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中华重症医学电子杂志 ›› 2016, Vol. 02 ›› Issue (04) : 287 -290. doi: 10.3877/cma.j.issn.2096-1537.2016.04.014

所属专题: 文献

综述

急性呼吸窘迫综合征血流动力学管理:聚焦机械通气
江伟1, 翁利1,()   
  1. 1. 100032 北京,中国医学科学院北京协和医院内科ICU
  • 收稿日期:2016-10-27 出版日期:2016-11-28
  • 通信作者: 翁利

Hemodynamic management in acute respiratory distress syndrome: focus on mechanical ventilation

Wei Jiang1, Li Weng1()   

  1. 1. Department of Medical ICU, Peking Union Medical College Hospital, Beijing 100730, China
  • Received:2016-10-27 Published:2016-11-28
  • Corresponding author: Li Weng
  • About author:
    Corresponding author: Wengli, Email:
引用本文:

江伟, 翁利. 急性呼吸窘迫综合征血流动力学管理:聚焦机械通气[J]. 中华重症医学电子杂志, 2016, 02(04): 287-290.

Wei Jiang, Li Weng. Hemodynamic management in acute respiratory distress syndrome: focus on mechanical ventilation[J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2016, 02(04): 287-290.

急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)肺保护性通气策略已得到广泛运用,但病死率并无明显下降,这与ARDS患者循环衰竭有一定关系。ARDS患者机械通气可引起的胸腔压力变化导致静脉回流减少,肺血管阻力升高。同时,由于ARDS疾病本身也可引起肺动脉压力升高,因此,如机械通气设置不当导致肺泡过度牵张,右心后负荷明显增加,可致右室功能障碍,发展为急性肺心病。ARDS肺保护性通气策略实施过程中应注意监测右心功能,调整通气策略,防止急性肺心病的发生。

Lung protective ventilation strategy in acute respiratory distress syndrome (ARDS) has been widely accepted, however, the mortality of ARDS has not been significantly decreased, which supposed to be related to circulatory failure in ARDS patients. Mechanical ventilation in ARDS patients will elevate intra-thoracic pressure, which will decrease venous return and increase pulmonary vascular resistance. Meanwhile, the pathophysiology of ARDS itself will induce pulmonary arterial hypertension. Inappropriate settings of mechanical ventilation may also cause over-stretch of alveoli and increased afterload of right heart, leading to right heart dysfunction or acute cor pulmonale. When practicing lung protective ventilation strategy in ARDS patients, we need to monitor right heart function to modify mechanical ventilation, so as to prevent acute cor pulmonale.

图1 呼吸对肺泡血管和肺泡外血管的作用示意图
图2 呼吸对肺血管阻力的作用示意图
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