氣道壓力釋放通氣模式的生理效應和使用策略

Airway Pressure Release Ventilation in Physical Effect and Clinic Strategies

龍芳(Fang Jung) ； 曾惠筠(Hui-Yun Tseng) ； 楊式興(Shih-Hsing Yang)

《呼吸治療》 15卷2期 (2016/07) Pp. 51-63

https://doi.org/10.6269/JRT.2016.15.2.05

摘要

氣道壓力釋放通氣(airway pressure release ventilation, APRV)是合併正壓通氣(positive-pressure ventilation)與自主呼吸(spontaneous breath)機械通氣模式，在臨床的應用上逐漸受到重視，成為呼吸治療的主要研究議題。近期動物研究認為在肺部損傷是肺部產生不均質病理變化，出現肺泡產生微應變(alveolar micro-strain)，且動態性應變 (dynamic strain)所造成的肺損傷是高於靜態性應變。然而利用APRV之高PEEP和T-low設定75%尖峰吐氣流速(peakexpiratory flow rate; PEFR)之終止，可維持微肺組織氣體均勻分佈並減少呼吸道微應變的發生。臨床研究發現APRV不僅可以對急性呼吸窘迫症候群 (acute respiratory distress syndrome, ARDS)的肺部獲得充分的復原使氧合改善，對呼吸器引發肺損傷(ventilator-induced lung injury，VILI)的預防也有顯著效果，業已成為呼吸衰竭病人合併頑固性低血氧優先選擇的通氣模式。本文接續先前發表的APRV文章，將其在生理效應與臨床應用彙整與討論，同時提供APRV完整的操作策略及調整觀念，有助於提升呼吸治療師在臨床的應用。

關鍵字

氣道壓力釋放通氣模式 ； 急性呼吸窘迫症候群 ； 呼吸器引發肺損傷

並列摘要

Airway pressure release ventilation (APRV) is combined Positive-pressure ventilation with Spontaneous breath ventilation mode and more pay attention to clinical application。In the various modes of mechanical ventilation, the positive pressure with spontaneous breathing model on the clinical application has become the center attention of this research field of respiratory therapy. In the recent studies, Whole lung micro-strain is elevated in humans with lung injury, and it has been suggested that dynamic strain is more injurious than static. However, in an injured lung, APRV high PEEP and T-low setting 75% for termination of peak expiratory flow rate, could maintain the most homogeneous distribution of gas at the micro-anatomic level as well as a reduction in conducting airway micro-strain. The mode of APRV can assist the patient with acute respiratory distress syndrome in the full recovery to improve oxygenation and have the significant effect of preventing ventilator-induced lung injury (VILI), therefore, this mode has become the prior treatment for patients with respiratory failure who suffered from refractory hypoxemia. In this article, our aim is to discuss the main pathophysiological aspects of APRV mode and intend to consider the numbers of research the implementation of APRV in clinic application.

並列關鍵字

Airway pressure release ventilation ； acute respiratory distress syndrome ； ventilator-induced lung injury