摘要
急性呼吸窘迫综合征的不同阶段与机械通气的策略刘大为（中国医学科学院中国协和医科大学北京协和医院加强医疗科）ＡｂｓｔｒａｃｔＭｅｃｈａｎｉｃａｌｖｅｎｔｉｌａｔｉｏｎｉｓｐｌａｙｉｎｇａｎｉｍｐｏｒｔａｎｔｒｏｌｅｉｎｔｈｅｔｒｅａｔｍｅｎｔｏｆａｃｕ...
Mechanical ventilation is playing an important role in the treatment of acute respiratory distress syndrome(ARDS).Though the prevalence is very high,ventilatoyinduced lung injury(VLI) is not easy to be recognized clinically.In the early stage of ARDS,the dependent parts of the lungs are compressed and atelectatic;whereas,the nondependent areas remain aerated and functional,which is just edematous.Ventilating these'baby lung'carries a high risk of VLI.It is necessary to find a compromise which keeps the less compliant alveoli open without overdistending the more compliant areas.A smaller tidal volume and a higher level of positive end expiratory pressure in order to avoid alveolar overdistension and reduce shear forces are recommended to use in these lungs.With time,edema is partially reabsorbed,fibrous processes occur and bullea develop progressively.So a higher level of the airway pressure should be considerably avoided.It is misleading to recommend tidal volume by body weight because the lung capacity is remarkably reduced in ARDS.Permissive hyercapnia,as a method that brings a new concept to mechanical ventilation clinically,has also limitation in clinical treatment.No matter what new modes are available,mechanical ventilation is working on either volume or pressure.The strategies of the ventilation support for patients with ARDS must depend on the timing and the pathophysiological basis of the disease.
出处
《基础医学与临床》
CSCD
1998年第1期15-19,共5页
Basic and Clinical Medicine
关键词
呼吸窘迫综合征
ARDS
机械通气
治疗
acute respiratory distress syndrome(ARDS) Mechanical ventilation ventilatoryinduced lung injury(VLI)
