急性呼吸窘迫综合征的容许性高碳酸血症的机械通气治疗

急性呼吸窘迫综合合征（ＡＲＤＳ）机械通气治疗的探索。方法观察了１０例ＡＲＤＳ患者。为了减低吸气末气道压力（ｐｐｌａｔ），减少肺气压伤，应用较低的潮气量（ＶＴ，ｘ＝６．５ｍｌ／ｋｇ），依靠自身肾脏代偿功能，容许一定限度的呼吸性酸中毒（简称呼酸）存在（ｐＨ≥７．１９）。在维持动脉血氧分压（ＰａＯ２）７．３ｋＰａ（１ｋＰａ＝７．５ｍｍＨｇ）左右情况下，尽量使用低水平吸氧浓度（ＦｉＯ２，ｘ＝０．５１）及呼气示正压（ＰＥＥＥＰ，ｘ＝０．９２ｋＰａ）（１ｋＰａ＝１０．２ｃｍＨ２Ｏ）。结果７例存活，其中３例在机械通气期间出现过呼酸，２例出现肺气压伤。结论在ＡＲＤＳ机械通气治疗中，使用较低ＶＴ及容许一定限度呼酸存在是值得重视的新观点，应在临床上进一步探索

Mechanical ventilation therapy with permissive hypercapnia on ARDSC

OBJECTIVE: Study of mechanical ventilation (MV) therapy of ARDS (acute respiratory distress syndrome). METHODS: Ten cases of ARDS were observed. Depending on patients' kidney compensation for respiratory acidosis, low tidal volume (VT, mean = 6.5 ml/kg) was used and certain respiratory acidosis was permitted in order to decrease airway plateau pressure and lung barotrauma. On the premise of keeping patients' PaO2 about 7.3 kPa (1 kPa = 7.5 mmHg), lowest possible FiO2 (mean = 0.51) and PEEP (mean = 0.92 kPa, 1 kPa = 10.2 cmH2O) were used. RESULTS: Seven of the ten survived. Three of them had respiratory acidosis and two had lung barotrauma during MV. CONCLUSION: Using lower VT and permitting certain respiratory acidosis are worthy to be considered in MV therapy of ARDS.