\u5728\u75c5\u5e8a\u65c1<\/p>\n
\u5982\u4f55\u6b63\u786e\u6ef4\u5b9a\u8bbe\u7f6ePEEP\uff1f<\/p>\n
\u82cd\u5357\u53bf\u4eba\u6c11\u533b\u9662 \u6881\u8273 <\/p>\n
\u91cd\u75c7\u884c\u8005\u7ffb\u8bd1\u7ec4<\/p>\n
\u673a\u68b0\u901a\u6c14\u7684\u6b63\u9762\u5f71\u54cd\u4e0e\u547c\u5438\u673a\u76f8\u5173\u6027\u80ba\u635f\u4f24\uff08VILI\uff09\u7684\u9884\u9632\u5bc6\u5207\u76f8\u5173\u3002\u547c\u6c14\u672b\u6b63\u538b(PEEP)\u7684\u5408\u7406\u5e94\u7528\u53ef\u51cf\u8f7b\u6b63\u538b\u901a\u6c14\u7684\u8d1f\u9762\u5f71\u54cd\u3002Ashbaugh\u56e2\u961f\u5728\u4ed6\u4eec\u7684\u5f00\u521b\u6027\u7814\u7a76\u4e2d\u89c2\u5bdf\u5230\u4e86PEEP\u5bf9\u6025\u6027\u547c\u5438\u7a98\u8feb\u7efc\u5408\u5f81(ARDS)\u60a3\u8005\u52a8\u8109\u6c27\u5408\u7684\u6b63\u9762\u5f71\u54cd\u3002\u7136\u800c\uff0c\u4eba\u4eec\u5f88\u5feb\u5c31\u8ba4\u8bc6\u5230\u4e86\u8fc7\u9ad8\u7684PEEP\u7684\u6f5c\u5728\u8d1f\u9762\u5f71\u54cd\uff0c\u5305\u62ec\u8840\u6d41\u52a8\u529b\u5b66\u7684\u53d7\u7d2f\u548c\u6c14\u538b\u4f24\u3002\u90a3\u6211\u4eec\u8be5\u5982\u4f55\u53bb\u786e\u5b9a\u673a\u68b0\u901a\u6c14\u60a3\u8005\u7684\u9002\u5f53PEEP\u6c34\u5e73\u5462?<\/p>\n
1 PEEP\u7684\u751f\u7406\u5b66\u6548\u5e94<\/p>\n
\u5e94\u7528PEEP\u53ef\u589e\u52a0\u547c\u6c14\u672b\u80ba\u5bb9\u79ef\uff0c\u4ece\u800c\u6539\u5584\u80ba\u987a\u5e94\u6027\uff0c\u7ee7\u800c\u964d\u4f4e\u9a71\u52a8\u538b(\u5e73\u53f0\u538b-PEEP)\u3002\u73b0\u5df2\u8bc1\u5b9e\u80ba\u90e8\u7684\u987a\u5e94\u6027\u6539\u5584\u4ee5\u53ca\u9a71\u52a8\u538b\u4e0b\u964d\u53ef\u4ee5\u6539\u5584\u60a3\u8005\u7684\u751f\u5b58\u7387\u3002\u5728\u547c\u6c14\u672b\uff0c\u5982\u679c\u6c14\u9053\u548c\u80ba\u6ce1\u4fdd\u6301\u4f4e\u6c34\u5e73\u7684\u538b\u529b\uff0c\u5728\u6f6e\u6c14\u91cf\u901a\u6c14\u65f6\u4e0d\u7a33\u5b9a\u7684\u80ba\u6ce1\u53ef\u80fd\u5b58\u5728\u53cd\u590d\u5f00\u653e\u548c\u584c\u9677\u3002\u80ba\u6ce1\u7684\u53cd\u590d\u5f00\u95ed\u4f7f\u5f97\u80ba\u5b9e\u8d28\u548c\u8fdc\u7aef\u5c0f\u6c14\u9053\u53d1\u751f\u6c38\u4e45\u6027\u7684\u526a\u5207\u635f\u4f24\u3002\u6b64\u5916\uff0c\u80ba\u6ce1\u8868\u9762\u6d3b\u6027\u7269\u8d28\u7684\u51cf\u5c11\uff0c\u4e5f\u4f1a\u5bfc\u81f4\u80ba\u6ce1\u584c\u9677\u3002\u80ba\u75c5\u53d8\u