ALI/ARDS患者使用保护性通气策略对于肺部损伤的影响

急性肺损伤(ALI)和急性呼吸窘迫综合征(ARDS)是常见的临床综合征,绝大多数ALI/ARDS患者需机械通气治疗,机械通气在提供可接受的肺部气体交换的同时治疗基础疾病,但机械通气本身也会引起肺部损伤,即机械通气性肺损伤(VILI)。而通过调整机械通气参数的设置,使用保护性通气策略可显著减低ALI/ARDS患者机械通气性肺损伤程度,从而减少肺部感染,缩短机械通气时间和住院时间,降低28天死亡率,明显改善ALI/ARDS患者的生存质量,起到最大程度地肺保护作用。本文从气道平台压,通气容积,呼气末正压等几个不同通气参数方面分别进行综述,讨论ALI/ARDS患者机械通气时使用保护性通气策略对于肺部损伤的影响。

The Influence of Lung Damage by using Protective Ventilation Strategy for ALI/ARDS Patients

ABSTRACT: Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) is a common clinical syndrome, the vast majority of ALI/ARDS patients require mechanical ventilation treatment, mechanical ventilation represents the main therapeutic support to maintain acceptable pulmonary gas-exchange whilst treating the underlying disease, however, mechanical ventilation itself can also cause lung damage, namely mechanical aeration lung injury (VILI). The use of protective ventilation strategies, which can implemented by adjusting the mechanical ventilation parameter Settings, can significantly reduce lung injury degree of ALI/ARDS patients caused by mechanical aeration, thus reduce the pulmonary infection, shorten the time of mechanical ventilation and hospitalization time, reduce the 28-day mortality, significantly improve the quality of the survival of patients with ALI/ARDS, maximize lung protection effect. In this paper, we respectively summarized different mechanical ventilation parameters, such as Pplat, VT and PEEP, discussing the influence of lung damage by using protective ventilation strategy for ALI/ARDS patients.