun;16(3):293-8. Can mechanical ventilation strategies reduce chronic lung disease? continuous positive airway pressure permissive hypercapnia patient-triggered ventilation volume-targeted ventilation proportional assist ventilation high-frequency ventilation Semin Neonatol. 2003 Dec;8(6):441-8 小潮气量和呼气末正压 lower tidal volume and PEEP Ventilation with lower tidal volumes versus traditional tidal volumes in adults for ALI and ARDS 1202 patients lower tidal volume (≤7ml/kg) low plateau pressure ≤30 cm H2O versus tidal volume 10 to 15 ml/kg Mortality at day 28 ? long-term morta