- 期刊
呼吸器導致的肺損傷與肺保護性通氣策略
Ventilator-Induced Lung Injury and Lung Protection Strategies during Mechanical Ventilation
摘要
呼吸器如刀之兩刃，可用作病患之呼吸支持，但亦可能引起傷害。臨床證實使用呼吸器，不僅會惡化原已存在的肺實質損傷，呼吸器本身也會引起肺部的傷害。 呼吸器導致之肺損傷(ventilator-induced lung injury, VILI)引起之機轉至今仍未完全被瞭解，目前一般認為與分裂性力量(disruptive forces)產生之剪力(shear force)及異常的分子生物及細胞的反應(aberrant molecular and cellular response)有關。在臨床使用上依其引起傷害之因素，可區分為壓力性傷害(barotrauma),容積性傷害(volutrauma)及生物性傷害(biotrauma)等。 為避免或減少呼吸器導致肺損傷之產生，所採取的肺保護性通氣策略(lung protective ventilation strategies, LPVS)之基本原則為儘可能避免讓肺泡過度擴張(overdistension)及反覆性張合(repetitive opening and collapse)；亦即採取低潮氣容積(low tidal volume)並使用適當之吐氣末正壓(positive end-expiratory pressure, PEEP)以達到上述目標。期使肺泡都儘可能張開並維持其張開(open up the lung and keep the lung open)，以降低使用呼吸器之併發症並增加病患之存活率。
並列摘要
The ventilator can have a positive or negative effect: it can provide ventilatory support for the patient, or induce lung injury. Mechanical ventilation can not only worsen pre-existing lung parenchymal injury, but also initiate lung injury de novo. The mechanisms of ventilator-induced lung injury (VILI) are not completely understood as yet. The possible mechanisms of VILI include shear force resulting from disruptive forces and aberrant molecular and cellular responses. VILI can be categorized clinically as barotrauma, volutrauma, and biotrauma. Lung protection strategies during mechanical ventilition have been applied to avoid VILI. The basic principles include avoiding overdistension and repetitive collapse and re-opening. Low tidal volume and proper positive end-expiratory pressure (PEEP) are recognized as the the best strategies to achieve these goals. The purpose of opening up the lung and keeping the lung open is to decrease the complications of mechanical ventilation and increase the survival rate of patients.
延伸閱讀
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