【精编医学资料】ARDS肺复张的测定-邱海波.pptx

急性呼吸窘迫综合征肺复张的测定与应用内容提要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(20-30%)肺损伤具有不均一性AandCfindingintheacuteorexudativephase肺容积/顺应性明显降低Reducedrangeofvolumeexcursion:LowcomplianceFlatteningatlowandhighvolumes:LowerandupperinflectionpointsBigatello:BrJAnaest1996UpperandLowerInflectionPoints通气/血流失调ImaginetheHardnesstoBlowupaBallon...SustaininflationSigh小潮气量通气—PHC防止肺泡过度膨胀最佳答案PEEP－防止剪切力(Shearforce)性损害内容提要P－V曲线法P－V曲线法等压法等压法P-V曲线法与等压法的比较肺复张容积测定—P-V曲线法CTmethodCT法--Gattinoni原理充气不良区(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CTmethods:RoubyvsGattinoni内容提要ARDS肺不张的影响因素---附加静水压ARDS下肺气体含量明显降低CTsectionlcated5cmbelowthecarinaNodifferenceswereobservedinthepercentageoflowerlobeslocatedbeneaththeheartintwogroupsCardiacmassandvolumeinARDS心脏下肺叶气体量明显降低ARDS–73%vsNS–21%塌陷肺泡的分布LungmorphologypatternDiffusedistributionARDS肺复张应用内容提要SI前后绵羊复张容积的变化SI有效组绵羊肺气体交换变化潮气量对肺复张的影响小潮气量通气的局限性MeanAirwaypressure5cmH2OMeanAirwaypressure25cmH2OMeanAirwayPressure40cmH2O不同VT的肺复张容积内容提要PEEP效应的影响因素---附加静水压与心脏的影响RothenH.etal.BrJAnaesth1993:71:788-795PEEP诱导recruitment的分布PEEP导致overdistention的分布PEEP效应的影响因素---塌陷肺泡的分布范围Diffuse:EquallossofaerationtotheupperandlowerlobesLocal:LossofaerationpredominatinginlowerlobesEffectofPEEPonrecruitmentandoverdistentionPEEP效应的影响因素---LIP的影响绵羊有无LIP组PEEP复张容积有无LIP患者的复张容积EffectofPEEPonrecruitmentandoverdistentionPEEP-inducedalvrecruitment对象：17例稳定ARDS患者VT=6ml/