急性呼吸窘迫综合征的研究现状及其进展-PPT课件.ppt

* 我们来看一下脓毒症的发病机理，感染和非感染因素都会导致内毒素的产生，从而刺激单核/巨噬细胞释放炎性介质，炎性介质的大量释放，激活中性粒细胞、损伤内皮细胞，并出现氧自由基的释放、脂质代谢产物、溶媒体酶等的产生，使得机体凝血机制紊乱、微循环障碍、细胞凋亡和组织细胞损伤。通过以上的分析，我们可以发现，在脓毒症的发病过程中，内毒素为始动病因，炎性介质则为直接致病因素。 * * * * * * * * * * * * * * * * * * * In the case of Acute Respiratory Distress Syndrome patients or patient with Acute Lung Injury, one can observe on a “Lower Inflexion Point”. The main reason for this can be explained as follow: - on the above picture, when the insufflation starts,only the alveoli “V1” are inflated. There total volume is V1. The alveoli “V2” are not recruited because of the collapsed airway; - but after a given level of pressure, this airway is opened and the alveoli “V2” can be inflated. Above this opening pressure, the total volume is “V1+V2”, and so, it is easy to understand that the compliance is greater. The PEEP level should be adjusted just above this LIP to recruit the maximum number of alveoli. * The above ARDS grey curve, plot in ZEEP, will give the physician an indication of how to set the external PEEP: it is said that a good value should be: Pressure at the LIP + 2 hPa. After having applied the PEEP to the patient for a certain amount of time, one can observe that: 1. The volume in the lungs at PEEP pressure (red curve) is higher than the volume in the chest at the same pressure level on the ARDS grey curve; 2. The slope of the curve during PEEP is lower than the slope during ZEEP. The first point can be explained by the recruiting effect of the PEEP. The second point can be explained by the fact during ZEEP, the alveoli are being recruited little by little all along the inflation. In other words, the slope during ZEEP is not representative to the compliance of the thoracic system. * * * * * * * * * * * * 目前多主张应用山莨菪碱（654-2），对其他血管扩张剂主张慎用。此外，近年来发现用一氧化氮(NO)吸入，能选择性地扩张通气良好而灌流不好区域的肺血管，改善通气/血流比值，提高动脉氧合。 2、血管扩张剂 * * ①654 - 2可以解除小血管的痉挛,降低肺微血管阻力及毛细血管通透性,改善V /Q比值,减轻微循环障碍引起的肺损伤; ②654 - 2具有细胞保护作用,主要通过阻断钙离子内流,抑制细胞膜的脂质过氧化,阻止花生四烯酸从细胞膜脱落、代谢,生成多种活性物质,减少或清除氧自由基的毒性介质作用