急性呼吸窘迫综合征的容许性高碳酸血症的机械通气治疗

Mechanical ventilation therapy with permissive hypercapnia on ARDSC

急性呼吸窘迫综合合征（ＡＲＤＳ）机械通气治疗的探索。方法观察了１０例ＡＲＤＳ患者。为了减低吸气末气道压力（ｐｐｌａｔ），减少肺气压伤，应用较低的潮气量（ＶＴ，ｘ＝６．５ｍｌ／ｋｇ），依靠自身肾脏代偿功能，容许一定限度的呼吸性酸中毒（简称呼酸）存在（ｐＨ≥７．１９）。在维持动脉血氧分压（ＰａＯ２）７．３ｋＰａ（１ｋＰａ＝７．５ｍｍＨｇ）左右情况下，尽量使用低水平吸氧浓度（ＦｉＯ２，ｘ＝０．５１）及呼气示正压（ＰＥＥＥＰ，ｘ＝０．９２ｋＰａ）（１ｋＰａ＝１０．２ｃｍＨ２Ｏ）。结果７例存活，其中３例在机械通气期间出现过呼酸，２例出现肺气压伤。结论在ＡＲＤＳ机械通气治疗中，使用较低ＶＴ及容许一定限度呼酸存在是值得重视的新观点。

Objective Study of mechanicalventilation(MV)therapy of ARDS(acuterespiratory distress syndrome)Methods Ten cades of ARDS were observed.Depending on patients′ kidney com pensation for respiratory acidosis,low tidal volume([AKV-〗 T[AKx-〗=6.5ml/kg)was used and certain respirato ry acidosis was permitted in order to decrease airway plateau pressure and lung barotrauma.On the premise of keeping patients′PaO 2about7.3kPa(1kPa=7.5mmHg),lowest possibleFiO 2([AKx-〗=0.51)and PEEP([AKx-〗=0.92 kPa,1 kPa=10.2cmH 2O)were used.Results Seven of the ten survived.Three of them had respiratory acidosis and two had lung barotrauma duringMV.Conclusion Using lower V T and permitting certain respiratory acidosis are worthy to be considered in MV therapy of ARDS.