彩经网

机械通气的未来:现在和过去的经验

  JIXINGHUXIJIONGPOZONGHEZHENG(ARDS)SHIJIXIETONGQIDEBULIYINGXIANGYUANYULIANGGEYINSU:KUAFEIYADEFEISHENGLIXINGSHENGGAO,YIJIZHENGYAHUOFUYATONGQISHIXIONGMOQIANGYALIDEFEISHENGLIXINGSHENGGAOHUOJIANGDI。KUAFEIYAXIANGGUANDEFUZUOYONGZHUYAOSHIHUXIJIXIANGGUANXINGFEISUNSHANG(ventilator-induced lung injury,VILI),ERXIONGMOQIANGYALIXIANGGUANDEFUZUOYONGZHUYAOSHIXUELIUDONGLIXUEGAIBIAN。JIXIETONGQISHISUOJIDEQUDONGYADUIKUAFEIYAHEXIONGMOQIANGYALIGAIBIANDEYINGXIANGQUJUEYUFEIHEXIONGBIDEDANXINGZULI。“RONGJISHANG”YINGGAIGUIYINYUGUODUDEXINGBIAN,ER“QIYASHANG”ZEYUANYUYINGLIGUODASUOZHI。ZAIRENTIZHONG,XINGBIANDAYU1.5SHI,XIANGDUIYINGDEFEINEIYINGLIDAYUE20 cmH2O,TONGYANGDETIAOJIANZAISHIYANDONGWUZHONGCHANSHENGLEYANZHONGDESHANGHAI。CHULEGAOCHAOQILIANGHEGAOKUAFEIYA,HUXIPINLVHEXIQILIUSUYEKENENGSHIDAOZHIVILIDEYUANYIN。WOMENWUFADEZHISIWANGLVZHONGNABUFENGUIYINYUJIXIETONGQIDAOZHIDEVILI,ERZUIJINDELINCHUANGSHIJIANDIAOCHAZHICHU:CHAOQILIANG7.5ml/kg、PEEP 8 cmH2O、PINLV20CI/FEN、XIANGGUANSIWANGLVWEI35%。YINCI,XUYAOGENGJIAQUANMIANQIEGETIHUADELIJIEARDSFABINGJIZHIYIJIYUJIXIETONGQIDEJIAOHUZUOYONG,YITIGAOWEILAIDEZHILIAOSHUIPING。LEJIEGONGNENGXINGFEIRONGJIDAXIAOYOUZHUYUDINGLIANGPINGGUXINGBIAN。CEDINGFEIBUJUNYIXINGHEYALIZENGJIADEQINGKUANGYOUZHUYUPINGGUJUBUYINGLI;TONGGUOFEIFUZHANGXIAOGUOKEYIZHIDAOPEEPDEXUANZEYISHIYINGFEIRONGJIHEDANXINGZULI。XUNZHAOYIGEJIXIETONGQIFUZHUDEANQUANYUZHIYIGUIFANGONGNENGXINGFEIRONGJIHEZUZHIYIZHIXING,ZHEIKENENGYOUZHUYUJINGQUEQUEDINGGETIJIXIETONGQIDEANQUANXIANDU。DANGJIXIETONGQIDESHEZHINANYIBIMIANVILIGAOFENGXIANSHI,YINGGAIKAOLVQITAFANGAN(BIRURENGONGFEI)。

