摘要
急性呼吸窘迫症候群生理學上的特點有肺臟易於塌陷的自然趨勢。肺泡撐開法(recruitment maneuver)是一個，''''將肺臟打開的策略''''(open lung strategy)聚焦於將肺泡撐開，以改善血氧，於病理，生理學上有其合適的理由。肺泡撐開法有各種不同的臨床技巧，包括連續性呼吸道正壓(continuous positive airway pressure)、間歇性嘆息通氣(intermittent sighs)、壓力控制通氣合併使用逐次增高吐氣末端正壓(PCV + high PEEP)等等。 實驗室或臨床研究應用肺泡撐開法於急性呼吸窘迫症候群有相當分歧的結果。於疾病初期、肺外疾病造成的急性呼吸窘迫、低吐氣末正壓者比較能獲得氧合改善，相反地，高潮氣容積或者高吐氣末正壓比較不傾向於發生原本充氣之肺泡重新塌陷(alveolar derecruitment），因此對肺泡撐開處置可能沒有反應。 本篇評論探討肺泡撐開法的病理生理學基礎，在急性肺損傷(acute lung imjury)的動物實驗的和臨床研究資料，及其不良反應。
並列摘要
The pathobiology of acute respiratory distress syndrome (ARDS) has a natural tendency to collapse. Recruitment maneuver, an 'open lung strategy' focusing on alveolar patency, has its pathophysiologic rationale. Various recruitment maneuvers exist, including sustained inflation to high pressures, intermittent sighs, and stepwise increases in positive end-expiratory pressure (PEEP) or peak inspiratory pressure. Data regarding the use of recruitment maneuvers in patients with ARDS show mixed results, with increased efficacy in those with early stage of ARDS, good compliance of the chest wall, Low PEEP, and in extrapulmonary ARDS. Patients with ARDS who are ventilated with high tidal volumes or high levels of PEEP are less apt to derecruitment and may not exhibit a response to recruiting interventions. In this review we discuss the pathophysiologic basis for the use of recruitment maneuvers, recent evidence in acute lung injury, as well as the adverse event of the technique.
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