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中华临床医师杂志(电子版) ›› 2022, Vol. 16 ›› Issue (02) : 179 -182. doi: 10.3877/cma.j.issn.1674-0785.2022.02.013

所属专题: 急危重症

综述

利于ARDS肺保护的气道内吸引技术
王宇娟1, 马四清2,()   
  1. 1. 810000 西宁,青海大学研究生院
    2. 810007 西宁,青海省人民医院重症医学科
  • 收稿日期:2021-05-28 出版日期:2022-02-15
  • 通信作者: 马四清
  • 基金资助:
    国家自然科学基金资助项目(81860351)

Endotracheal suction for lung protection in acute respiratory distress syndrome

Yujuan Wang1, Siqing Ma2,()   

  1. 1. Graduate School of Qinghai University, Xining 810000, China
    2. Department of Critical Care Medicine, Qinghai People's Hospital, Xining 810007, China
  • Received:2021-05-28 Published:2022-02-15
  • Corresponding author: Siqing Ma
引用本文:

王宇娟, 马四清. 利于ARDS肺保护的气道内吸引技术[J/OL]. 中华临床医师杂志(电子版), 2022, 16(02): 179-182.

Yujuan Wang, Siqing Ma. Endotracheal suction for lung protection in acute respiratory distress syndrome[J/OL]. Chinese Journal of Clinicians(Electronic Edition), 2022, 16(02): 179-182.

急性呼吸窘迫综合征(ARDS)患者有创机械通气时有两种气道内吸引技术,为开放式气道吸引技术与密闭式气道吸引技术。前者主要是在气道内吸引时,断开患者与机械通气管路连接即暂停机械通气,将吸痰管伸入到气管插管内吸引;后者气道内吸引时,不会断开呼吸机与患者的连接。呼气末正压(PEEP)通气是改善氧合的主要措施之一,进行开放式气道内吸引时,断开PEEP,导致肺泡塌陷,可能会增加分流效应、死腔样通气和通气/灌注不匹配,进一步加重肺损伤。本文从分流、死腔、呼吸机相关肺损伤及血流动力学角度进行分析,探讨利于ARDS肺保护的气道内吸引技术。

There are two techniques of airway suction during invasive mechanical ventilation in patients with acute respiratory distress syndrome (ARDS): open airway suction and enclosed airway suction. To do the former, patients are disconnected from ventilators in the airway suction, and suction tubes are put into the endotracheal tubes to suck; to do the latter, patients will not be disconnected from ventilators. Positive end-expiratory pressure (PEEP) ventilation is one of the main measures to improve oxygenation. When open endotracheal suction is performed, disconnection of PEEP leads to alveolar collapse. It may increase shunt effect, dead cavity ventilation, and ventilation/perfusion mismatch, and further aggravate lung injury. In this paper, we analyze the shunt, dead cavity, ventilator-related lung injury, and hemodynamics, and explore the endotracheal suction technique for lung protection in ARDS.

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