  GUANJIANCI:JIXIETONGQI,JIXINGHUXIJIONGPOZONGHEZHENG,HUXIJIXIANGGUANXINGFEISUNSHANG,JIXIENENG,TIWAIMOFEIYANGHE

彩经网  ZAIWEILAIDESHUNIANNEI,JIXIETONGQIRENGRANKENENGSHILINCHUANGSUOXUYAODEFUZHUSHOUDUAN。WOMENXIANZAIYIRENSHIDAOLEWENDINGXUELIUDONGLIXUE、RENJITONGBU、BAOLIUJILI、BIMIANQIGUANCHAGUANSUNSHANG、BADONGTAIGUODUCHONGQIJIANDAOZUISHAO、JIANCESHENGWUFANYING(SUOYOUJIXIETONGQIDEZHONGYAOMUBIAO)DEZHONGYAOXING。RANER,WOMENZAIBENWENZHONGZHONGDIANCHANSHUDESHIJIANSHAOZUZHISUNSHANG,YITIGAORENGONGTONGQIDEANQUANXING。ERQIE,WOMENBAFENXIXIANDINGYUARDSRENQUN,TAMENSHIJIESHOUJIXIETONGQIHUANZHERENQUNZHONGXUYAOCHULIWENTIZUIDUODE。RANER,ANQUANDEZHILIAOYUANZETONGYANGSHIYONGYUSUOYOUJIXIETONGQIHUANZHE。YAOSHIXIANRENGONGPENGZHANGFEI(LIRU,ZENGJIAKUAFEIYA(PL),QIDAOYAJIANQUXIONGMOQIANGYA(Paw – Ppl)),YOULIANGZHONGJIERANXIANGFANDEXUANZEKEYISHIYONG:YAOMEWANQUANQIDAOZHENGYATONGQI,TONGSHIXIONGMOQIANGYAYEHUIZENGJIA;YAOMEWANQUANFUYATONGQI,CISHIXIONGKUOYINWAIBUDEFUYAZUOYONGERBEIKUOZHANG。ZAIZHEILIANGZHONGJIDUANFANGSHIZHIJIAN,KEYICAIYONGHUNHEMOSHITONGQI,ZHUYAOSHITIGONGQIDAOZHENGYADETONGSHIYUNXUHUXIJIDEZIZHUSHOUSUO,ZHEIHUIZAIXIQISHIJIANGDIXIONGMOQIANGYALI(BIAO1)。WEILEJINYIBUTANTAO,WOMENBIXULEJIEMUQIANJIXIETONGQICUNZAIDEWENTI。

彩经网  JIXIETONGQIDEBULIYINGXIANGKEYIFENWEILIANGDALEI:YILEIYUGUOGAODE/FEISHENGLIXINGDEKUAFEIYA(YIBANSHIZHENGYA)YOUGUAN,LINGYILEIYUGUOGAODE/FEISHENGLIXINGDEPINGTAIYABIANHUAYOUGUAN,BUGUANZHENGYAHAISHIFUYATONGQI(TU1)。

  TU1.KUAFEIYA(ΔPL)HEXIONGMOQIANGYA(ΔPpl)ZAIFUYAHUOZHENGYATONGQIZHONGDEBIANHUA。ZUO:ZHUJIANSHENGGAOHUOJIANGDIDEXIONGMOQIANGYABIANHUAKENENGZAOCHENGDEBULIHOUGUO。GUANJIANSHIDUIJINGMAIHUILIUZENGJIAHUOJIANGDIDEYINGXIANG。YOU:SUIZHEKUAFEIYA(ΔPL)ZHUJIANZENGJIAKENENGCHANSHENGDEXUGUANSUNHAI。BUGUANZAIFUYATONGQI(CICHUJIXIANO)HUOSHIZHENGYATONGQIGUOCHENGZHONG,ΔPLDOUSHIZHENGZHI。WENZHONGXIANGSHU。ΔPawQIDAOYABIANHUA。

彩经网  WULUNSHIZHENGYAHAISHIFUYATONGQI,XIONGMOQIANGYALIDEBIANHUACHENGDUHEQUSHIYOULAIYUXIONGBIDEDANXINGZULI(EW)YUZHENGGEHUXIXITONGDEDANXINGZULI(Etot)DEBILV。HOUZHEDENGYUXIONGBIYUFEIDEDANXINGZULIZHIHE。YINCI,ZAIZHENGYATONGQISHI,KEYONGYIXIAGONGSHIBIAOSHITAMENZHIJIANZAIJINGTAISHIDEGUANXI:

  RANER,ZAIFUYATONGQISHI,FEIPENGZHANGDEQUDONGLILAIYUANYUHUXIXITONGWAIWEIDEYALI(ΔPneg)JIANGDI,SUOYISHIYONGYUYIXIAGONGSHI:

  XUYAOZHUYIDESHI,ZAIARDSSHI,EW/EtotDEPINGJUNZHISHI0.7,KEYIZAI0.2~0.8ZHIJIANBODONG。

  XIANRAN,ZAIRENGONGFUZHUTONGQISHI,JIXIEFUZHUDEZHENGYAYUHUXIJICHANSHENGDEYALI(ΔPmusc)(BIAO1)TONGSHICUNZAI,XIONGQIANGNEIYALIDESHIJIBIANHUAJIUSHI“TUI-LA”LIANGGEZUOYONGLIDEJIEGUO。YINCI:

