呼吸机治疗的肺保护策略.ppt

Hypercapnic acidosis attenuates endotoxin induced acute lung injury attenuated the decrement in oxygenation improved lung compliance reduced alveolar neutrophil infiltration and histologic indices of lung injury Am J Respir Crit Care Med. 2004 Jan 1;169(1):46-56 第二十八页，编辑于星期三：二十一点 二十五分。 Hypercapnic acidosis is protective in an in vivo model of ventilator-induced lung injury 12 rabbits ventilator-induced lung injury (VILI) PaCO2 40 mm Hg n = 6 PaCO2 80-100 mm Hg n = 6 respiratory mechanics (plateau pressures) 27.0 ± 2.5 20.9 ± 3.0 p = 0.016 gas exchange (PaO2 ) 165.2 ± 19.4 77.3 ± 87.9 p = 0.02 wet:dry weight 9.7 ± 2.3 6.6 ± 1.8 p = 0.04 bronchoalveolar lavage fluid protein concentration 1350 ± 228 656 ± 511 p = 0.03 cell count 6.86 x 105 2.84 x 105 p = 0.021 injury score 7.0 ± 3.3 0.7 ± 0.9 p 0.0001 Am J Respir Crit Care Med. 2002 Aug 1;166(3):403-8 ?  第二十九页，编辑于星期三：二十一点 二十五分。 Effects of high PCO2 on ventilated preterm lamb lungs Preterm surfactant-treated lambs with a high tidal volume (Vt) 30 min acute lung injury. Vt 6-9 mL/kg 5.5 h PCO2 40-50 mm Hg add to the ventilator circuit PCO2 95 ±5 mm Hg heart rates blood pressures plasma cortisol values oxygenation no different ↑ white blood cells ↑hydrogen peroxide production ↑ IL-1beta, IL-8 cytokine mRNA expression in cells from the alveolar wash Histopathology less lung injury Pediatr Res. 2003 Mar;53(3):468-72. 第三十页，编辑于星期三：二十一点 二十五分。 Permissive hypercapnia for the prevention of morbidity and mortality in mechanically ventilated newborn infants Two trials involving 269 newborn infants no evidence ↓the incidence of death or CLD at 36 weeks