肺复张对重症患者血流动力学的影响

Hemodynamic effects of lung recruitment maneuvers in critically ill patients

各种原因引起的肺不张常常导致肺内分流增加、静脉血氧合不充分最终出现低氧血症甚至呼吸衰竭。肺复张的目的就是通过迅速短暂的增加气道压力来打开塌陷的肺泡。虽然肺复张可以改善氧合,但由于心肺以及心脏的左、右心室间的相互作用,可能造成胸内压力升高从而对心血管系统产生严重的影响。这篇综述的目的就是总结肺复张过程中心肺间的病理生理特征并探讨在肺复张过程中如何更好地监测这些特征的变化,从而在临床工作中更好地使用肺复张。

Atelectasis leads to increased intrapulmonary shunt, venous admixture and hypoxaemia. Lung recruitment maneuvers aim to quickly reverse this scenario by applying increased airway pressures for a short period of time, which means to open the collapsed alveoli. Although the procedure can improve oxygenation, elevated intrathoracic pressures can inflict serious effects on the cardiovascular system due to the heart-lung and right and left ventricle interactions. The purpose of this article is to give an overview on the pathophysiological background of the heart-lung interactions and the best way to monitor these changes during lung recruitment.