  TONGGUOJIYUYIDINGDEQIDAOYASHIFEIBEIDONGPENGZHANGSHI,YOUYUXIONGBIDANXINGZENGJIA(BIRU, EW/EtotSHENGGAO)DECUNZAI,XIONGMOQIANGYALISHENGGAOHUIGENGMINGXIAN;ERZAIYIXIETEBIEFEIPANGDEBINGLIZHONG,YOUYUFEIDEDANXINGZENGJIA(BIRU,DIEW/Etot; JIANFANGCHENG (1))DECUNZAI,XIONGMOQIANGYALIZEZENGGAOHENSHAO。WOMENCANKAODESUOYOUFANGCHENGZHISHIYUXIONGMOQIANGZHENSHIFASHENGDEQINGKUANGXIANGJIEJIN,SHIJISHANGXIONGKUONEIDEXIONGMOQIANGYALIBINGBUSHIJUNYIDE,ERSHIQUJUEYUJIGEYINSU,BIRU:SUIZHEFEIHEXIONGBIJIEPOUXINGTAIDEBUTONGERCHENGXIANCHUDEZHONGLITIDUCHAYIHEJUBUYALIBIANHUADENG。JINGUANHENNANZHUNQUECELIANGXIONGMOQIANGNEIYA,DANTADEBIANHUAHUIYINGXIANGZHEZHONGXINJINGMAIYAHEJINGMAIHUILIU。YIBUDAXINGDESHIYANXINGLINCHUANGZHUZUOCHANSHULESUOYOUKENENGCHUXIANDE、YUJIXIETONGQIYINQIDEYOUXIAOXUNHUANRONGLIANGJIANSHAOXIANGGUANDEBINGFAZHENG。DANGZHENGGEHUXIZHOUQIZHONGXIONGMOQIANGDOUBAOCHIZHENGYASHISIHUGENGRONGYIFASHENG,BIRU:ZAISHIYONGHUQIMOZHENGYA(PEEP)FUZHUTONGQISHI。SHENZANG、GANZANG、CHANGDAODOUKENENGHUIYINJINGMAICHONGXUEHEGUANZHUJIANSHAOERSHOUSUN。

彩经网  ZAIZIZHUHUXIGUOCHENGZHONG,KENENGHUICHUXIANXIONGMOQIANGFUYAGUODIDEQINGKUANG,YOUQISHIHUANZHEJUYOUQIANGLIEDEHUXINULI,TONGSHIFEISHUNYINGXINGYOUJICHABIANCHENG“YINGFEI”SHI(JIANFANGCHENG(3))。LIRU:ZAIARDSSHI,YOUYUSHICHANGSHENDADEHUXIQUDONGLIZUOYONG,SHIDAONEIYAFUXIANGBODONGKEYICHAOGUO20-25cmH2O。CHULEZENGJIAHUXIGONGHEYANGHAOZHIWAI,RUCIDADEXIONGQIANGNEIFUYAHEFEIJIANZHINEIFUYAHAIKECUJINJINGMAIHUILIUBINGJIAZHONGFEISHUIZHONGDEXINGCHENG。ZHEIZHONGXIANXIANGSHOUXIANSHIYOUBarachDENGRENZAI1938TICHULAIDE,ZAIRUJINZHENGYATONGQIDESHIDAILI,LISUODANGRANDIBEIZAICIQIANGDIAO。ZUIJINDEYANJIUBIAOMING,SHOUSUNDEFEIZAIJULIEDEHUXINULIGUOCHENGZHONGHUICHUXIANQITIBAIDONGXIANXIANG,ZHEIKENENGHUIFANGDAJUBUXINGBIANBINGQIEDAOZHIZUZHISUNSHANG。LILUNSHANG,MOUXIERENJIBUTONGBU(LIRU:SHUANGCHUFAHEHUXILEIJI),RUGUOPINFAHE/HUOCHENGZUFASHENGYEKENENGHUIZAOCHENGSUNSHANG。