90e8\u4f4d\u7684\u80ba\u6ce1\u584c\u9677\u53ef\u5bfc\u81f4\u80ba\u90e8\u76f8\u5bf9\u6b63\u5e38\u7684\u80ba\u6ce1\u4f18\u5148\u901a\u6c14\u5e76\u8fc7\u5ea6\u81a8\u80c0\uff0c\u5f15\u8d77\u4e86\u80ba\u7684\u5f62\u53d8\u3002\u56e0\u6b64\uff0c\u5728\u201c\u5a74\u513f\u201d\u80ba\u4e2d\uff0c\u901a\u6c14\u8f83\u597d\u7684\u533a\u57df\u66f4\u6613\u4e8e\u53d1\u751f\u635f\u4f24\u3002\u5f62\u53d8\u9009\u62e9\u6027\u5730\u5206\u5e03\u5728\u5145\u6c14\u548c\u975e\u5145\u6c14\u80ba\u6ce1\u7684\u4ea4\u754c\u8fb9\u7f18\u3002\u9002\u5f53PEEP\u6c34\u5e73\u7684\u5e94\u7528\u53ef\u4ee5\u51cf\u8f7b\u6f6e\u6c14\u91cf\u901a\u6c14\u5f15\u8d77\u7684\u80ba\u6ce1\u53cd\u590d\u5f00\u95ed\uff0c\u4ece\u800c\u51cf\u8f7b\u80ba\u7684\u5e94\u529b\u3002\u6b64\u5916\uff0c\u51cf\u8f7b\u80ba\u7684\u5e94\u529b\u53ef\u51cf\u8f7b\u708e\u75c7\u53cd\u5e94\u548c\u968f\u4e4b\u800c\u6765\u7684\u751f\u7269\u635f\u4f24\u3002\u5e94\u7528PEEP\u6709\u52a9\u4e8e\u7ef4\u6301\u80ba\u6ce1\u5728\u547c\u6c14\u672b\u4ecd\u4fdd\u6301\u5f00\u653e\u72b6\u6001\uff0c\u51cf\u5c11\u6f6e\u6c14\u91cf\u901a\u6c14\u65f6\u80ba\u6ce1\u5468\u671f\u6027\u5f00\u95ed\u5e26\u6765\u7684\u4e0d\u5229\u5f71\u54cd\u3002\u5f53\u80ba\u6ce1\u5728\u547c\u6c14\u672b\u4ecd\u4fdd\u6301\u5f20\u5f00\u653e\u65f6\uff0c\u5c31\u4f1a\u51cf\u5c11\u76f8\u5bf9\u6b63\u5e38\u7684\u80ba\u6ce1\u51fa\u73b0\u8fc7\u5ea6\u5145\u6c14(\u56fe1)\u3002\u56e0\u6b64\uff0c\u5e94\u529b\u5bf9\u901a\u6c14\u548c\u584c\u9677\u80ba\u7684\u8fb9\u7f18\u7684\u4f5c\u7528\u51cf\u5f31\u3002\u603b\u7684\u6765\u8bf4\uff0c\u6700\u4f73PEEP\u6c34\u5e73\u53ef\u63d0\u4f9b\u8f83\u5747\u5300\u7684\u80ba\u901a\u6c14\u3002\u800c\u4e14\uff0cPEEP\u53ef\u4f7f\u584c\u9677\u7684\u80ba\u6ce1\u590d\u5f20\uff0c\u51cf\u5c11\u80ba\u5185\u5206\u6d41\uff0c\u6539\u5584\u6c27\u5408\u3002<\/p>\n
\u56fe1. \u5de6\uff1a\u80ba\u5e95\u5904\u90e8\u5206\u584c\u9677\u7684\u80ba\u6ce1\u3002\u53f3\uff1a\u589e\u52a0PEEP\u540e\uff0c\u80ba\u6ce1\u590d\u5f20\u3002<\/p>\n
2 PEEP\u7684\u526f\u4f5c\u7528<\/p>\n
