ards患者的肺复张-北京协和医院教学讲义.ppt

内容 小潮气量通气的问题 肺复张的理论与实践 肺复张与PEEP 肺复张后的PEEP 不同复张方法的差异 肺复张的临床适应症 肺复张的副作用 肺复张存在的问题 RM保护肺内皮而非肺泡上皮 试验动物: 大鼠 模型制备: 酸(pH 1.5)吸入 机械通气: Vt 6 ml/kg PEEP 5 cmH2O FiO2 1.0 F 60 – 70 bpm 复张操作: 30 cmH2O x 30 s x 2 间隔1分钟 Frank JA, McAuley DF, Gutierrez JA, Daniel BM, Dobbs L, Matthay MA. Differential effects of sustained inflation recruitment maneuvers on alveolar epithelial and lung endothelial injury. Crit Care Med 2005; 33: 181-188 RM保护肺内皮而非肺泡上皮 Frank JA, McAuley DF, Gutierrez JA, Daniel BM, Dobbs L, Matthay MA. Differential effects of sustained inflation recruitment maneuvers on alveolar epithelial and lung endothelial injury. Crit Care Med 2005; 33: 181-188 RM: ARDS早期 vs. 晚期 Villagra A, Ochagavia A, Vatus S, Murias G, Fernandez MF, Aguilar JL, Fernandez R, Blanch L. Recruitment Maneuvers during Lung Protective Ventilation in Acute Respiratory Distress Syndrome. Am J Respir Crit Care Med 2002; 165: 165-170 原发性ARDS对RM反应不佳 Saline lavage Oleic acid injury Pneumonia Van der Kloot TE, Blanch L, Youngblood AM, Weinert C, Adams AB, Marini JJ, Shapiro RS, Nahum A. Recruitment Maneuvers in Three Experimental: Models of Acute Lung Injury Effect on Lung Volume and Gas Exchange. Am J Respir Crit Care Med 2000; 161: 1485-1494 Sustained inflation CPAP 40/30 CPAP 60/30 CPAP 60/30 油酸损伤模型RM作用短暂 Lim CM, Adams AB, Simonson DA, Dries DJ, Broccard AF, Hotchkiss JR, Marini JJ. Intercomparison of recruitment maneuver efficacy in three models of acute lung injury. Crit Care Med 2004; 32: 2371-2377 PEEP 8 PEEP 12 PEEP 16 不同病因对RM的反应 Lim CM, Adams AB, Simonson DA, Dries DJ, Broccard AF, Hotchkiss JR, Marini JJ. Intercomparison of recruitment maneuver efficacy in three models of acute lung injury. Crit Care Med 2004; 32: 2371-2377 RM + PEEP PEEP only RM: ARDSp与ARDSexp Lim CM, Jung H, Koh Y, Lee JS, Shim TS, Lee SD, Kim WS, Kim DS, Kim WD. Effect of alveolar recruitment maneuver in early acute respiratory distress syndrome according to antiderecruitment strategy, etiological category of diffuse lung inj