  ZAIJIXIETONGQIBEIYINGYONGYUARDSHUANZHEZHIHOUBUJIU,JIDUANKUAFEIYADEBULIYINGXIANGJIUBEIRENSHIDAOLE。ZAOXIENIANJIAN,ZUICHUDEZHILIAOMUBIAOSHIWEICHIXUEQIDEZHENGCHANGHEBIMIANRENJIBUTONGBU,ZAINEISHIHOU,HUXIJIDEBAOJINGXITONGHENCHA,ERJISONGYAOBEIRENWEISHIYOUHAIDESUOYIBEIXIANZHISHIYONG。YINCI,CHAOQILIANGHEHUXIPINLVCHANGCHANGBEIFENBIESHEZHIWEI15ml/kgHE15-20CI/FEN。TONGGUOZHEIZHONGFANGFA,ZHIYOUSHAOSHUHUANZHECHUXIANRENJIDUIKANG,DANSHIQIYASHANG(ZHUYAOSHIQIXIONG)CHUXIANDEHENKUAIQIEHENCHANGJIAN。ZHEIZHONGQINGKUANGCHUXIANDEGUOYUPINFAN,YIZHIYUZAIARDSHUANZHEKAISHIJIXIETONGQISHIJIUBEIJIANYIYUFANGXINGLIUZHISHUANGCEXIONGQIANGBISHIYINLIUGUAN。“QIYASHANG”BEIYONGYUMIAOSHULINCHUANGSHANGCHUXIANDEQITIYICHU:LIRUQIXIONG、ZONGGEQIZHONG、JIANZHIXINGFEIQIZHONG、QITISHUANSAIDENGXIANXIANG。DANSHI,CONGGENGGUANGFANDEYIYILAISHUO,QIYASHANGYEBAOKUOVILI。

  DreyfussDENGRENTICHULEBUTONGDEGUANDIAN,YUQIDAOYALIXIANGDUIYING,TAMENGENGQIANGDIAOFEIPENGZHANG(XINGBIAN)DEDEZUOYONG。ZAIXIANZHIXIONGBIYUNDONGERBIMIANGUODUDEFEIXINGBIANHUOSUNSHANGDEQINGKUANGXIAYINGYONGGAOQIDAOYA。XIANGFANDE,ZAITONGYANGDEQIDAOYAXIAJIECHUXIONGBIYUESHUSHI,FEISUNSHANG(“RONGJISHANG”)JIUHUIZENGJIA。RUGUOWOMENRENWEIFEIPENGZHANGDELILIANGBUSHIQIDAOYAERSHIKUAFEIYA(YEJIUSHIPaw – Ppl),ZEQIYASHANG(barotrauma)HERONGJISHANG(volutrauma)JIUXIANGYIMEIYINGBIDEZHENGFANLIANGMIAN。ZHEIGEBIANLIANGNENGGENGJINGQUEDEFANYINGZUOYONGYUFEIZUZHIDENENGLIANG。SHIJISHANG,FUHEYIXIAGONGSHI:

  ZAIZHEILI,ΔVSHIFEIRONGJIDEBIANHUA,XIANGDUIYUQIJINGXIDE(WUYINGLIZUOYONGXIADE)FEIRONGJI、GONGNENGCANQILIANG(FRC),ELspecSHIFEIZUZHIDANXINGZULI,DANXINGZULIFANYINGFEIDEJUEDUIPENGZHANGNENGLI。

  YINCI,YINGLIHEXINGBIANZHIBIWEIYIGECHANGSHU,XIANGDANGYUFEIDANXINGZULIELspec。ZHEIGEZHIZAIZHENGCHANGGETIHEJIXINGFEISUNSHANGHUANZHEZHONGSHIXIANGSIDE,PINGJUNYUE12cmH2O。YEJIUSHISHUO,DANGGONGNENGCANQILIANG(FRC)JIABEISHI,ZUOYONGYUFEIZUZHIDEYINGLIHUISHENGGAO12cmH2O。SHIJISHANG,ZAIXIQIHOU,YINGLIKEYIDADAO24cmH2O,YINWEIΔV/FRCDEBIZHIWEI2。SHIYANYANJIUZHENGSHI“QIYASHANG/RONGJISHANG”XUYAOFEIDEBUFENQUYUDADAOQIJIXIANRONGLIANG。ZAIZHEILI,JIAOYUANGUJIAJIEGOUBEIWANQUANKUOZHANG,CONGERBIANWEI“ZUZHISHENZHANG”DEYUESHULI。ZHEIYIGAINIANBEIZONGJIEYUTU2ZHONG,CHENGWEILIJIEQIYASHANGHERONGJISHANGDEJICHU。

