特殊患者的肺保护性通气策略

Lung Protective Ventilation Strategies in Special Patients

机械通气可导致呼吸机相关性肺损伤(ventilator-associated lung injury, VALI),主要包括容积伤、气压伤、不张伤、生物伤和剪切伤。肺保护性通气策略(lung protective ventilation strategy, LPVS)是近几年来针对VALI而发展起来的机械通气新策略,其目的为尽可能的保护肺组织减少机械通气性损害。LPVS主要包括小潮气量、最佳的呼气末正压、肺复张等;LPVS的实施可以改善肺顺应性和肺泡处的气体交换,减少肺水肿和感染的发生,降低术后肺部并发症(postoperative pulmonary complications, PPCs)的发生率。本文拟讨论对于某些特殊患者应用肺保护性通气策略方面的进展。

Mechanical ventilation brought about ventilator-associated lung injury (VALI), which consisted mainly of volume injury, ventilatory injury, atretic injury, biological injury and shear injury. Lung protective ventilation strategy (LPVS) is a new mechanical ventilation strategy developed in recent years against VALI. Its purpose is to protect lung tissue and reduce mechanical ventilation damage as much as possible. The protective lung ventilation strategy mainly includes neap tidal volume, optimal positive end-expiratory pressure, pulmonary retention, etc. Implementation of LPVS can improve lung compliance and gas exchange in alveoli, reduce the occurrence of pulmonary edema and infections, and reduce the incidence of postoperative pulmonary complications (PPCs). This article intends to discuss advances in the application of lung protective ventilation strategies in some special patients.