脑肺超声联合实现脑保护通气策略个体化

doi:10.3969/j.issn.1674-490X.2021.04.004

摘要/Abstract

摘要： 对于高颅压合并严重肺损伤的患者,不恰当的机械通气会导致“脑肺互损”。急性呼吸窘迫综合征的保护性通气策略有导致高颅压风险,因此治疗过程中要实现肺和脑的双重保护,防止机械通气导致脑部发生二次损伤。在应用呼气末正压、肺复张、俯卧位通气时会影响严重颅脑创伤患者脑部生理功能:通过改变心输出量、平均动脉压、静脉回流等影响脑灌注压调节,进而对颅内压产生不利的影响。肺超声和脑超声能够在床旁监测肺通气功能和脑生理功能改变,指导需机械通气的神经重症患者合理设定呼吸机参数,实现脑保护性通气策略。

关键词: 急性呼吸窘迫综合征, 脑损伤, 肺超声, 脑超声

Abstract: When patients have both intracranial hypertension and severe lung injury, Improper mechanical ventilation can lead to “lung brain mutual damage”. Because of the risk of intracranial hypertension caused by protective ventilation strategies adopted by acute respiratory distress syndrome patients, it is necessary to protect the lung and brain at the same time to prevent secondary brain damage by mechanical ventilation. Positive end-expiratory pressure, recruitment maneuvers and prone positioning may have effects on cerebral physiology of traumatic brain injury patients: they may negatively affect intracranial pressure, based on the cerebral perfusion pressure regulation(through changes in cardiac output, mean arterial pressure, venous return). Lung ultrasound(LUS)and brain ultrasound(BUS)have proven their potential in respectively monitoring lung aeration and brain physiology at the bedside. For those neurocritical patients who need mechanical ventilation, LUS and BUS can guide us to set ventilator parameters reasonably and realize brain-protective ventilation strategy.

Key words: acute respiratory distress syndrome, brain injury, lung ultrasound, brain ultrasound

中图分类号:

瞿海龙,张红强,张冰,梁璐. 脑肺超声联合实现脑保护通气策略个体化[J]. 医学研究与教育, 2021, 38(4): 23-28.

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