  TU2.FEIXINGBIAN(CHAOQILIANG/GONGNENGCANQILIANG)YUFEIYALI(KUAFEIYA)DEHANSHU。SHUJULAIZIAgostoniHEHyatt。RUTUSUOSHI,KUAFEIYAWEI12cmH2O(TEYIXINGFEIDANXINGZULI)SHIFRCZENGJIAYIBEI。WOMENWUDUANDEBIAOCHUKUAFEIYA(PL)DE“WEIXIAN”QUYU,CISHIYINGBIANCHAOGUO1.5(JIYUSHIYANSHUJU)。PL:KUAFEIYA。

  ZAIGUANCHARONGJISHANGYINGXIANGDEDUIBIYANJIUZHONG,CHAOQILIANGJINGCHANGYONGMEIGONGJINLIXIANG(YUCE)TIZHONG(PBW)LAIBIAOSHI,QITUSHICHAOQILIANGYUYUJIFEIRONGJIXIANGGUAN。RANER,YOUYUARDSHUANZHEKECHONGQIFEIRONGJI(“YINGERFEI”DEGAINIAN)DECHAYI,ZHEIZHONGBIAOZHUNHUAWEINENGTIDAIFEIDEXINGBIAN。JINGUANYOUZHEIXIEJUXIANXING,ARDS NetworkFAXIAN,ZAIFEIXUANZEXINGARDSYANGBENZHONGJIYUANYUCETIZHONGSHIYONG6ml/kgDAITI12ml/kgDECHAOQILIANGSHI,SHENGCUNLVTIGAOLE9%。ZHIDEZHUYIDESHI,ZAIJIAOQINGDEARDSHUANZHEZHONG,SIFENWEISHUYEFAXIANLEZHEIGEYOUSHI,ZHEIXIEHUANZHEDE“YINGERFEI”RONGJIJIAODA。SHENGCUNLVHESIQIANGTONGQIZHIJIANDEFUXIANGGUANXINGSIHUSHIHELIDE,ZHENGRUGAOTANSUANXUEZHENGYIYANG,KENENGYUYOUGONGNENGDEYINGERFEIXIANGDUIRONGJIJIQIJINGSHOUDE“FEIBAOHUXING”TONGQIDAOZHIDEXINGBIANYOUGUAN。CHAOQILIANGCHAOGUO20-30ml/kgLIXIANGTIZHONGSHI,HUIDUISHIYANDONGWUDEJIANKANGFEICHANSHENGSUNHUAI。SUIRANJIANGJIANKANGFEIYUARDSHUANZHEDEFEIZHIJIEBIJIAOYOUKEYIZHICHU,DANSHI“YINGERFEI”DELIXUETEXING(RU:BISHUNYINGXING)HEZHENGCHANGFEIXIANGSI。ARDS NetworkQIANGLIEJIANYIBIMIANSHIYONGDACHAOQILIANG,XIANYISHENKEYOUQIARUQIFENDIYINGXIANGZHELINCHUANGSHIJIAN。RANER,YAOBIMIANRONGJISHANGCHULEDANCHUNDEKAOLVCHAOQILIANGWAIHAIYAOKAOLVFEIDEXINGBIAN(LIRU,CHAOQILIANGHEJINGXIFEIRONGJIDEBIZHI)。ZAIZHEIZHONGQINGKUANGXIA,ZUIJINGUANZHUDEJIAODIANZHUANXIANGLEQUDONGYA(DENGYUCHAOQILIANGYUSHUNYINGXINGDEBIZHI),ERBUZHISHICULVEDEJINGTIPINGTAIYA。WOMENYEBIXUTIXINGZIJI,ZAIXIANQIANDESUIJIDUIZHAOSHIYANZHONGFAXIANJIESHOUYUE10ml/kgCHAOQILIANGDEARDSHUANZHEBIYUE7ml/kgCHAOQILIANGDEHUANZHESHENGCUNLVGENGHAO。YINCI,ZHENGRUYOURENTIYIDE“CHAOBAOHUXINGTONGQI”(JINGTIWAIQINGCHUCO2),YEJIUSHIBACHAOQILIANGJIANGDAOXIAOYU6ml/kg,ZHEIBUYIDINGYOUYI,YINWEIYANZHONGTONGQIBUZUHEJIFADEFEIBUZHANGKENENGDIXIAOXIANQIANDEYOUSHI,CHUFEIQITAYUFANGXINGHUOBUCHANGXINGCELVEKEYITIGAOPINGJUNQIDAOYAYIZENGJIAQUANFEIDEYINGLI。YINGZHUYIJIYAOBIMIANGUODUDEGAOXINGBIAN,YEYAOBIMIANFEISHENGLIXINGDEDIXINGBIAN。

