肺复张对急性呼吸窘迫综合征的疗效观察

目的 观察肺复张对急性呼吸窘迫综合征(ARDS)患者的治疗效果.方法 观察7例符合美国/欧洲危重症学会诊断标准ARDS早期患者,应用压力控制型呼吸机,在吸氧体积分数为100％条件下,监测血流动力学参数及血管外肺水指数(EVLWI).肺复张开始时将呼吸机模式调整为压力控制,吸气压力(Pi) =24 cm H2O(1cmH2O=0.0981 kPa),呼气末正压(PEEP)10cm H2O,f=50,吸呼比为5∶1.此后,先将PEEP上调至24 cm H2O,Pi上调至45 cm H2O,维持3次吸气再将Pi下调至30 cm H2O,立即查动脉血气.如果PaO2＜450mmHg (1mmHg=0.133kPa),在上次压力的基础上增加5 cm H2O,直到PaO2＞ 450 mm Hg,认为复张成功.随后,逐渐以2 cm H2O下调PEEP,每次下调后再重复上述步骤,直到PEEP到达某数值时PaO2＜ 350 mm Hg,在此PEEP上增加2 cm H2O则认为是最佳PEEP.保持气道压力不少于4h,监测复张前后血气指标以及血液动力学指标并进行比较.如果复张过程中血液动力学不稳定则立即停止复张.结果 方差分析结果表明:6位患者复张后4 h PaO2较基础明显增加(P＜0.01),PEEP比基础状态明显升高(P＜0.01),EVLWI则显著降低(P＜0.01).1位患者因血液动力学不稳而终止复张.7位患者均未出现复张相关并发症,并且6位患者治愈.结论 应用肺复张治疗ARDS是安全有效的.     

肺复张对急性呼吸窘迫综合征患者血管外肺水的影响

目的 探讨肺复张(RM)策略对急性呼吸窘迫综合征(ARDS)患者血管外肺水(EVLW)的影响.方法 采用随机对照病例研究方法,将20例ARDS患者随机分为RM组和对照组.按肺保护性通气策略的原则给患者进行机械通气;用双水平气道正压(BIPAP)通气模式进行RM,每8 h重复1次,连续7 d或至脱机前;除RM外,其余治疗两组相同.记录患者的基线资料和每日RM结束后的EVLW、血管外肺水指数(EVLWI)、呼吸力学参数、氧合指数(PaO2/FiO2)、中心静脉压(CVP)、血浆胶体渗透压(COP)以及糖皮质激素、肾上腺素能药物用量和24 h液体出入量平衡等影响EVLW各因素的数值.结果 RM组和对照组EVLW、EVLWI随时间延长呈逐渐降低趋势,但两组间比较差异无统计学意义(P均>0.05).两组间CVP、COP和去甲肾上腺素、氢化可的松用量比较差异均无统计学意义(P均>0.05);RM组多巴胺用量在4 d时明显少于对照组(P<0.05);液体出入量平衡RM组7 d时为负平衡,对照组则为正平衡(P<0.05).RM组平均气道压(Pmean)的均值[(18.8±3.2)cm H2O(1 cm H2O=0.098 kPa)]和肺准静态顺应性(Cstat)的均值[(36.5±14.5)ml/cm H2O]均明显高于对照组[(16.6±3.9)cm H2O和(29.3±12.0)ml/cm H2O,P均<0.05];其中RM组5 d时Cstat大于2 d和3 d时(P均<0.05).两组间PaO2/FiO2比较则未见明显差异(P均>0.05).结论 针对ARDS患者实施的RM治疗并没有明显影响EVLW,而仅起到了改善肺呼吸力学特征的作用.本研究中所涉及的影响肺水的因素并未影响肺水的形成和清除.     

Lung recruitment maneuver effects on respiratory mechanics and extravascular lung water index in patients with acute respiratory distress syndrome

BACKGROUND:

Animal experiments showed that recruitment maneuver (RM) and protective ventilation strategy of the lung could improve oxygenation and reduce extravascular lung water. This study was to investigate the effects of RM on respiratory mechanics and extravascular lung water index (EVLWI) in patients with acute respiratory distress syndrome (ARDS).

