腹腔感染患者肺脏保护的管理策略

Management strategy of lung protection in patients with intra-abdominal infection

肺脏保护在腹腔感染(IAI)患者的医治过程中非常重要。本文重点分享IAI患者肺脏保护的管理策略。在实施IAI个体化呼吸保护时,良好的温湿化和胸腔物理治疗、必需的营养支持、严格的气囊管理、保持高卧体位、减轻镇痛镇静的持续时间和深度,有利于保持有效的咳嗽能力和预防隐性吸入。同时,需要预防呼吸机相关机械通气的损伤,做好急性呼吸窘迫综合征小潮气量、限制平台压力、膈肌保护和右心保护性策略。在进行个体化呼吸功能状态的评估和监测时,对于行机械通气治疗的IAI患者可以使用呼吸力学指标包括气道阻力、呼吸系统顺应性、最大吸气压(MIP)和气道闭合压(P0.1);未行机械通气治疗的IAI患者可以使用床旁简易肺功能指标,包括吸气和呼气的用力肺活量、吸气和呼气峰值流速、最大吸气压力和吐气压力以及1 s量和1 s率等。在肺康复中,实施"湿、翻、拍、咳、扩、吹、动"七字原则的肺脏保护技术。

Lung protection is important in the treatment of patients with intra-abdominal infection(IAI).This article focuses on the management strategy of lung protection in IAI patients.In the implementation of IAI individual respiratory protection,good humidification and chest physical therapy,nutritional support,strict balloon management,keeping a semi-supine position,and reducing the duration and depth of analgesia and sedation are helpful to maintain effective coughing capacity and prevent silent aspiration.It is also necessary to prevent ventilator-associated lung injury in mechanical ventilation,and implement strategies of small tidal volume,limited platform pressure,diaphragmatic protection and right heart protection ventilation in acute respiratory distress syndrome(ARDS).Respiratory mechanical indicators,including airway resistance,respiratory compliance,maximum inspiratory pressure(MIP),and airway closure pressure(P0.1)can be used in IAI patients receiving mechanical ventilation for individualized assessment and monitoring of respiratory functional status.Patients with IAI who have not been treated with mechanical ventilation can use simplified bedside lung function indicators,including forced vital capacity of inhalation and exhalation,maximum inspiratory pressure and exhalation pressure,as well as volume and rate of 1s.In pulmonary rehabilitation,the protection technique of the seven-word principle of humidification,turning,patting,coughing,expansion,blowing and mobilization are implemented.