  BANSUIARMASHIYANPINGLUNDETICHU,32cmH2ODEPINGTAIYAZUOWEI(BEIDONG)JIXIETONGQIDEANQUANSHANGXIAN。CONGCI,30cmH2ODEJIXIANZEHENSHAOBEILINCHUANGSHIJIANHELINCHUANGSHIYANSUOZHIYI。SHISHISHANG,70kgDEZHENGCHANGREN(FRCYUE2000ml,SHUNYINGXINGYUE80ml/cmH2O),30 cmH2ODEPINGTAIYAXIANGDANGYUDAYUE2400mlDECHAOQILIANG(XINGBIAN=1.2)。ZAIZHENGCHANGDONGWU,RUGUOYI15CIDEHUXIPINLVGONGZUO54XIAOSHI,ZHEIZHONGXINGBIANJIHUSHIWUHAIDE。ZAIZHEIZHONGQINGKUANGXIA,JIASHEXIONGBIHEFEIDANXINGXIANGSI,ZEKUAFEIYAJIANGDAYUESHI15cmH2O(JIANTU2)。RANER,ZHENGRUYIJINGTIDAODE,ARDSSHI,FEIDANXINGHEZHENGTIHUXIXITONGDANXINGDEBILVKENENGHUIYOUSUOBUTONG,CONG0.2—0.8BIANHUA。

彩经网  YINWEIKUAFEIYADENGYUSHIJIADEQIDAOYACHENGYIEL/EtotDEBILV,“ANQUANDE”30 cmH2OKENENGDAOZHIKUAFEIYADIZHI6 cmH2OHUOGAODA24 cmH2O,ZHEISHIJIEJINDADAOFEIZONGRONGLIANGSUOXUDEYALI(TU 2),DUIDONGWUKENENGSHIZHISIXINGDE。YINCI,ZAITEDINGDEHUANZHEQUNTIZHONG,SHIYONG30 cmH2O,KENENGDAOZHIGUODUDEXINGBIANHUOTONGQIBUZUHEDIYANGXUEZHENG。ZAIAODALIYAHEXINXILANH1N1LIUXINGQIJIAN,ZHEIZHONGQINGKUANGHENKENENGFASHENGYUYIXIEDIEL/EtotBILV(RU,YUNFUHUOFEIPANGHUANZHE)DEHUANZHE。ZHEIXIESUOJIZAIDEDIEL/EtotBILVDEH1N1LIUGANHUANZHE(ECMORENXUAN)DUILIEZHONG,JINJINTONGGUOANQUANDIZENGJIAPINGTAIYA,ECMOYEXUSHIKEYIBIMIANDE。ZHENGRURONGJISHANGKAOLVXINGBIANERBUSHICHAOQILIANGGENGKEQU,QIYASHANGKAOLVKUAFEIYAERBUSHIPINGTAIYAYEGENGKEQU。(JIANFANGCHENG(6))。

  JINGUANDADUOSHUYANJIUZAICHULIVILISHIGENGGUANZHUYUHUXIDEJINGTAIBUFEN(CHAOQILIANG、PINGTAIYAHEPEEP),QITAZHONGYAODEYINSUYESHIBUYINGGAIBEIHUSHIDE。ZAIWOMENKANLAI,ZUIXIANGGUANDESHIHUXIPINLV(RU,MEIFENZHONGDISONGQIANZAIDERONGJISHANGHUOQIYASHANGDUOSHAOCI?)HEXIQILIUSU(RU,SHISHIYICITONGQIQIANZAIDERONGJISHANGHUOQIYASHANGDUOKUAICHUXIAN?)。

