【正文】 比(xiānɡ bǐ)，*P 0.05,ARDS肺復張應用(y236。ngy242。ng),第四十二頁，共八十八頁。 t243。 y224。,Rothen H. et al. Br J Anaesth 1993:71:788795,Reexpansion of atelectasis during general anaethesia,A: CT scan at level of right disphragm B: CT scan 5cm above right diaphragm,ARDS肺復張應用(y236。)overdistention的分布,Volume of overdistension(ml)=0.42?Parenchyma900。ngy242。,Effect of PEEP on recruitment and overdistention,Puybasset L. ICM, 2000, 26:1215,ARDS肺復張應用(y236。,綿羊(mi225。ng),第五十七頁，共八十八頁。nhu224。i r243。) PaO2 method DO2導向性PEEP選擇 肺復張容積導向性PEEP選擇Recruitment volume method,ARDS肺復張應用(y236。ngy242。,V.N.Okamoto et al. Unpublished data, 2003,ARDS肺復張應用(y236。),第六十八頁，共八十八頁。),第七十頁，共八十八頁。232。ng),第七十三頁，共八十八頁。n),Gattinoni L, Caironi P, Pelosi P, et al. Am J Respir Crit Care Med, 2001, 164:17011711,ARDS肺復張應用(y236。,ARDS患者不同(b249。,ARDS早期PEEP的調(diào)整(ti225。,不同通氣模式(m243。sh236。ngy242。ng)總結(jié),急性呼吸窘迫綜合征肺復張的測定與應用。結(jié)果：PaO2+PaCO2從178.4?76.5mmHg升至487.8 ? 139.1mmHg，維持肺復張PEEP水平為22?4cmH2O。ng)充氣肺區(qū)體積增加。ng),第八十六頁，共八十八頁。 t243。,不同通氣模式(m243。,不同(b249。 與PEEP5cmH2O相比較，P 0.05。ny225。,PEEP and Survoval,A post hoc analysis, 53 patients,Barbas CSV, Medeiros DM, Magaldi RB, et al. Am J Respir Crit Care Med, 2002, 165: A218,ARDS肺復張應用(y236。,PEEP缺乏大量肺泡(f232。),第七十一頁，共八十八頁。),第六十九頁，共八十八頁。,對象：47例早期ARDS患者，VCV，VT=8ml/kg， PEEP=10cm/H2O，RR20次/分，I：E=1：1 分組與方法： ARM+PEEP組：ARM實施方法為逐步增加PEEP至1 230cm/H2O(extended sigh)， 結(jié)束后PEEP設為15cm/H2O ARM組：ARM后PEEP仍為10cm/H2O PEEP組：根底通氣(tōng q236。ng)：17例ARDS患者，VT=6ml/kg, PEEP=10cm/H2O PEEP選擇方法：PCV，PIP=15+PEEP，每2min調(diào)PEEP 2345cmH2O，至FiO2為100% PaO2+PaCO2400mmHg，每1520min降低PEEP，至PaO2較前一次降低5%, PEEP水平為前一次PEEP 結(jié)果：PaO2+PaCO2從178.4?76.5mmHg升至487.8 ? 139.1mmHg，維持肺復張PEEP水平為22?4cmH2O,V.N.Okamoto et al. Unpublished data, 2003,ARDS肺復張應用(y236。),ARDS肺復張應用(y236。ngy242。,VTinduced alv recruitment,ARDS肺復張應用(y236。,PEEPinduced alv recruitment,16pat with ARDS LIS 3 Csts 39(ZEEP) CT scan Over 1000~900 Normal 900~500 Low 500~100 Ate –100~+100 PEEP 0 vs 15,Luiz M, Rouby JJ. Am J Respir CCM, 2001,163:1444,ARDS肺復張應用(y236。ng),第五十六頁，共八十八頁。oy236。ng),第五十二頁，共八十八頁。,PEEP效應的影響因素 塌陷肺泡的分布(fēnb249。udǎo)recruitment的分布,Puybasset L. ICM, 2000, 26:1215c,In lower lobes: Alv recruitment (ml) = 0.16 X Endexpir lung volume(ml) –24ml,ARDS肺復張應用(y236。,PEEP效應的影響因素(yīn s249。ng),第四十五頁，共八十八頁。,Mean Airway Pressure 40 cm H2O,CT Scan : ARDS pig model 30 kg,Optimized Lung Volume Strategy,ARDS肺復張應用(y236。ngy242。tǐ)交換變化,*,*,與SI前相比(xiānɡ bǐ)，*P 0.05,ARDS肺復張應用(y236。 y224。ngy242。,塌陷(tāxi224。,Cardiac mass and volume in ARDS,Cardiac mass was increased by 27% vs NS Mechanism of cardiac mass: Edema of cardiac wall RV dilation secondary to pul hypertension Hyperkinetic state related to SIRS,CT scan ARDS study group. AJRCCM, 2000,161:2005,ARDS肺復張應用(y236。ng),第二十八頁，共八十八頁。i r243。肺泡復張，充氣不良和正常充氣肺區(qū)體積增加 方法 ZEEP和PEEP