\u5e94\u7528\u4e0d\u6070\u5f53\u7684\u9ad8PEEP\uff0c\u53ef\u5bfc\u81f4\u5438\u6c14\u538b\u529b\u4e0a\u5347\u3001\u80ba\u6ce1\u8fc7\u5ea6\u81a8\u80c0\u548cVILI\u6301\u7eed\u5b58\u5728\u3002\u6b64\u5916\uff0cPEEP\u53ef\u80fd\u4e0d\u4f1a\u50cf\u9884\u60f3\u7684\u90a3\u6837\u4f7f\u584c\u9677\u7684\u80ba\u6ce1\u590d\u5f20;\u76f8\u53cd\uff0c\u5b83\u53ef\u80fd\u4f7f\u5df2\u7ecf\u901a\u6c14\u7684\u80ba\u6ce1\u8fc7\u5ea6\u81a8\u80c0\u3002\u4e0e\u5df2\u901a\u6c14\u7684\u80ba\u6ce1\u8fc7\u5ea6\u5145\u6c14\u76f8\u6bd4\uff0c\u584c\u9677\u7684\u80ba\u6ce1\u7684\u590d\u5f20\u7a0b\u5ea6\u53ef\u80fd\u56e0PEEP\u6c34\u5e73\u548c\u584c\u9677\u80ba\u7684\u201c\u53ef\u590d\u5f20\u6027\u201d\u800c\u4e0d\u540c\u3002\u56e0\u6b64\uff0c\u5e94\u7528PEEP\u53ef\u80fd\u4f1a\u4f7f\u80ba\u590d\u5f20\u3001\u80ba\u6ce1\u8fc7\u5ea6\u81a8\u80c0\u6216\u4e24\u8005\u517c\u800c\u6709\u4e4b\u3002<\/p>\n
\u8fc7\u9ad8PEEP\u6c34\u5e73\u4e5f\u53ef\u5bfc\u81f4\u80f8\u8154\u5185\u9ad8\u538b\uff0c\u963b\u788d\u9759\u8109\u56de\u6d41\uff0c\u4ece\u800c\u4f7f\u5fc3\u8f93\u51fa\u91cf\u4e0b\u964d\u3002\u5f53\u80ba\u6bdb\u7ec6\u8840\u7ba1\u627f\u53d7\u7684\u538b\u529b\u589e\u5927\uff0c\u53ef\u53d1\u751f\u584c\u9677\uff0c\u5bfc\u81f4\u80ba\u8840\u7ba1\u963b\u529b\u589e\u52a0\uff0c\u4ece\u800c\u589e\u52a0\u53f3\u5fc3\u5ba4\u7684\u540e\u8d1f\u8377\u3002\u8fc7\u9ad8\u7684PEEP\u53ef\u4f7f\u80ba\u6ce1\u538b\u5347\u9ad8\uff0c\u751a\u81f3\u5927\u4e8e\u80ba\u6bdb\u7ec6\u8840\u7ba1\u538b\uff0c\u8fd9\u53ef\u5bfc\u81f4\u80ba\u6bdb\u7ec6\u8840\u7ba1\u584c\u9677\uff0c\u76f8\u5bf9\u4e8e\u901a\u6c14\u800c\u8a00\uff0c\u8840\u6d41\u704c\u6ce8\u51cf\u5c11\uff0c\u5bfc\u81f4\u80ba\u6ce1\u6b7b\u8154\u589e\u52a0\u3002\u9ad8PEEP\u8fd8\u53ef\u80fd\u589e\u52a0\u6c14\u538b\u4f24\u7684\u98ce\u9669\u3002\u88681\u63cf\u8ff0\u4e86\u589e\u52a0PEEP\u7684\u6f5c\u5728\u4f18\u52bf\u548c\u53ef\u80fd\u7684\u526f\u4f5c\u7528\u3002<\/p>\n
\u88681. \u589e\u52a0PEEP\uff1a\u652f\u6301\u4e0e\u53cd\u5bf9\u7684\u7406\u7531<\/p>\n
3 \u5982\u4f55\u6ef4\u5b9aPEEP\uff1f<\/p>\n
3.1 \u5e94\u7528PEEP\u8868<\/p>\n
ARDS-net\u8bd5\u9a8c\u4f7f\u7528\u4e86\u57fa\u4e8eFiO2\u9700\u6c42\u7684\u8868\u683c\u6765\u5e94\u7528PEEP\u3002\u5c3d\u7ba1\u7b80\u5355\u6613\u7528\uff0c\u4f46\u57fa\u4e8eFiO2\u6c34\u5e73\u6ef4\u5b9aPEEP\u7684\u65b9\u6cd5\uff0c\u5e76\u6ca1\u6709\u8003\u8651\u5230\u80ba\u7684\u53ef\u590d\u5f20\u6027\uff0c\u4ee5\u53ca\u5728\u589ePEEP\u540e\u6c27\u5408\u5f97\u4e0d\u5230\u6539\u5584\u7684\u60c5\u51b5\u3002\u4e8b\u5b9e\u4e0a\uff0c\u60a3\u8005\u4e2a\u4f53\u5bf9PEEP\u7684\u53cd\u5e94\u53ef\u80fd\u5b58\u5728\u5f88\u5927\u7684\u5dee\u5f02\u6027\u3002<\/p>\n
