ARDS患者的肺复张-nursing.ppt

肺复张对护士的要求 了解肺复张的目的 密切监测生命体征的变化 肺复张后不要轻易脱开呼吸机 吸痰 吸痰对氧合及肺容积的影响 Dyhr T, Bonde J, Larsson A: Lung recruitment maneuvers are effective to regain lung volume and oxygenation after open endotracheal suctioning in acute respiratory distress syndrome. Crit Care 2003, 7:55-62 吸痰管大小与压力改变 Morrow BM, Futter MJ, Argent AC. Endotracheal suctioning: from principles to practice. Intensive Care Med 2004; 30: 1167-1174 吸痰导致氧合下降 Lasocki S, Lu Q, Sartorius A, Fouillat D, Remerand F, Rouby J-J. Open and Closed-circuit Endotracheal Suctioning in Acute Lung Injury: Efficiency and Effects on Gas Exchange. Anesthesiology 2006; 104: 39-47 吸痰对氧合的影响 Lindgren S, Almgren B, Hgman M, Lethvall S, Houltz E, Lundin S, Stenqvist O. Effectiveness and side effects of closed and open suctioning: an experimental evaluation. Intensive Care Med 2004; 30: 1630-1637 肺复张防止吸痰导致的肺容积减少 SWIVELpsv CLOSEDpsv CLOSED SWIVEL DISCONNECTION Prevention of Endotracheal Suctioning-induced Alveolar Derecruitment in Acute Lung Injury Maggiore SM, Lellouche F, Pigeot J, Taille S, Deye N, Durrmeyer X, Richard J-C, Mancebo J, Lemaire F, Brochard L. Am J Respir Crit Care Med 2003; 167: 1215-1224 肺复张能够防止吸痰导致的氧合下降 Lasocki S, Lu Q, Sartorius A, Fouillat D, Remerand F, Rouby J-J. Open and Closed-circuit Endotracheal Suctioning in Acute Lung Injury: Efficiency and Effects on Gas Exchange. Anesthesiology 2006; 104: 39-47 肺复张: 总结 ARDS患者有效肺容积缩小 肺泡反复塌陷与开放导致剪切力损伤 肺复张是保护性通气策略的重要组成 肺复张的成功取决于 足够的压力与时间 合适的PEEP 医务人员的理解 ARDS患者的肺复张 ALI/ARDS的定义 ALI 急性起病 胸片对称的侵润影 PaO2/FiO2 ? 300 mmHg PAWP ? 18 mmHg或没有左心衰的证据 ARDS 急性起病 胸片对称的侵润影 PaO2/FiO2 ? 200 mmHg PAWP ? 18 mmHg或没有左心衰的证据 ARDS肺部形态学的改变 Puybasset L, et al. Regional distribution of gas and tissue in acute respiratory distress syndrome. I. Consequences for lung morphology. Intensive Care Med 2000; 26: 857-69. ARDS肺部形态学的改变 ARDS患者 健康对照 CT平均密度(HU) -256 ? 21 -654 ? 8 组织容积(ml/m2 BSA) 31.6 ? 1.7 16.7 ? 0.8 气体容积(ml/m2 BSA) 11.5 ? 1.2 32.2 ? 1.8 胸腔内总容积(ml/m2 BSA) 43.0 ? 2.3 49.0 ? 2.5 Gattinoni L, et al. Relatio