急性呼吸窘迫症候群病患之呼吸器吐氣末陽壓及潮氣容積之設定－一個持續爭論的議題

Positive End-expiratory Pressure and Tidal Volume in the Acute Respiratory Distress Syndrome-A Continuous Controversy

曲長科(Chang-Ke Chu) ； 陳昌文(Chang-Wen Chen)

《內科學誌》 20卷3期 (2009/06) Pp. 197-202

https://doi.org/10.6314/JIMT.2009.20(3).01

摘要

急性肺傷害(acute lung injury)/急性呼吸窘迫症候群(acute respiratory distress syndrome)是加護病房常見之病症。呼吸器對此類病患而言是一個救命的工具，但也可能引發進一步的肺部傷害（即呼吸器引發之肺傷害，ventilator-induced lung injury）。其中吐氣末陽壓(positive end-expiratory pressure, PEEP)及潮氣容積(tidal volume, V(下标 T))之設定猶如一把雙面刃。一方面它可改善病患之氧合狀態；另一方面又可能造成肺泡過度擴張引發壓力性創傷(barotrauma)，容積性創傷（volutrauma）及生物性創傷（biotrauma）。眾所週知，較低的潮氣容積及較大的吐氣末陽壓對病人預後可能較為有利，但對個別病患而言，同樣的設定卻會導致不同的結果，亦即每個病患的安全範圍不盡相同。如何針對個別病患達到最理想之設定正考驗著臨床醫師。“嬰兒肺”(baby lung)的觀念有助於我們對個別病患做出更適當，更安全的呼吸器設定。

關鍵字

急性呼吸窘迫症狀群 ； 嬰兒肺 ； 吐氣末陽壓 ； 壓力指數 ； 呼吸器引發之肺傷害 ； 保護性換氣策略

並列摘要

Acute lung injury/acute respiratory distress syndrome is a common condition encountered in the intensive care units. Mechanical ventilator is a life-saving tool for these patients, but it also can induce further unwished lung injury. The setting of the positive end-expiratory pressure (PEEP) and tidal volume is like a two-face sword. It can improve the oxygenation status, but on the other hand, it may also induce barotrauma, volutrauma and biotrauma. It was well-known that the lower tidal volume and higher PEEP may be helpful for patients with ARDS. But the same setting for different patients will induce opposite results. That means the safe area for each patient is not the same. To achieve the best setting for each patient is a challenge for the physicians. The concept of the ＜||＞baby lung＜||＞ help us to set the ventilator more safely and adequately.

並列關鍵字

Acute respiratory distress syndrome ； Baby lung ； Positive end-expiratory pressure ； Stress index ； Ventilator-induced lung injury ； Protective-ventilation strategy