呼吸治疗肺保护指南ppt课件.ppt

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1、呼吸机治疗的肺保护策略1呼吸机相关性肺损伤acuteparenchymallunginjuryandanacuteinflammatoryresponseinthelung.cytokines→alveoliandthesystemiccirculation→multipleorgandysfunctionmortality↑2呼吸机相关性肺损伤ventilator-inducedlunginjury容量性损伤Volutrauma（largegasvolumes）压力性损伤Barotrauma（highairwaypressure）不张性损伤Atelectotraum

2、a（alveolarcollapseandre-expansion）生物性损伤Biotrauma（increasedinflammation）3肺损伤病理alveolarstructuraldamagepulmonaryedema、inflammation、fibrosissurfactantdysfunctionotherorgandysfunctionexacerbatethedisturbanceoflungdevelopmentSeminNeonatol.2002Oct;7(5):353-60.4Approachesinthemanagementofacute

3、respiratoryfailureinchildrenprotectiveventilatoryandpotentialprotectiveventilatorymodeslowertidalvolumeandPEEPpermissivehypercapniahigh-frequencyoscillatoryventilationairwaypressurereleaseventilationpartialliquidventilationimproveoxygenationrecruitmentmaneuverspronepositioningkineticthe

4、rapyreduceFiO2andfacilitategasexchangeinhalednitricoxideandsurfactantCurrOpinPediatr.2004Jun;16(3):293-8.5Canmechanicalventilationstrategiesreducechroniclungdisease?continuouspositiveairwaypressurepermissivehypercapniapatient-triggeredventilationvolume-targetedventilationproportionalass

5、istventilationhigh-frequencyventilationSeminNeonatol.2003Dec;8(6):441-86小潮气量和呼气末正压lowertidalvolumeandPEEP7VentilationwithlowertidalvolumesversustraditionaltidalvolumesinadultsforALIandARDS1202patientslowertidalvolume(≤7ml/kg)lowplateaupressure≤30cmH2Oversustidalvolume10to15ml/kgMortalit

6、yatday28long-termmortalitywasuncertainlowandconventionaltidalvolumewithplateaupressure≤31cmH2OwasnotsignificantlydifferentCochraneDatabaseSystRev.2004;(2):CD0038448Higherversuslowerpositiveend-expiratorypressuresinpatientswiththeacuterespiratorydistresssyndrome549patientsacutelunginjur

7、yandARDSlower-PEEPgroup8.3±3.2cmH2Ohigher-PEEPgroup13.2±3.5cmH2O(P<0.001).tidal-volume6ml/kgend-inspiratoryplateau-pressure≤30cmH2OTheratesofdeath24.9%27.5%(p=0.48)Fromday1today28,breathingwasunassisted14.5±10.4days13.8±10.6days(p=0.5)clinicaloutcomesaresimilarwhetherlowerorhig