彩经网  HUXIPINLVBEIRENWEISHIXIANGDUIBUZHONGYAODE,YINWEITONGCHANGRENWEISHIWEILEWEICHIPaCO2ZAIKEJIESHOUDEFANWEI。YINCI,ZAIARDS NetworkSHIYANZHONG,29CI/FENDEHUXIPINLVXIANGGUANDEDICHAOQILIANGYU16CI/FENDEGAOCHAOQILIANGBIJIAO,JUYOULICHENGBEIXINGDEYIYI。JINGUANRUCI,ZAIMOUXIEQINGKUANGXIAHUXIPINLVYEKENENGBUHUICHENGWEIDAOZHIVILIDEYINSU。

彩经网  DANZAIGETIHUXIZHOUQIZHONGCHUXIANDONGTAIYALIBIANHUASHI,ZENGJIAHUXIPINLVDEWEIHAIJIHUSHIKENDINGDE。YUJINSHUPILAOLEISI,ZHEISHIGAOYINGLIZHOUQI(QIEHUAN)CISHUDEZUOYONG,KENENGYOUZHUYUJIANGHUXIPINLVDEZUOYONGSHIWEIVILIDEGONGTONGJUEDINGYINSU。ZAILITIFEIHEDAXINGDONGWUZHONG,JIANGDIHUXIPINLVZAIJIANSHAOVILIZHONGTIXIANCHULEQUEQIEDEYICHU。XIANGFAN,DANGTIGAOYALIFANWEISHI,GAOPINXIAOCHAOQILIANGTONGQIKENENGHUIZAOCHENGSUNHAI。

彩经网  GAOXIQILIUSUDUIVILIDEQIANZAIYINGXIANGKENENGYUJUBUJIAJUDEJIZHONGYINGLIYOUGUAN,SHIYIGESHOUZUZHIZHANDANXINGTEXINGYINGXIANGDEWENTI。SHIYANXINGWENXIANYIZHIBIAOMING,JIYUTEDINGDEPINGTAIYA,HUOTEDINGDEXINGBIAN,SUODISONGRONGLIANGDEPINLV(RU,XIQILIUSU)ZAIVILIFABINGGUOCHENGZHONGQIDAOMINGQUEDEZUOYONG。JINGUANYOURENZAILUOJISHANGQIWANGGAOXIQILIUSUSUOZHIDESUNHAIZHUYAOJIZHONGYUQIDAO,DANGAOXIQILIUSUQIANGDIAODUIFEISHIZHIDESUNHAI,HENYOUKENENGYINWEIZHANDANXINGDIAOJIEBUNENGMANZUZAIXUNSUFASHENGPENGZHANGSHIJISHIXIAOCHUPOHUAIXINGDELILIANG。JIASHELIUSUDUIJIXIEXINGFEIJUNZHIFEI(RU,ARDS)DEZUOYONGGAOYUJUNZHIFEI。CIWAI,YIZHONGYOUYALIKONGZHISUODISONGDECHAOQILIANGKENENGBILIULIANG-KONGZHIJUYOUGENGDADEWEIXIANXING,RONGJI-QIEHUANSHITONGQISHIXIANLEHENGDINGDELIULIANG,YINWEIQIANZHEDEXIQIFENGLIUSUKENENGDADAOGENGGAODEZHI。ZUIHOU,SUIRANHENSHAOYOUYANJIU,HUQILIUSUKONGZHIKENENGQIANZAIDIJIANQINGWEIXIAOFEIBUZHANGDEFASHENG,YINGXIANGPAIQISHIZUZHIZIWOZHONGZUFASHENGDEYINGLI。

