术中肺保护性通气的新进展

New Progress in Intraoperative Pulmonary Protective Ventilation

肺保护性通气是指在机械通气时使用合适的通气策略降低呼吸机相关肺损伤的发生率。呼吸机相关损伤的主要机制为机械通气时肺泡反复开放塌陷造成的肺泡上皮细胞受损,进而引发一系列炎性反应。通过应用小潮气量及呼气末正压可有效预防肺泡过度膨胀及完全塌陷,最小化术后肺部并发症发生风险。其最早应用于ARDS患者机械通气中,近年来大量研究发现肺保护性通气在全麻机械通气中应用可减少术后肺部并发症。本文就肺保护性通气原理及术中应用进行综述。

Lung protective ventilation was used to decrease the occurrences of ventilator inducedlung injury(VILI).The major cause of VILI during mechanical ventilation is the alveoli injured by cyclic hyperinflation and collapsethen leading to endothelium inflammation.But by using a low tidal volume and PEEP,intraoperative protective ventilation reduces the tendency to cyclic alveolar hyperinflation and collapse,and thus minimizes the risk of postoperative pulmonary complications.Lung protective ventilation was applied in mechanical ventilation of ARDS patients at the earliest.A number of studies of intraoperative protective ventilation published recently indicatedits benefit for healthy patients under general anesthesia.This review was about the mechanism and intraoperative application of lung protective ventilation.