METHODS:

Thirty patients with ARDS were randomized into a RM group and a non-RM group. In the RM group, after basic mechanical ventilation stabilized for 30 minutes, RM was performed and repeated once every 12 hours for 3 days. In the non-RM group, lung protective strategy was conducted without RM. Oxygenation index (PaO₂/FiO₂), peak inspiratory pressure (PIP), Plateau pressure (Pplat), static pulmonary compliance (Cst) and EVLWI of patients before treatment and at 12, 24, 48, 72 hours after the treatment were measured and compared between the groups. Hemodynamic changes were observed before and after RM. One-way ANOVA, Student''s t test and Fisher''s exact test were used to process the data.

RESULTS:

The levels of PaO₂/FiO₂ and Cst increased after treatment in the two groups, but they were higher in the RM group than in the non-RM group (P<0.05). The PIP and Pplat decreased after treatment in the two groups, but they were lower in the RM group than in the non-RM group (P<0.05). The EVLWI in the two groups showed downward trend after treatment (P<0.05), and the differences were signifcant at all time points (P<0.01); the EVLWI in the RM group was lower than that in the non-RM group at 12, 24, 48 and 72 hours (P<0.05 or P<0.01). Compared with pre-RM, hemodynamics changes during RM were significantly different (P<0.01); compared with pre-RM, the changes were not significantly different at 120 seconds after the end of RM (P>0.05).

CONCLUSIONS:

RM could reduce EVLWI, increase oxygenation and lung compliance. The effect of RM on hemodynamics was transient.KEY WORDS: Lung recruitment maneuver, Acute respiratory distress syndrome, Respiratory mechanics, Extravascular lung water index, Hemodynamics, Lung protective ventilation, Oxygenation index     

肺复张策略在全麻术后发生急性呼吸窘迫综合征肥胖患者中的应用

目的 探讨在全麻术后发生急性呼吸窘迫综合征(ARDS)肥胖患者中应用肺复张法(LRM)治疗对氧合、呼吸力学参数及预后的影响.方法 选取我院ICU 2005-01～2008-04收治的外科全麻术后发生ARDS的肥胖患者32例,随机分为对照组(n=14)和肺复张组(n=18),两组基本通气模式均采用双相气道正压通气(BiPAP);复张方法:BiPAP模式下将高压与低压均调为30～40 cm H2O,维持20～50 s完成肺复张.分别观察两组患者动脉血气分析、呼吸力学参数和预后指标,比较两组上述参数的差异.结果 复张组氧合指数与对照组比较从12 h起开始有明显改善,差异有统计学意义(P＜0.05),24、72 h也均维持在较高数值.对照组氧合指数改善的时间较晚达72 h.对照组存在CO2的轻度潴留,复张组无明显的CO2潴留.呼吸力学指标改变各组间差异无统计学意义(P＞0.05).两组间28 d病死率差异无统计学意义(P＞0.05).复张组机械通气时间和住ICU时间较对照组明显缩短(P＜0.05).结论 LRM可以显著改善全麻术后发生ARDS肥胖患者的氧合,较早开放萎陷的肺泡,明显缩短机械通气时间和住ICU时间.     

Mechanistic scheme and effect of "extended sigh" as a recruitment maneuver in patients with acute respiratory distress syndrome: a preliminary study

OBJECTIVE: To devise a new form of sigh ("extended sigh") capable of providing a sufficient recruiting pressure x time, and to test it as a recruitment maneuver in patients with acute respiratory distress syndrome. DESIGN: Prospective uncontrolled clinical trial. SETTING: Medical intensive care unit of a university-affiliated hospital. PATIENTS: Twenty consecutive patients diagnosed with acute respiratory distress syndrome (18 men, 2 women, age 59 +/- 10 yrs). INTERVENTIONS: From baseline settings of tidal volume (Vt) 8 mL/kg and positive end-expiratory pressure (PEEP) 10 cm H2O on volume control mode with the high pressure limit at 40 cm H2O, the Vt-PEEP values were changed to 6-15, 4-20, and 2-25, each step being 30 secs (inflation phase). After Vt-PEEP 2-25, the mode was switched to continuous positive airway pressure of 30 cm H2O for a duration of 30 secs (pause), after which the baseline setting was resumed following the reverse sequence of inflation (deflation phase). This extended sigh was performed twice with 1 min of baseline ventilation between. MEASUREMENTS AND RESULTS: Airway pressures and hemodynamic parameters were traced at each step during the extended sigh. Arterial blood gases and physiologic parameters were determined before the extended sigh (pre-extended sigh), at 5 mins after two extended sighs (post-extended sigh), and then every 15 mins for 1 hr. In our average patient, the recruiting pressure x time of the inflation phase was estimated to be 32.8-35.4 cm H2O x 90 secs. Compared with the inflation phase, inspiratory pause pressure of the deflation phase was lower at Vt-PEEP 6-15 (28.9 +/- 2.7 cm H2O vs. 27.3 +/- 2.8 cm H2O) and 4-20 (31.8 +/- 2.9 cm H2O vs. 31.1 +/- 2.9 cm H2O; both p <.05). Compared with pre-extended sigh, Pao2 (81.5 +/- 15.3 mm Hg vs. 104.8 +/- 25.0 mm Hg; p <.001) and static respiratory compliance both increased post-extended sigh (27.9 +/- 7.9 mL/cm H2O vs. 30.2 +/- 9.7 mL/cm H2O; p =.009). Improvement in these parameters was sustained above pre-extended sigh for the duration of the study. Major hemodynamic or respiratory complications were not noted during the study. CONCLUSION: We present a new form of sigh (i.e., extended sigh) capable of achieving an augmented recruiting pressure x time through a prolonged inflation on a gradually increased end-expiratory pressure. In view of the sustained effect and absence of major complications in our patients, extended sigh could be a useful recruitment maneuver in acute respiratory distress syndrome.     

