肺泡再擴張術及吐氣末正壓設定的演變及新進展

The New Development of Recruitment Maneuvers and the Determination of the Best "Positive End-expiratory Pressure" in Acute Respiratory Distress Syndrome

鄭人碩(Jen-Suo Cheng) ； 林偉傑(Wei-Chieh Lin) ； 陳昌文(Chang-Wen Chen) ； 張漢煜(Han-Yu Chang)

《內科學誌》 25卷2期 (2014/04) Pp. 86-93

https://doi.org/10.6314/JIMT.2014.25(2).05

摘要

急性呼吸窘迫症，是一個致死率很高的症候群，雖然低潮氣容積及低氣道高原壓力的機械通氣策略可以改善這類病人的預後，但是在臨床上，仍然無法完全解決呼吸器相關的肺部損傷。肺泡再擴張術不論就生理學的觀點或者是近幾年的臨床研究，都可以觀察到氧合濃度改善的趨勢。本篇將探討近幾年來肺泡再擴張術之進展及如何選擇維持肺泡打開的最佳化吐氣末正壓，以及非侵入性即時監測肺部通氣的新儀器（電阻抗）的運用及介紹。

關鍵字

肺泡再擴張術（Recruitment maneuvers） ； 最佳化吐氣末正壓（Optimal positive end-expiratory pressure） ； 急性呼吸窘迫症（Acute respiratory distress syndrome）

並列摘要

Acute respiratory distress syndrome (ARDS) is a life-threatening syndrome. Although the low-tidal-volume lung protective strategy has been proven to improve prognosis, it is still unable to manage all the patients with ventilator-associated lung injury. Accumulating evidence has shown that the recruitment maneuvers can improve the oxygenation in these patients based on the pathophysiology of ARDS. Herein, we review the evolvement and recent advance of the alveolar recruitment maneuvers and the various approaches to determine the optimal post-expiratory positive pressure following recruitment. We also introduce a non-invasive, real-time and bed-side used alveolar ventilation monitor, the electrical impedance tomography.