肺復張與吐氣末正壓在急性呼吸窘迫症候群的新進展

New Progress of Recruitment Maneuver and Best PEEP in Acute Respiratory Distress Syndrome

賴勁翰(Ching Han Lai) ； 陳昌文(Chang-Wen Chen)

《內科學誌》 32卷4期 (2021/08) Pp. 257-263

https://doi.org/10.6314/JIMT.202108_32(4).04

摘要

肺泡復張術（alveolar recruitment maneuver）可以打開肺泡，加上吐氣末正壓（positive end-expiratory pressure, PEEP）可以避免肺泡塌陷，是臨床上處理急性呼吸窘迫症候群所面臨的“低血氧”與“肺部塌陷／肺部不均質（heterogeneity）”等問題的方法。這些方法，在邏輯上看似合理且有效，然而，近年來的研究顯示，肺復張對病人可能是有害的。因此，本篇綜論探討肺復張近年來的演進，及對於“用肺復張打開肺泡”觀點的改變，另外，也探討如何篩選適當的病人，執行肺泡復張術以獲得好處。

關鍵字

肺復張（Recruitment） ； 吐氣末正壓（PEEP） ； 急性呼吸窘迫症候群（Acute respiratory distress syndrome, ARDS）

並列摘要

Alveolar recruitment maneuver could open up the lung and keep the lung open when combined with the best PEEP selection. These methods, which are seemingly rational and effective logistically, are applied to the acute respiratory distress syndrome for dealing with hypoxemia and lung collapse/inhomogeneity. Nevertheless, clinical trials in the recent years revealed the recruitment maneuver might be harmful to the patients. Therefore, this review would discuss the progress of the recruitment maneuver and the changing concept of ＂opening the lungs with recruitment maneuver＂. Moreover, we discuss how to select the ideal patients who would benefit from recruitment maneuver.