Alveolar recruitment maneuver in patients with subarachnoid hemorrhage and acute respiratory distress syndrome: A comparison of 2 approaches

Purpose

The purpose of the study was to compare 2 alveolar recruitment maneuvers (ARMs) approaches in patients with subarachnoid hemorrhage (SAH) and acute respiratory distress syndrome (ARDS).

Material and Methods

Sixteen SAH patients with ARDS were randomized in 2 similar groups. One received ARM with continuous positive airway pressure (CPAP) of 35 cm H₂O for 40 seconds (CPAP recruitment), whereas the other received pressure control ventilation with positive-end expiratory pressure of 15 cm H₂O and pressure control above positive end-expiratory pressure of 35 cm H₂O for 2 minutes (pressure control recruitment maneuver [PCRM]). Intracranial pressure (ICP) and cerebral perfusion pressure (CPP) were measured before and after ARM. The ratio of arterial oxygen tension to fraction of inspired oxygen was measured before and 1 hour after the ARM.

Results

After ARM, ICP was higher in CPAP recruitment (20.50 ± 4.75 vs 13.13 ± 3.56 mm Hg; P = .003); and CPP was lower in CPAP recruitment (62.38 ± 9.81 vs 79.60 ± 6.8 mm Hg; P = .001). One hour after the ARM, the ratio of arterial oxygen tension to fraction of inspired oxygen increased significantly only in PCRM (108.5 to 203.6; P = .0078).

Conclusion

In SAH patients with ARDS, PCRM did not affect ICP and decreased CPP in safe levels, besides improving oxygenation.     

俯卧位通气加肺复张对急性呼吸窘迫综合征的作用

目的 评价俯卧位通气(PPV)联合肺复张(RM)对急性呼吸窘迫综合征(ARDS)犬的肺保护作用及机制.方法 经股静脉快速注入油酸建立犬ARDS模型,容积控制通气,在小潮气量(VT,10 ml/kg)+高呼气末正压(PEEP,16 cm H2O,1 cm H2O=0.098 kPa)通气基础上,按随机数字表法分为仰卧位组、俯卧位组、仰卧+RM组、俯卧+RM组,每组6只.测定通气后0.5、2和4 h血清细胞因子.4 h后经股动脉放血处死动物,开胸取肺;取左肺组织制备匀浆,测定细胞因子;取右肺测定湿/干重(W/D)比值及制备病理切片,行病理评分.结果 ①通气4 h时仰卧+RM组血清白细胞介素-8(IL-8)浓度明显高于其他3组(P均<0.05),且仰卧+RM组血清肿瘤坏死因子-α(TNF-α)浓度明显高于俯卧位组及俯卧+RM组(P均<0.05).②俯卧位组及俯卧+RM组背侧肺组织匀浆中IL-8浓度明显低于仰卧位组(P均<0.05),TNF-α浓度明显低于仰卧+RM组(P均<0.05).③俯卧位组、俯卧+RM组右肺W/D比值明显低于仰卧位组及仰卧+RM组(P均<0.05).④俯卧位组及俯卧+RM组背侧病理评分显著低于仰卧位组及仰卧+RM组(P均<0.05).结论 在犬ARDS模型中,予以小VT+PEEP的肺保护性通气时,在俯卧位实施RM可以减轻肺损伤.     

