急性呼吸窘迫综合征肺复张潜能评估

Assessment of lung recruitment potential in acute respiratory distress syndrome

肺复张是急性呼吸窘迫综合征(ARDS)的一项重要治疗策略。肺可复张性的评估对于改善氧合,减少呼吸机相关性肺损伤有着重要的意义。评估肺可复张性的方法主要有影像学评估与功能性评估两种。CT法仍是评价肺可复张性的金标准。尽管P-V曲线法和肺部超声法可以在床旁提供肺可复张性的证据,但是他们并不能对肺的过度膨胀做出判断。电阻抗断层成像法可以分别观察重力依赖区与非重力依赖区域的肺的复张与塌陷的过程。PET-CT法除了可以有效的评估肺可复张性之外,能够更好地评估复张过程中肺的炎性反应。在评估肺可复张性的同时,如何在床旁判断肺的过度膨胀仍须进一步的研究。

Recruitment maneuver （RM） plays a key role in the treatment of acute respiratory distress syndrome. Assessment of lung recruitability may reach a good compromise between improvement of oxygenation and reduction of ventilation-induced lung injury. Lung imaging and functional assessment are two main methods to evaluate alveolar recruitment. CT remains the gold standard in the assessment of lung recruitablity. Although P-V curve and lung ultrasound can provide evidences of alve- olar recruitment at bedside,the two methods can＇t provide information of lung hyperinflation. Electrical impedace tomography allows bedside assessment of tidal recruitment in dependent and nondependent regions. In addition to assessment of lung re- cruitablity, PET/CT can also evaluate the lung inflammation during RM. Further research is required for bedside assessment of lung hyperinflation combining alveolar recruitment.