ARDS肺复张的临床实施概要.ppt

* * * Although PaO2/FiO2 Or PaO2 + PaCO2 400 (FiO2 100%) is a relable indicator for lung recruitment, the procedure is complex and there is no continuous blood gas monitor in china To find new procedure to evaluate/titrate PEEP is necessary. * * * * * * * * * * * * * * * * * * * * * * * * * 肺复张使三种ARDS模型CI明显下降（P﹤0.05），对盐酸吸入组中CI 影响较大。a,在盐酸吸入组中CI的降到复张前CI的0.63，油酸静脉注入组CI降到复张前0.81，生理盐水肺泡灌洗组中CI降到复张前0.77，前者比后两者下降明显（P﹤0.05）。b,在油酸静脉注入组和生理盐水肺泡灌洗组，复张后CI迅速恢复至复张前水平，而在盐酸吸入组中CI缓慢回升，约5分钟后接近肺复张前水平 。 * * 在盐酸吸入组，PCV法对CI的影响小（P﹤0.05） 。PCV过程中CI降到复张前CI的0.75，而SI则降到0.54，IP降到0.61。 * * * 小结 肺复张是ARDS降低肺不张, 减少肺内分流的重要手段 塌陷肺泡是否能够开放受多种因素影响 肺复张的方法(手段, 压力,时间,次数) 原发病(pul vs non-pul)与病理特征 ARDS病程 肺泡过度膨胀(VILI)与循环干扰 多数ARDS患者通过高条件的肺复张可实现塌陷肺泡的复张 * * * * But the lung protective ventilation strategies is not enough for ARDS ARDS animal and clinical study show that there are a lot of consolidation in dependent zone when lung protective ventilation strategies was used * * * In a low ARDS, the compliance curve shifts to the right. This results in either low volumes for any set pressure or higher pressure for any set volume. * Why does V/Q matching matter? And….. Why does the supine position contribute to a V/Q mismatch for the ARDS patient? We have to have two things in order for diffusion to occur successfully. We have to have gas in the alveoli and we have to have adequate perfusion in the capillary. When the blood and gas match, diffusion is an efficient process for oxygen delivery. When all goes well, Oxygen will diffuse from the alveoli into the capillary and CO2 will diffuse from the capillary into the alveoli to be removed through exhalation based upon a simple pressure gradient. There are several factors that can hinder this process in an injured or diseased lung. If we have inadequate ventilation, inadequate perfusion or a diffusion defect, Oxygen delivery can be impaired. If we have a decreased (low) V/Q ratio, the result is typically some degree of pulmonary shunting. Pulmonar