肺开放／复张的机械通气策略的研究进展

Research progress of mechanical ventilation strategies in open lung aproach/recruitment maneuvers

广泛性、小灶性肺不张和肺泡萎陷是急性肺损伤（acute lung injury，ALI）／急性呼吸窘迫综合征（acute respiratory distress syndrome，ARDS）的主要病理改变，也是引起肺容量减少、肺内分流（Qs／QT）增加、顺应性下降和顽固性低氧血症的主要原因。机械通气能有效纠正缺氧，减少肺损伤，是治疗ALI／ARDS的重要措施，但也可因正压通气和肺泡反复萎陷／复张产生的剪切力，引起机械通气相关性肺损伤（ventilator associated lunginjury，VALI），包括气压伤、容积伤、生物伤等。针对VALI致伤因素，一系列保护性肺通气策略（lung protective ventilatory strategy，LPVS）被提出，本文就近年来肺开放／复张的机械通气策略的研究进展作一综述。

Focal atelectasis catholicity and alveolus collapse is the main pathology change in acute lung injury（ALI）/acute respiratory distress syndrome（ARDS）, also is the main cause of reduced lung capacity, lung split stream（Qs/QT ） increase,lower complaisance and refractory hypoxemia. Mechanical ventilation can effectively correct hypoxia and reduce lung injury. It is an important measure of ALI/ARDS treatment. Shear stress that positive pressure ventilation and alveolus collapse/recruitment generate can cause ventilator associated lung injury（VALI） including barotrauma,volutrauma, biotrauma and so on. Regarding factors of VALI, a series of lung protective ventilatory strategies were proposed. This article summarizes emphatically mechanical ventilation application in open lung aproach（OLA）/recruitment maneuvers in recent years.