肺保护性通气治疗急性呼吸窘迫综合征进展.pdfVIP

肺保护性通气治疗急性呼吸窘迫综合征进展 中文摘要 急性呼吸窘迫综合征(ARDS)是临床常见的危重症之一，死亡率高。严重感染、 创伤和外科大手术后常会发生直接或间接的肺功能损伤，甚至造成ARDS 。常以呼 吸窘迫、顽固性低氧血症和非心源性肺水肿为临床特征。其病理机制目前尚不明 确，其实质可能是由于炎症反应失衡。机械通气是治疗 ARDS 的有效手段，但不 恰当的机械通气将会造成呼吸机相关性肺损伤。肺保护性通气是目前 ARDS 有创 通气的主要策略，主要包括：小潮气量通气，肺复张，相对较高的PEEP 。静脉注 射全氟化碳，连续肾脏替代疗法(CRRT)等其他治疗有助于ARDS 患者的机械通气。 机械通气已经成为 ARDS 患者不可缺少的关键治疗技术。本文通过文献回顾，就 肺保护性通气治疗急性呼吸窘迫综合征进展作一综述。 【关键词】急性呼吸窘迫综合征;机械通气;肺保护性通气策略 1 Lung protective ventilation f or acute respiratory distress syndrome progress Abstract Acute respiratory distress syndrome （ARDS ） is one of clinical common critical disease, which has high mortality rate. Severe infection, trauma and surgical major surgery often cause direct or indirect pulmonary function injury, even cause ARDS.It often has clinical features like respiratory distress, refractory hypoxemia and non cardiac pulmonary edema. It‟s pathological mechanism is not yet clear, the essence of this disease may be due to inflammatory response imbalances. Mechanical ventilation is an effective method for treatment of ARDS, but improper mechanical ventilation will cause breathing machine correlated lung damage. Lung protective ventilation is the main strategy to the ARDS invasive ventilation currently, mainly includes: Small tidal volume ventilation, recruitment maneuvers and a relatively high PEEP. Intravenous fluorinated carbon, continuous renal replacement therapy(CRRT) and other treatment can help the ARDS patients to proceed the mechanical ventilation. Mechanical ventilation has become an indispensable key treatment technology to ARDS patients. Through literature review, thi