氣道壓力釋放通氣於燒傷病患運用之經驗

燒傷病患的預後，主要是與皮膚燒傷的面積，以及肺部是否有吸入性傷害是直接相關的。這類病患通常呼吸驅力大，且肺部變化往往也是非常快速的。本患者為一位48歲男性，於兵工場發生閃光彈爆炸，造成50%燒傷及吸入性傷害，入院即使用體外膜氧合器（Extra Corporeal Membrane Oxygenation，ECMO），脫離ECMO後第兩天，發生肺部急遽惡化，雙側嚴重浸潤，呼吸器吸入氧氣分率（Inspired oxygen fraction，FiO2）上調至100%，肺部血痰及血塊極多，因呼吸驅力過大且無法使用鎮靜劑及肌肉鬆弛劑完全抑制，考量病人不適合使用ECMO，也無法使用高頻震盪通氣（High-frequency oscillatory ventilation，HFOV）或壓力控制型反比例通氣（pressure controlled inverse ratio ventilation，PCIRV）來增加病人氧合，因此使用氣道壓力釋放通氣（airway pressure release ventilation，APRV）通氣模式處置，減少鎮靜劑及肌肉鬆弛劑使病人自然呼吸，增進肺部擴張，改善病人通氣與血流灌注比值（ventilation/Perfusion，V/Q），6小時後FiO2即下調至60%，且胸部X光放射圖像改善，雙側浸潤減少。APRV配合病人自然呼吸，以較低之氣道壓力，達成最大量的肺泡回復（recruitment），是成功改善本個案肺部情況之因素，本篇報告旨在探討並了解APRV應用。

關鍵字

氣道壓力釋放通氣；吸入性傷害；肺泡回復

並列摘要

The prognosis of burns patients is mainly directly related to the burn area of their skin and their lung with inhalation injury or not. This kind of patients is usually with larger respiratory demands, and their lung conditions often change quickly.This patient was a forty-eight years old man with inhalation injury and fifty-five percent burn on the body caused in the accident that flash bangs burst in the arsenal .He was on ECMO (Extra Corporeal Membrane Oxygenation) after addmitted to the hospital. After having weaned from ECMO, his lung condition was exacerbating sharply in two days. There were severe bilateral infiltration, bleeding and a large amount of sputum with blood in his lung, so we adjusted FiO2 (Inspired oxygen fraction) of the ventilator up to 100%.On the other hand, his respiratory demands were too large to be sedated with sedatives and muscle relaxants. We considered ECMO (Extra Corporeal Membrane Oxygenation) wasn't applicable to him to improve his saturation, nor were HFOV (High-frequency oscillatory ventilation) and PCIRV (pressure controlled inverse ratio ventilation). Thus, we chose APRV (airway pressure release ventilation) and reduced the doses of the sedatives for allowing patient to spontaneously breath, advance lung expansion and improve the balance between ventilation and perfusion (ventilation/ Perfusion, V/Q). Then, the level of FiO2 was decreased to sixty percent in six hours, and his chest X-Ray image showed less bilateral infiltration.Permitting spontaneously breathing and lowering airway pressure to achieve the maximum of alveolar recruitment with lower airway pressure was the main reasons is that APRV succeeded in improving the lung condition of this case. The purpose of the report is to discuss the application of APRV.

並列關鍵字

Airway pressure release ventilation ； Inhalation injury ； Recruitment

國際替代計量

氣道壓力釋放通氣於燒傷病患運用之經驗

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