最新精编医学专题—ARDS肺复张的测定-邱海波.ppt

急性呼吸窘迫综合征肺复张的测定(cèdìng)与应用第二页共八十八页。第三页共八十八页。内容提要(nèirónɡtíyào)Lungvolumedecreasedmarkedly(TLCVCTVFRC)---alveolaredema---pulmonarysurfactant---InterstitialpumonaryedemadepressbrochioleandinducespasmCompliancereducedsignificantlyVentilation/perfusionmismatch---intrapulmonaryshuntanddeadspacelikeeffectsCTscan70-80%的肺野呈现高密度区分布：下垂部位(dependentfield)提示：参与通气肺泡明显减少(jiǎnshǎo)(20-30%)肺损伤具有不均一性AandCfindingintheacuteorexudativephase肺容积(róngjī)/顺应性明显降低Reducedrangeofvolumeexcursion:LowcomplianceFlatteningatlowandhighvolumes:LowerandupperinflectionpointsBigatello:BrJAnaest1996UpperandLowerInflectionPoints通气(tōngqì)/血流失调ImaginetheHardnesstoBlowupaBallon...SustaininflationSigh小潮气量通气—PHC防止肺泡过度膨胀最正确(zuìjiā)PEEP－防止剪切力(Shearforce)性损害内容提要(nèirónɡtíyào)P－V曲线(qūxiàn)法P－V曲线(qūxiàn)法等压法等压法P-V曲线(qūxiàn)法与等压法的比较肺复张容积(róngjī)测定—P-V曲线法CTmethodCT法--Gattinoni原理充气(chōnɡqì)不良区(100Hu~500Hu)、正常充气区(500Hu~900Hu)、无充气区(100Hu~+100Hu)和过度充气区(900Hu~1000Hu)。肺泡复张充气不良和正常充气肺区体积增加方法ZEEP和PEEP呼气末螺旋CT根据层面厚度计算不同CT值肺体积肺复张后充气不良与正常充气肺组织体积增加值Gattinoni’svsRouby’sCT法比较(bǐjiào)CTmethods:RoubyvsGattinoni内容提要(nèirónɡtíyào)ARDS肺不张的影响(yǐngxiǎng)因素---附加静水压ARDS下肺气体(qìtǐ)含量明显降低CTsectionlcated5cmbelowthecarinaNodifferenceswereobservedinthepercentageoflowerlobeslocatedbeneaththeheartintwogroupsCardiacmassandvolumeinARDS心脏下肺叶(fèiyè)气体量明显降低ARDS–73%vsNS–21%塌陷(tāxiàn)肺泡的分布LungmorphologypatternDiffusedistributionARDS肺复张应用(yìngyòng)内容提要(nèirónɡtíyào)SI前后绵羊(miányáng)复张容积的变化SI有效组绵羊肺气体(qìtǐ)交换变化潮气量对肺复张的影响(yǐngxiǎng)小潮气量通气(tōngqì)的局限性MeanAirwaypressure5cmH2OMeanAirwaypressure25cmH2OMeanAirwayPressure40cmH2O不同(bùtónɡ)VT的肺复张容积内容提要(nèirónɡtíyào)PEEP效应的影响因素(yīnsù)---附加静水压与心脏的影响RothenH.etal.BrJAnaesth1993:71:788-795PEEP诱导(yòudǎo)recruitment的分布PEEP导致(dǎozhì)overdistention的分布PEEP效应的影响因素---塌陷肺泡的分布(fēnbù