肺复张手法和肺开放策略在肺内型成人呼吸窘迫综合征中的临床观察:附6例报告

目的 观察肺复张手法(RM)和肺开放策略(OLA)在肺内型成人呼吸窘迫综合征(ARDS)机械通气患者中应用的有效性和安全性.方法 肺内型ARDS患者6例,按需进行RM(30～35cm H2O,30～40s),中等PEEP[(12.1±2.0 cm H2O)]保持开放.记录RM前后的最低和最高指尖氧饱和度(SO2,脉氧计)、动脉血气.结果 SO2于复张后(3.7±2.0)min开始上升,(86.1±89.0)min升至较为稳定的高水平,在中等PEEP水平下维持＞5h,并显著改善患者SO2;复张前(88±5)%与复张后(97±2)%比较,差异有统计学意义(P=0.000).结论 单次肺复张手法和肺开放策略在短期内可迅速、安全、有效改善有基础肺疾病的(严重肺气肿、肺大疱除外)肺内型ARDS患者的SO2,并维持于较高水平.     

Increased plasma levels of heparin-binding protein in patients with acute respiratory distress syndrome

Introduction

Heparin-binding protein (HBP) is an antimicrobial protein stored in neutrophil granules and plays a role in endothelial permeability regulation. The aim was to assess the diagnostic and prognostic value of measuring HBP in patients with acute lung injury (ALI)/acute respiratory distress syndrome (ARDS).

Methods

Plasma HBP was collected from 78 patients with ALI/ARDS, 28 patients with cardiogenic pulmonary edema (CPE) and 20 healthy volunteers at enrollment. Levels of HBP were measured by ELISA.

Results

Patients with ALI/ARDS had significantly higher median levels of HBP compared with patients with CPE (17.15 (11.95 to 24.07) ng/ml vs. 9.50 (7.98 to 12.18) ng/ml, P <0.001) at enrollment. There was no significant difference between CPE patients and healthy subjects in terms of HBP value (P = 0.372). The HBP levels of nonsurvivors was significantly higher than that of survivors (23.90 (14.81 to 32.45) ng/ml vs. 16.01 (10.97 to 21.06) ng/ml, P = 0.012) and multivariate logistic regression showed HBP (odds ratio =1.52, P = 0.034) was the independent predictor for 30-day mortality in patients with ALI/ARDS.

Conclusions

Plasma HBP levels of ALI/ARDS patients were significantly higher than that of CPE patients. HBP was a strong prognostic marker for short-term mortality in ALI/ARDS.     

60例急性呼吸窘迫综合征患者应用肺复张策略治疗的护理

目的 探讨呼气末正压递增法肺复张策略在急性呼吸窘迫综合征中的应用与护理.方法 选择急性呼吸窘迫综合征患者60例,在进行肺复张策略前后,观察患者的氧饱和度(SpO2)、氧合指数、肺静态顺应性、平台压的变化.结果 患者应用肺复张策略后,SpO2、氧合指数、肺静态顺应性明显增加,平台压进行性降低,差异有统计学意义(P<0.05).结论 肺复张策略能充分复张塌陷肺泡,改善气体交换,增加氧合及肺的顺应性,并且降低气道压等.     

肺复张对急性呼吸窘迫综合征患者开放吸痰后氧合及血流动力学的影响

目的研究肺复张（LR）对急性呼吸窘迫综合征（ARDS）患者开放吸痰（ETS）后的治疗价值。方法选择20例需要机械通气的ARDS／急性肺损伤（ALI）患者，在标准通气稳定30min后按流程随机分组。ETs＋LR组在ETs后立即实施LR，60min后行第2次ETS，但不实施LR；ETS—LR组在ETS后不实施LR，60min后行第2次ETS，并立即实施LR。监测实验过程中各时间点的动脉血氧分压（PaO2）及血流动力学参数，如中心静脉压（CVP）、心率（HR）、平均动脉压（MAP）。结果所有患者血流动力学参数基本稳定，无心律失常发生。患者实施ETS后PaO2显著下降，ETS前后比较差异有显著性（P均〈0．05）；ETS后实施与不实施LR比较，在5和15min时PaO2差异有显著性（P均〈0．05）。结论ARDS／ALI患者在ETS后立即予以LR，患者可以耐受，其血流动力学未受到显著干扰，且可以迅速改善低氧血症。     

