ARDS肺复张的实施ppt参考课件.ppt

疗效 动物实验证实肺开放策略可改善氧合和肺保护作用。 临床应用结果不一 * 影响因素 病程：早期疗效好 病因：肺原性或肺外原因 体位 PEEP和潮气量 吸入氧浓度 胸壁顺应性 * 不良反应 心输出量下降：血压降低，胸壁顺应性差及氧合改善欠佳的患者更加明显 脑灌注压降低 气压伤 细菌移位 加速细胞因子、炎症介质的产生和释放 * 肺复张和陷闭的监测 肺功能指标：如血气分析等 影像学检查：CT、EIT等 静态和动态呼吸力学：P-V曲线等 肺内气体容积测量:FRC * LOGO * 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. Pulmonary shunting is defined as that portion of the cardiac output (blood) that enters the left side of the heart without exchanging gases with alveolar gases. Normal physiologic shunt is 3-5% of the Cardiac Output. This is due to the bronchial, pleural, and thebesian venous drainage back into the left heart. Capillary shunting is commonly caused by (1) alveolar collapse or atelectasis, (2) alveolar fluid accumulation , or (3) alveolar consolidation. In other words, poor ventilation. This, put into simple clinical terms, means that we have perfusion passing by alveolar units that are not ventilated, and therefore unable to participate in gas exchange. The consequence is blood that is passing through the pulmonary vault without being re-oxygenated and would be evidenced by a decrease in arterial oxygen tension. Oxygen delivery is compromised. The sum of the anatomic an