有创机械通气临床应用进展.ppt

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1、有创机械通气临床应用进展2乙胺碘呋酮致ARDS2021/8/293国内首例MDS继发PAP4胸腺瘤合并免疫缺陷疾病Good’ssyndrome5丙基硫氧嘧啶相关血管炎继发肺泡出血综合征6细支气管肺泡癌（IV期）7双侧肺动脉主干栓塞2021/8/298桥脑（呼吸调整中枢和长吸中枢）延髓（节律呼吸控制中枢）大脑皮层（随意呼吸控制中枢）脊髓（神经信息传导与反馈通道）呼吸系统循环系统通过气血屏障进行气体交换，排出二氧化碳，进行氧合吸入氧，排出二氧化碳Mortalityratesofsevererespiratoryfailurepatientsduringthepastyears9AnnInter

2、nMed.2004;140(5):338-345正压机械通气的目的正压机械通气能够解决肺的通气和部分换气功能能够有效改善和维持最适氧合和促进二氧化碳排出，维持生命支持的氧的需要，为疾病的恢复赢得时机在进行正压机械通气的同时，应采取有效的措施尽量减小机械通气相关副作用1011机械通气为正压通气，与人体正常情况下的负压呼吸相违背，因而也可产生多种与机械通气的相关并发症出血性肺损伤Biotrauma气胸氧中毒正压机械通气的并发症12呼吸机所致肺损伤(Ventilatorinducedlunginjury,VILI)ConceptofVILI机械通气患者机械通气过程中出现肺泡的反复萎陷/复张和/或

3、肺的过度膨胀而继发的肺实质损伤肺的基础疾病会增加发生VILI的几率，尤其是ARDS/ALI患者RespirCare.2005;50(5):64913HistoryofVILI从基础到临床IntensiveCareMed.2006;32:24–3314RiskfactorsofVILIBabylung:The“babylung”conceptoriginatedasanoffspringofcomputedtomographyexaminationswhichshowedinmostpatientswithALI/ARDSthatthenormallyaeratedtissuehasthed

4、imensionsofthelungofa5-to6-year-oldchildB:babylungBrJAnaesth2004;92:261-702021/8/2915IntensiveCritCareNurs.2004;20:358—36516IncreasedVolume(lung-stretch)-grossbarotrauma-diffusealveolardamageAggravatingLungInjuryFactorsDecreasedLungVolumes-effectsonsurfactant-recruitment/de-recruitment17RespirCare

5、.2005;50(5):64918BiologicalmarkersofVILICHEST2006;130:1906–1914PBEF:pre–B-cellcolonyenhancingfactorsTNFR:solubletumornecrosisfactorreceptor2021/8/2919Largetidalvolume:Volutrauma1HighplateauPressure:Barotrauma2Lowendexpiratorypressure:Atelectrauma3AlveolarShearStress:Biotrauma4RiskfactorsofVILIAcut

6、eRespiratoryFailureClassificationALI/ARDSNonALI/ARDS:AECOPD,Asthma,Acutecardiogenicpulmonaryedema,pulmonaryfibrosis,pulmonaryembolism,………202021/8/2921RespirCare.2001;46(2):130-148LowtidalvolumeventilationShouldTidalVolumeBe6mL/kgPredictedBodyWeightinVirtuallyAllPatientsWithAcuteRespiratoryFailure?

7、2021/8/2922CritCareMed.2008;36:296–327Lowtidalvolumeventilation:ALI/ARDS23Lowtidalvolumeventilation:ALI/ARDS24ARDSNet.NEngJMed2000;342:1301-1308.Lowtidalvolumeventilation:ALI/ARDS2021/8/2925Mortality*-Lowvs.Tradi