急性呼吸窘迫综合征肺复张策略的研究进展

急性呼吸窘迫综合征（acute respiratory distress syndrome，ARDS）的概念是由Ashbaugh等于1967年首次提出的，以非心源性肺水肿、呼吸窘迫和难治性低氧血症为其主要临床特征，当时称之为成人呼吸窘迫综合征（adult respiratory distress syndrome）。后来人们逐渐认识到，ARDS是急性肺损伤（acute lung injury，ALI）的终末阶段，是由各种原因所致急性肺部损伤所引发的呼吸衰竭，于是美国胸科医师学会和欧洲危重病学会分别于1992年5月和10月将成人呼吸窘迫综合征更名为急性呼吸窘迫综合征。     

密闭式吸痰结合高氧法和/或肺泡复张术对ARDS小猪心率、血压的影响

目的探讨高氧法和/或肺泡复张术在密闭式吸痰时对急性呼吸窘迫综合征(ARDS)小猪心率、血压的影响。方法16只小猪给予清洁剂(1.370±0.637)mg/kg气管注入制作ARDS模型。随机将模型猪分为呼气末正压(PEEP)5cmH2O和10cmH2O2组,每组8只。每只小猪按随机顺序分别采用单纯法、高氧法、复张法、结合法4种密闭式吸痰法吸痰,观察各组吸痰前1min心率、血压的变化,分别与吸痰后1,3,5,10min的结果进行比较。结果在PEEP5cmH2O组,4种方法吸痰后1min,ARDS小猪收缩压(SBp)均下降(P<0.05),单纯密闭式吸痰法在吸痰后10minSBp仍低于吸痰前基线水平(P<0.05);在PEEP10cmH2O组,4种方法吸痰后SBp也均下降,但与吸痰前基线水平比较差异无统计学意义(P>0.05)。各种方法在吸痰前后ARDS小猪心率及舒张压变化无统计学意义。结论不论在PEEP5cmH2O还是10cmH2O水平,各种密闭式吸痰方法对ARDS小猪心率、血压的影响趋势均一致,都可引起血压下降,PEEP5cmH2O时所引起的血压下降持续时间较长,因此,吸痰时更需要采取有效辅助措施以逆转对机体的不利影响。     

肺复张治疗肺外源性急性呼吸窘迫综合征的效果评价

目的 观察肺复张对肺外源性急性呼吸窘迫综合征(ARDS)患者氧合指数[氧分压(PaO2)/吸入氧气浓度(FiO2)]、呼吸力学及血流动力学的影响.方法 14例肺外源性ARDS患者行保护性肺通气,稳定后开始肺复张治疗.实施控制性肺膨胀(SI)进行肺复张,每8小时进行1次,共3天,纪录每天第1次患者治疗前及治疗后1小时的血气指标、呼吸机参数及肺复张前后的血流动力学指标.结果 1、2、3天肺复张治疗后1小时患者PaO2/FiO2较治疗前均有上升,(162.6±19.80)mmHg vs(220.93±34.10)mmHg,(195.6±24.40) mmHg vs (243.3±34.60)mmHg,(222.57±27.40) mmHg vs(254.71±38.90)mmHg(P＜0.05或＜0.0l);气道峰压[PIP:(35.64±2.71)cmH2O vs(34.07±2.58)cmH2O,(32.86±3.30)cmH2O vs(30.93±3.15)cmH2O,(30.14±2.66)cmH2O vs (28.07±3.27)cmH2O,P＜0.01]、气道平台压[Pplat:(31.29±2.49)cmH2O vs (28.93±2.63) cmH2O,(28.79±3.02) cmH2O vs(26.86±3.13)cmH2O,(25.71±2.09)cmH2O vs(23.57±2.34)cmH2O,P＜0.01]在肺复张治疗后均下降,呼吸系统静态顺应性(Cst)在肺复张治疗后改善,且整体呈升高趋势[(26.21±3.26)ml/cmH2O vs (30.14±3.70) ml/cmH2O,(29.36±4.25) ml/cmH2O vs (33.64±5.30) ml/cmH2O,(32.14±5.05) ml/cmH2O vs (35.57±5.57)ml/cmH2O,P＜0.01)];14例患者中有9例在肺复张过程中心率升高、血压下降,但均能于复张后3分钟恢复至复张前水平,余患者肺复张过程中心率、血压未见明显波动,14例患者均无心律失常发生.结论 对于肺外源性ARDS,肺复张可明显改善氧合,改善呼吸系统顺应性,对血流动力学影响轻徽.     

