创伤性颅脑损伤患者机械通气的研究进展

The advances of mechanical ventilation in patients with traum atic brain injury

机械通气是创伤性颅脑损伤(traumatic brain injury, TBI)患者呼吸支持的重要手段,广泛应用于脑损伤患者的救治中。然而,由于"肺脑交互"的存在,目前TBI患者机械通气方法的选择尚存争议。通过对近年来的相关研究进行回顾及总结,大潮气量、过度通气和高碳酸血症均可影响患者脑血流量和颅内压,应谨慎使用;呼气末正压通气(positive end expiratory pressure, PEEP)和肺复张(recruitment maneuvers, RMs)可以改善患者肺部换气,但可能对患者脑血流动力学产生不利影响。在行脑和肺的多模式监测、维持稳定动脉血压及充足的脑氧灌注的前提下,使用PEEP和RMs似乎是安全的。而有关TBI的最佳通气策略尚需进一步探索和发掘。

Mechanical ventilation is regarded as an important respiratory support method for patients with traumatic brain injury (TBI). It′s widely used during the treatment for these patients. However, because of the existence of "brain-lung crosstalk", it′s still be controversial about the strategies of mechanical ventilation for patients with TBI. We reviewed and summarized the related research in recent years. We suggested cautiously using large tide volume, hyperventilation and hypercapnia in clinical practice because they do have some negatively influences on cerebral blood flow and intracranial pressure. The use of positive end expiratory pressure (PEEP) and recruitment maneuvers (RMs) can improve the exchange of gas within the pulmonary, but they may have adverse effects on cerebral hemodynamics. It seems safe by taking the strategies of PEEP and RMs when adequate monitors were used for both lung and brain to guarantee stable arterial blood pressure and adequate cerebral oxygen perfusion. However, the best ventilation strategy for patients with TBI still need to be further explored.