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1、有創(chuàng)機(jī)械通氣臨床應(yīng)用進(jìn)展2乙胺碘呋酮致ARDS2021/8/293國內(nèi)首例MDS繼發(fā)PAP4胸腺瘤合并免疫缺陷疾病Good’ssyndrome5丙基硫氧嘧啶相關(guān)血管炎繼發(fā)肺泡出血綜合征6細(xì)支氣管肺泡癌（IV期）7雙側(cè)肺動(dòng)脈主干栓塞2021/8/298橋腦（呼吸調(diào)整中樞和長吸中樞）延髓（節(jié)律呼吸控制中樞）大腦皮層（隨意呼吸控制中樞）脊髓（神經(jīng)信息傳導(dǎo)與反饋通道）呼吸系統(tǒng)循環(huán)系統(tǒng)通過氣血屏障進(jìn)行氣體交換，排出二氧化碳，進(jìn)行氧合吸入氧，排出二氧化碳Mortalityratesofsevererespiratoryfailurepatientsduringthepastyears9AnnInter
2、nMed.2004;140(5):338-345正壓機(jī)械通氣的目的正壓機(jī)械通氣能夠解決肺的通氣和部分換氣功能能夠有效改善和維持最適氧合和促進(jìn)二氧化碳排出，維持生命支持的氧的需要，為疾病的恢復(fù)贏得時(shí)機(jī)在進(jìn)行正壓機(jī)械通氣的同時(shí)，應(yīng)采取有效的措施盡量減小機(jī)械通氣相關(guān)副作用1011機(jī)械通氣為正壓通氣，與人體正常情況下的負(fù)壓呼吸相違背，因而也可產(chǎn)生多種與機(jī)械通氣的相關(guān)并發(fā)癥出血性肺損傷Biotrauma氣胸氧中毒正壓機(jī)械通氣的并發(fā)癥12呼吸機(jī)所致肺損傷(Ventilatorinducedlunginjury,VILI)ConceptofVILI機(jī)械通氣患者機(jī)械通氣過程中出現(xiàn)肺泡的反復(fù)萎陷/復(fù)張和/或
3、肺的過度膨脹而繼發(fā)的肺實(shí)質(zhì)損傷肺的基礎(chǔ)疾病會(huì)增加發(fā)生VILI的幾率，尤其是ARDS/ALI患者RespirCare.2005;50(5):64913HistoryofVILI從基礎(chǔ)到臨床IntensiveCareMed.2006;32:24–3314RiskfactorsofVILIBabylung:The“babylung”conceptoriginatedasanoffspringofcomputedtomographyexaminationswhichshowedinmostpatientswithALI/ARDSthatthenormallyaeratedtissuehasthed
4、imensionsofthelungofa5-to6-year-oldchildB:babylungBrJAnaesth2004;92:261-702021/8/2915IntensiveCritCareNurs.2004;20:358—36516IncreasedVolume(lung-stretch)-grossbarotrauma-diffusealveolardamageAggravatingLungInjuryFactorsDecreasedLungVolumes-effectsonsurfactant-recruitment/de-recruitment17RespirCare
5、.2005;50(5):64918BiologicalmarkersofVILICHEST2006;130:1906–1914PBEF:pre–B-cellcolonyenhancingfactorsTNFR:solubletumornecrosisfactorreceptor2021/8/2919Largetidalvolume:Volutrauma1HighplateauPressure:Barotrauma2Lowendexpiratorypressure:Atelectrauma3AlveolarShearStress:Biotrauma4RiskfactorsofVILIAcut
6、eRespiratoryFailureClassificationALI/ARDSNonALI/ARDS:AECOPD,Asthma,Acutecardiogenicpulmonaryedema,pulmonaryfibrosis,pulmonaryembolism,………202021/8/2921RespirCare.2001;46(2):130-148LowtidalvolumeventilationShouldTidalVolumeBe6mL/kgPredictedBodyWeightinVirtuallyAllPatientsWithAcuteRespiratoryFailure?
7、2021/8/2922CritCareMed.2008;36:296–327Lowtidalvolumeventilation:ALI/ARDS23Lowtidalvolumeventilation:ALI/ARDS24ARDSNet.NEngJMed2000;342:1301-1308.Lowtidalvolumeventilation:ALI/ARDS2021/8/2925Mortality*-Lowvs.Tradi
