急性呼吸窘迫综合征的通气策略及呼气末气道正压的应用

Adequate positive end-expiratory pressure for acute respiratory distress syndrome

急性呼吸窘迫综合征（acute respiratory distress syndrome，ARDS）的临床特征是呼吸窘迫和严重的低氧血症，大部分的患者都需要机械通气。但是机械通气应用不当也会引起呼吸机相关性肺损伤，在某些情况下这种损伤甚至是致命的。在机械通气过程中应用呼气末气道正压（positive end—expiratory pressure，PEEP）可改善患者的低氧血症同时也可预防或减轻呼吸机相关性肺损伤。遗憾的是，尽管近40年来人们进行了大量的研究，但有关最佳PEEP压力水平的选择一直存在着争议。

Acute respiratory distress syndrome is characterized clinically as respiratory distress and severe hypoxemiac. Almost all the patients require mechanical ventilation. But,inadequate use of ventilation can unexpectedly lead to ventilator-induced lung injury and in some conditions this injury may be deadly. Application of positive end-expiratory pressure （PEEP） could improve hypoxemia as well as prevent or reduce ventilator-induced lung injury. Unfortunately, although many clinical and experimental studies has been conducted in the past 4 decades,it remains controversial about setup of an adequate PEEP level.