第40卷第4期2023年8月医学研究与教育MedicalResearchandEducationVol.40No.4Aug.,2023本文引用:张红强,张冰,瞿海龙.急性呼吸窘迫综合征顽固性低氧的挽救治疗策略[J].医学研究与教育,2023,40(4):3136.DOI:10.3969/j.issn.1674490X.2023.04.005.·临床医学·急性呼吸窘迫综合征顽固性低氧的挽救治疗策略张红强,张冰,瞿海龙(河北大学附属医院急诊医学科,河北保定071000)摘要:急性呼吸窘迫综合征(acuterespiratorydistresssyndrome,ARDS)病因多样,以急性低氧、顺应性降低、非心源性肺水肿、双肺弥漫性渗出为特点。保护性通气策略已被临床广泛实施,然而仍有10%~15%患者死于顽固性低氧。目前对于这些患者多采取挽救性治疗,如俯卧位通气、早期应用肌肉松弛剂、各种肺复张、实施非常规通气模式、吸入肺血管活性药物、体外膜肺氧合等。这些挽救策略可改善患者氧合,但是否降低病死率、改善预后却备受争议。而且不同方法各有利弊,需根据患者个体情况采取相应治疗策略。关键词:急性呼吸窘迫综合征;低氧血症;机械通气;呼吸机相关肺损伤DOI:10.3969/j.issn.1674490X.2023.04.005中图分类号:R56文献标志码:A文章编号:1674490X(2023)04003106SalvagestrategiesforacuterespiratorydistresssyndromewithrefractoryhypoxiaZHANGHongqiang,ZHANGBing,JUHailong(EmergencyDepartment,AffiliatedHospitalofHebeiUniversity,Baoding07100,China)Abstract:Acuterespiratorydistresssyndromeisaconditionofvariedetiologycharacterizedbytheacuteonsetofhypoxemia,reducedlungcompliance,noncardiogenicpulmonaryedemaanddiffuseexudativelesionsofbothlungs.Althoughprotectiveventilationstrategyhasbeenimplementedinclinicalpractice,anestimated10%-15%ofthedeathsinARDSarecausedduetorefractoryhypoxemia.Inthesecases,cliniciansmayresortto“salvagetherapies”.Theseincludepronepositionventilation,applicationofearlyneuromuscularblockers,vari-ousrecruitmentmaneuvers,unconventionalventilationmodes,inhaledpulmonaryvasodilators,andextracorpore-almembraneoxygenation.Allthesalvagetherapieshavebeenassociatedwithimprovedoxygenation,butwhethertoreducemortalityandimproveprogno...