无创正压通气治疗急性呼吸窘迫综合征的前瞻性队列研究

目的 观察和评价无创正压通气(NPPV)对急性呼吸窘迫综合征(ARDS)的疗效和安全性.方法 采用前瞻性队列研究,分析2004年1月-2007年12月北京朝阳医院呼吸重症监护病房(RICU)使用NPPV治疗ARDS患者的临床资料.结果 ①31例患者纳入本研究,其中男23例,女8例;年龄20～76岁,平均(49±17)岁;NPPV前急性生理学与慢性健康状况评分系统Ⅰ(APACHE Ⅰ)评分(14±8)分,氧合指数(PaO2/FiO2)(123±32)mm Hg(1 mm Hg=0.133 kPa).②NPPV成功率为74.2%(23/31),非肺部感染所致ARDS的成功率显著高于肺部感染所致ARDS(100%比60%,P=0.017).③与NPPV前相比,成功组NPPV治疗后2 h及24 h的心率(HR)、呼吸频率(RR)及PaO2/FiO2均有显著改善(P均<0.01),而失败组上述指标不但无显著改善,尚伴有动脉血二氧化碳分压(PaCO2)逐渐升高(P<0.05).患者均无NPPV相关的严重并发症.结论 对于无NPPV禁忌的ARDS患者,NPPV可作为一线呼吸支持手段;但对于在短期应用NPPV后生命体征及动脉血气无显著改善者,尤其是肺部感染诱发ARDS时应及早改为有创通气.     

Lung sonography and recruitment in patients with early acute respiratory distress syndrome: A pilot study

Introduction  

Bedside lung sonography is a useful imaging tool to assess lung aeration in critically ill patients. The purpose of this study was to evaluate the role of lung sonography in estimating the nonaerated area changes in the dependent lung regions during a positive end-expiratory pressure (PEEP) trial of patients with early acute respiratory distress syndrome (ARDS).     

小潮气量通气加肺复张法对急性呼吸窘迫综合征疗效的影响

目的在小潮气量（VT）机械通气的基础上．观察应用肺复张法（RM）治疗急性呼吸窘迫综合征（ARDS）的临床疗效，为临床RM的使用提供依据。方法选择2003年1月-2004年3月北京复兴医院重症监护治疗病房（ICU）收治的28例ARDS患者，随机分为小VT＋RM组（RM组）和小VT组（non—RM组）。第一个24h采用容量控制通气（CMV）．24h后根据病情选择机械通气方式。VT 6ml／kg；尽可能在吸入氧浓度（FiO2）〈0．60时达目标氧合的最小呼气末正压（PEEP）水平，限制平台压≤30cm H2O（1cm H2O=0．098kPa）。RM为吸入纯氧，持续气道正压（CPAP）40cm H2O．持续40s，8h 1次，共5d。除RM外．其他治疗相同。记录基础状态和连续5d的机械通气参数、血气分析结果及生命体征，比较两组氧合改善和肺损伤指标变化，观察RM的不良反应和气压伤发生率。结果①两组动脉血氧分压和氧合指数（PaO2／FiO2）均明显改善，差异有显著性（P均〈0．05）。②两组白细胞介素-6（IL-6）水平均呈下降趋势．RM组下降幅度更明显，差异有显著性（P〈0．05）。③两组均无气压伤发生。④RM后心率无明显变化，也无其他心律失常发生；平均动脉压也无明显波动。结论反复多次RM可增加气体交换，改善氧合，进一步减少呼吸机相关性肺损伤（VALI）。应用RM较安全，简便易行，耐受性好，临床观察未见低氧血症和对血流动力学的明显影响。     

Pumpless extracorporeal interventional lung assist in patients with acute respiratory distress syndrome: a prospective pilot study

Introduction  

Pumpless interventional lung assist (iLA) is used in patients with acute respiratory distress syndrome (ARDS) aimed at improving extracorporeal gas exchange with a membrane integrated in a passive arteriovenous shunt. In previous studies, feasibility and safety of the iLA system was demonstrated, but no survival benefit was observed. In the present pilot study we tested the hypothesis that timely initiation of iLA using clear algorithms and an improved cannulation technique will positively influence complication rates and management of lung protective ventilation.