3.2 \u6839\u636e\u6c27\u5408\u7684\u53cd\u5e94<\/p>\n
\u6839\u636e\u6c27\u5408\u53cd\u5e94\u6ef4\u5b9aPEEP\u662f\u4e00\u79cd\u5e38\u7528\u7684\u65b9\u6cd5\u3002\u5982\u679cPEEP\u80fd\u4f7f\u80ba\u590d\u5f20\uff0c\u51cf\u5c11\u4e86\u80ba\u5185\u5206\u6d41\u5c31\u5e94\u8be5\u80fd\u6539\u5584\u6c27\u5408\u3002\u5c3d\u7ba1\u80ba\u6ce1\u590d\u5f20\u4e0e\u6c27\u5408\u6539\u5584\u4e4b\u95f4\u7684\u76f8\u5173\u6027\u53ef\u80fd\u4e0d\u4e00\u81f4\uff0c\u4f46\u7ecfPEEP\u6cbb\u7597\u540e\u6c27\u5408\u597d\u8f6c\u5df2\u88ab\u8bc1\u660e\u53ef\u6539\u5584\u751f\u5b58\u7387\u3002\u968f\u7740PEEP\u6c34\u5e73\u589e\u9ad8\uff0cPaCO2\u6c34\u5e73\u4e5f\u5347\u9ad8\uff0c\u8fd9\u63d0\u793a\u5b58\u5728\u80ba\u6ce1\u8fc7\u5ea6\u81a8\u80c0\u3002<\/p>\n
3.3 \u76d1\u6d4b\u987a\u5e94\u6027<\/p>\n
\u4f20\u7edf\u4e0a\u8ba4\u4e3a\uff0c\u968f\u7740PEEP\u7684\u5e94\u7528\uff0c\u987a\u5e94\u6027\u51fa\u73b0\u76f8\u5e94\u7684\u6539\u5584\uff0c\u5219\u8868\u660e\u80ba\u5df2\u590d\u5f20\u3002\u5728Suter\u56e2\u961f\u53d1\u8868\u7684\u5177\u6709\u91cc\u7a0b\u7891\u610f\u4e49\u7684\u7814\u7a76\u5f53\u4e2d\uff0c\u663e\u793a\u5f53PEEP\u6ef4\u5b9a\u5230\u83b7\u5f97\u9ad8\u5927\u7684\u9759\u6001\u987a\u5e94\u6027\u65f6\uff0c\u6c27\u8f93\u9001\u6700\u5927\u3002\u4ee5\u9759\u6001\u987a\u5e94\u6027\u4e3a\u5bfc\u5411\u6765\u8c03\u6574PEEP\u6c34\u5e73\uff0c\u53ef\u6539\u5584\u6c27\u5408\u548c\u5668\u5b98\u529f\u80fd\u3002\u7136\u800c\uff0c\u80ba\u987a\u5e94\u6027\u7684\u589e\u52a0\uff0c\u53ef\u80fd\u4ec5\u4ec5\u53cd\u6620\u7740\u80ba\u6ce1\u5468\u671f\u6027\u5f00\u653e\u548c\u584c\u9677\uff0c\u80ba\u5e76\u6ca1\u6709\u771f\u6b63\u7684\u590d\u5f20\u3002<\/p>\n
3.4 \u76d1\u6d4b\u9a71\u52a8\u538b<\/p>\n
\u9a71\u52a8\u538b\u7b49\u4e8e\u6f6e\u6c14\u91cf\u9664\u4ee5\u9759\u6001\u987a\u5e94\u6027\u3002\u56e0\u6b64\uff0c\u5bf9\u4e8e\u6052\u5b9a\u7684\u6f6e\u6c14\u91cf\uff0c\u968f\u7740PEEP\u7684\u589e\u52a0\uff0c\u9a71\u52a8\u538b\u51fa\u73b0\u964d\u4f4e\u63d0\u793a\u80ba\u6ce1\u5df2\u590d\u5f20\u3002\u7136\u800c\uff0c\u9a71\u52a8\u538b\u7