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1、有創(chuàng)機械通氣臨床應用進展2乙胺碘呋酮致ARDS2021/8/293國內首例MDS繼發(fā)PAP4胸腺瘤合并免疫缺陷疾病Good’ssyndrome5丙基硫氧嘧啶相關血管炎繼發(fā)肺泡出血綜合征6細支氣管肺泡癌（IV期）7雙側肺動脈主干栓塞2021/8/298橋腦（呼吸調整中樞和長吸中樞）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（神經信息傳導與反饋通道）呼吸系統(tǒng)循環(huán)系統(tǒng)通過氣血屏障進行氣體交換，排出二氧化碳，進行氧合吸入氧，排出二氧化碳Mortalityratesofsevererespiratoryfailurepatientsduringthepastyears9AnnInter
2、nMed.2004;140(5):338-345正壓機械通氣的目的正壓機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二氧化碳排出，維持生命支持的氧的需要，為疾病的恢復贏得時機在進行正壓機械通氣的同時，應采取有效的措施盡量減小機械通氣相關副作用1011機械通氣為正壓通氣，與人體正常情況下的負壓呼吸相違背，因而也可產生多種與機械通氣的相關并發(fā)癥出血性肺損傷Biotrauma氣胸氧中毒正壓機械通氣的并發(fā)癥12呼吸機所致肺損傷(Ventilatorinducedlunginjury,VILI)ConceptofVILI機械通氣患者機械通氣過程中出現(xiàn)肺泡的反復萎陷/復張和/或
3、肺的過度膨脹而繼發(fā)的肺實質損傷肺的基礎疾病會增加發(fā)生VILI的幾率，尤其是ARDS/ALI患者RespirCare.2005;50(5):64913HistoryofVILI從基礎到臨床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
