雙相氣道正壓通氣於急性呼吸窘迫症候群病患的臨床使用

Clinical Application of Biphasic Positive Airway Pressure/Airway Pressure Release Ventilation on Patients with Acute Respiratory Distress Syndrome

龍芳(Fang Long) ； 邊苗瑛(Mauo-Ying Bien)

《馬偕護理雜誌》 2卷2期 (2008/07) Pp. 7-15

https://doi.org/10.29415/JMKN.200807_2(2).0001

摘要

目前臨床上以去除致病因素為治療急性呼吸窘迫症候群（acute respiratory distress syndrome，ARDS）或急性肺損傷（acute lung injury，ALI），首要方針，而肺保護策略與降低肺傷害併發症也是重要措施。呼吸器的設定與使用已逐漸由正壓通氣（positive pressure ventilation）改為增加自主呼吸（spontaneous breath）為主流之模式，雙相氣道正壓通氣（biphasic positive airway）減少鎮定劑使用、改善氧合及降低氣道壓力，使肺部可獲得充分的復原，以及預防併發症，故已成為急重症呼吸衰竭時重要的通氣模式。由於雙相氣道正壓通氣逐漸受重視，新一代呼吸器皆已具此通氣模式之功能，以達成臨床需求。為此，臨床工作人員除了對於雙相氣道正壓通氣原理與生理影響應有正確認識之外，亦須正確評估與執行最適合的調整，始能獲得最佳療效。本文主要目的是以雙相氣道正壓通氣模式應用於ARDS/ALI病患，其產生的生理效應、對鎮定劑與肌肉鬆弛劑使用影響，以及此通氣模式的臨床應用做綜合討論。

關鍵字

雙相氣道正壓通氣 ； 氣道壓力釋放通氣 ； 自主呼吸

並列摘要

The treatment strategy of acute respiratory distress syndrome (ARDS) or acute lung injury (ALI) is to get rid of the causing factor(s) as well as to offer lung protection aiming at reducing the complications of lung injury. In recent years, addition of spontaneous breath to positive pressure ventilation has become the main stream. Many studies have shown that application of biphasic positive airway pressure ventilation (BIPAP) /Airway Pressure Release Ventilation (APRV) in patients with ARDS can improve ventilation/perfusion ratio, reduce the use of sedative and muscle relaxants, increase oxygenation and decrease mean airway pressure, facilitate the recovery of injured lung, and prevent complications. Therefore, BIPAP is currently considered an important mode in ventilation support to patients with ARDS. The beneficial effects of BIPAP/APRV rendered its availability in new generation of ventilators. In order to meet the clinical demand, clinical staff members should understand the principle and physiologic effects of BIPAP. In addition, to optimize the therapeutic effects the staff members should make proper assessment of the patient and carries out appropriate adjustment. This review article focuses on the application of BIPAP /APRV in ARDS, covering the physiological influence, the effects on sedatives and muscles relaxants, and clinical practice.

並列關鍵字

biphasic positive airway pressure ventilation ； airway pressure release ventilation ； spontaneous breath