  BIAO2XIANSHILEZAIGUOQUJINIANLIZHILIAOARDSDEBUTONGRENQUNTONGQIDESHUJUJIJIEGUO。FENBIEYU2002NIAN、2011NIAN、2016NIANYOUEstebanDENG、VillarDENG、BellaniDENGTIGONGLEGUANCHAXINGYANJIU。ZHEISANXIANGYANJIUBAOKUOFEIXUANZEXINGDEARDSHUANZHE,BINGFANYINGLERICHANGSHIJIAN。WEILEZUOBIJIAO,WOMENZAISUIJISHIYANZHONGZENGJIALERUXUANHUANZHEDEZHILIAOHEJIEGUO,CONGGUANGFANDEARDSRENQUNZHONGSHAIXUANCHUPAICHUBIAOZHUN。YUCHAOQILIANGBIJIAO,GENGDUODIGUANZHUPINGTAIYA,ZAIARDS Network ARMASHIYANHOUYIZHIBAOCHIZAI30cmH2OYIXIA。HUXIPINLVMEIYOUXIANZHUDEBIANHUA,YINWEITASIHUCHUYUWEICHIPaCO2ZAI35—45mmHgDEZHENGCHANGFANWEIWEIMUDE。PEEPZHISHIZHONGPINGJUN7-8cmH2O,ZUIGAOSHUIPINGDA15 cmH2O,JINXITONGDIYINGYONGYULINCHUANGSHIYAN。JIANYUBellaniDENGJINXINGDEYIXIANGZUIDA、ZUIXINDEDIAOCHASUOBAODAODETONGQISHUJU,WOMENXIANGZHIDAOPBW7.6ml/kgDECHAOQILIANG、HUXIPINLV18.6CI/FEN、PEEP8.4cmH2ODETONGQIHUANZHEVILISIWANGDEBUFENYUANYIN。DAOMUQIANWEIZHI,WOMENRENWEIBUKENENGHUIDAZHEIYIWENTI,YINWEIZHEIYIWENTIZAIGAIJINWEILAIJIXIETONGQIQIDAOZHIGUANZHONGYAODEZUOYONG。DEQUE,RUGUODANGQIANVILISUOZHISIWANGLVYIJINGFEICHANGDILE,NEIMEWOMENBUNENGQIWANGCONGMUQIANTONGQISHIJIANZHONGHUODEHENDADEGAIJIN。WOMENBIXUSHOUXIANGENGHAODILEJIEHUXIJISHEZHIDEZUOYONG,LEJIEFEIZANGBINGLISHENGLIXUE,YIJITAMENZHIJIANDEXIANGHUZUOYONG。

  PBW YUCETIZHONG,PEEP HUQIMOZHENGYA,RCT SUIJIDUIZHAOSHIYAN,RR HUXIPINLV,Vt CHAOQILIANG

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彩经网  TU3ZUISHANGFANGTIAOKUANG:JIANHUADEYUNDONGFANGCHENG,XIANSHILEZAIJIDINGDESHIKE,GAOYUrelaxedRONGJIHUXIXITONG(P)NEIDEYALIDENGYUDANXINGYALI(HUXIXITONGDEDANXING Ers CHENGYIFEIRONGLIANGDEBIANHUA)、QITIYIDONGSUOXUDEYALI(LIULIANGCHENGYIQIDAOZULI)、YIJIBAOCHIFEINEIYAGAOYUHUQIMODAQIYA(PEEP)SUOXUDEYALI(RUGUOCUNZAIDEQINGKUANGXIA)SANZHEZHIHE。RUGUOSANGEYINSUZHONGDEMEIYIXIANGDOUCHENGYICHAOQILIANGDEBIANHUA,JIKEHUODEMEICIHUXIDENENGLIANG。

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彩经网  I:E XIHUBI,PEEP HUQIMOZHENGYA,Powerrs HUXIXITONGDEJIXIEGONGLV,RR HUXIPINLV,△V RONGLIANGBIANHUA,Raw QIDAOZULI

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彩经网  ZONGZHI,WOMENRENWEIDUIWEILAIHUANZHE“GAIJIN”JIXIETONGQIDEKENENGFANGFA(TUJING)BAOKUOYIXIAJIGEBUZHOU:

彩经网  ● CELIANG/GUCEFEIDEBUJUNZHIXINGYIPINGGUYINGLITISHENGDEPUBIANCUNZAI,YIJIPINGGUJIXIENENG/YINGLI—XINGBIANDEFENBUGUILV。

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彩经网  ● RUGUOBUNENGZHAODAOBIMIANVILIGUODUFENGXIANDEJIXIETONGQISHEZHI,ZETIDAIFANGFA(RURENGONGFEI)YINGGAIKAOLV。