20xx年醫(yī)學(xué)專題—ards肺復(fù)張的測(cè)定-邱海波-wenkub.com
2025-10-21 14:14 本頁面
【正文】 結(jié)果：PaO2+PaCO2從178.4?76.5mmHg升至487.8 ? 139.1mmHg，維持肺復(fù)張PEEP水平為22?4cmH2O。ng)充氣肺區(qū)體積增加。ng)總結(jié),急性呼吸窘迫綜合征肺復(fù)張的測(cè)定與應(yīng)用。ng),第八十六頁，共八十八頁。ngy242。 t243。sh236。,不同通氣模式(m243。,不同通氣模式(m243。,不同(b249。,ARDS早期PEEP的調(diào)整(ti225。 與PEEP5cmH2O相比較，P 0.05。,ARDS患者不同(b249。ny225。n),Gattinoni L, Caironi P, Pelosi P, et al. Am J Respir Crit Care Med, 2001, 164:17011711,ARDS肺復(fù)張應(yīng)用(y236。,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(fù)張應(yīng)用(y236。ng),第七十三頁，共八十八頁。,PEEP缺乏大量肺泡(f232。232。),第七十一頁，共八十八頁。),第七十頁，共八十八頁。),第六十九頁，共八十八頁。),第六十八頁，共八十八頁。,對(duì)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(shí)施方法為逐步增加PEEP至1 230cm/H2O(extended sigh)， 結(jié)束后PEEP設(shè)為15cm/H2O ARM組：ARM后PEEP仍為10cm/H2O PEEP組：根底通氣(tōng q236。,V.N.Okamoto et al. Unpublished data, 2003,ARDS肺復(fù)張應(yīng)用(y236。ng)：17例ARDS患者，VT=6ml/kg, PEEP=10cm/H2O PEEP選擇方法：PCV，PIP=15+PEEP，每2min調(diào)PEEP 2345cmH2O，至FiO2為100%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(fù)張PEEP水平為22?4cmH2O,V.N.Okamoto et al. Unpublished data, 2003,ARDS肺復(fù)張應(yīng)用(y236。ngy242。),ARDS肺復(fù)張應(yīng)用(y236。) PaO2 method DO2導(dǎo)向性PEEP選擇 肺復(fù)張容積導(dǎo)向性PEEP選擇Recruitment volume method,ARDS肺復(fù)張應(yīng)用(y236。ngy242。i r243。,VTinduced alv recruitment,ARDS肺復(fù)張應(yīng)用(y236。nhu224。,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(fù)張應(yīng)用(y236。ng),第五十七頁，共八十八頁。ng),第五十六頁，共八十八頁。,綿羊(mi225。oy236。,Effect of PEEP on recruitment and overdistention,Puybasset L. ICM, 2000, 26:1215,ARDS肺復(fù)張應(yīng)用(y236。ng),第五十二頁，共八十八頁。ngy242。,PEEP效應(yīng)的影響因素 塌陷肺泡的分布(fēnb249。)overdistention的分布,Volume of overdistension(ml)=0.42?Parenchyma900。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(fù)張應(yīng)用(y236。,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(fù)張應(yīng)用(y236。,PEEP效應(yīng)的影響因素(yīn s249。 y224。ng),第四十五頁，共八十八頁。 t243。,Mean Airway Pressure 40 cm H2O,CT Scan : ARDS pig model 30 kg,Optimized Lung Volume Strategy,ARDS肺復(fù)張應(yīng)用(y236。ng),第四十二頁，共八十八頁。ngy242。ngy242。tǐ)交換變化,*,*,與SI前相比(xiānɡ bǐ)，*P 0.05,ARDS肺復(fù)張應(yīng)用(y236。ng)復(fù)張容積的變化,*,*,與SI前相比(xiānɡ bǐ)，*P 0.05,ARDS肺復(fù)張應(yīng)用(y236。 y224。ng),local distribution,第三十六頁，共八十八頁。ngy242。,Lung morphology pattern,Local Diffuse LIP No Yes Normally aerated 55?12% 24 ?12% Poorly aerated 23 ?8% 40 ?12% Distribution modal Bimodal Unimodal Peak of CT distr 727Hu/27Hu 7Hu Compltot 57 ?5 46 ? 11,Vieira SRR. AJRCCM, 1999, 159: 1612,ARDS肺復(fù)張應(yīng)用(y236。,塌陷(tāxi224
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