684\u964d\u4f4e\u662f\u7531\u4e8e\u987a\u5e94\u6027\u6539\u5584\u6240\u81f4\u3002\u56e0\u6b64\uff0c\u57fa\u4e8e\u9a71\u52a8\u538b\u6765\u8c03\u6574PEEP\u5c31\u4e0e\u57fa\u4e8e\u9759\u6001\u987a\u5e94\u6027\u6765\u8c03\u6574PEEP\u4e00\u6837\uff0c\u5177\u6709\u76f8\u540c\u7684\u5c40\u9650\u6027\u3002Amato\u56e2\u961f\u5bf9\u6765\u81ea9\u9879\u968f\u673a\u5bf9\u7167\u8bd5\u9a8c\u76843562\u540d\u60a3\u8005\u8fdb\u884c\u4e86\u591a\u5c42\u6b21\u4e2d\u4ecb\u5206\u6790\u3002\u7814\u7a76\u663e\u793a\uff0c\u9a71\u52a8\u538b\u4e0e\u751f\u5b58\u7387\u4e4b\u95f4\u7684\u76f8\u5173\u6027\u6700\u5f3a\uff0c\u9a71\u52a8\u538b\u529b\u8d8a\u9ad8\uff0c\u6b7b\u4ea1\u7387\u5c31\u76f8\u5e94\u589e\u52a0\u3002\u6539\u53d8\u6f6e\u6c14\u91cf\u548cPEEP\u4e4b\u540e\uff0c\u53ea\u6709\u9a71\u52a8\u538b\u968f\u7740\u540c\u6b65\u53d8\u5316\uff0c\u624d\u4e0e\u751f\u5b58\u7387\u76f8\u5173\u3002<\/p>\n
3.5 \u76d1\u6d4b\u98df\u9053\u538b<\/p>\n
\u5728\u673a\u68b0\u901a\u6c14\u65f6\uff0c\u6c14\u9053\u538b\u8d8b\u5411\u4f7f\u80ba\u6269\u5f20\uff0c\u800c\u80f8\u8154\u5185\u538b\u7684\u4f5c\u7528\u6070\u6070\u76f8\u53cd\u3002\u56e0\u6b64\uff0c\u771f\u6b63\u4f5c\u7528\u4e8e\u80ba\u6ce1\u58c1\u4f7f\u80ba\u6ce1\u6269\u5f20\u7684\u538b\u529b\u662f\u8de8\u80ba\u538b\u3002<\/p>\n
\u8de8\u80ba\u538b=\u6c14\u9053\u538b-\u80f8\u8154\u5185\u538b<\/p>\n
\u80f8\u58c1\u548c\u8179\u90e8\u5f02\u5e38(\u5982\uff1a\u80f8\u5916\u4f24\u3001\u80f8\u8154\u79ef\u6db2\u3001\u80a5\u80d6\u3001\u8179\u8154\u5ba4\u9694\u7efc\u5408\u5f81\u7b49)\u4f1a\u589e\u52a0\u80f8\u5185\u538b\uff0c\u56e0\u6b64\uff0c\u5b83\u4eec\u662f\u964d\u4f4e\u8de8\u80ba\u538b\u7684\u3002\u80f8\u58c1\u5f39\u6027\u589e\u52a0(\u80f8\u58c1\u786c\u5ea6\u589e\u52a0)\u53ef\u62b5\u6d88\u8de8\u80ba\u538b\uff0c\u4ece\u800c\u963b\u788d\u80ba\u81a8\u80c0\u3002\u5c06PEEP\u6c34\u5e73\u8bbe\u7f6e\u4e3a\u5927\u4e8e\u6216\u7b49\u4e8e\u80f8\u8154\u5185\u538b\uff0c\u53ef\u4ee5\u9632\u6b62\u547c\u6c14\u671f\u95f4\u80ba\u6ce1\u584c\u9677\u3002\u98df\u9053\u538b\u63a5\u8fd1\u80f8\u8154\u5185\u538b\uff0c\u53ef\u4ee5\u901a\u8fc7\u76d1\u6d4b\u98df\u9053\u538b\u5e76\u6839\u636e\u5b83\u6765\u8bbe\u7f6e\u6070\u5f53\u7684PEEP\u6c34\u5e73\u3002<\/p>\n
\u5728\u4e00\u9879RCT\u4e2d\uff0c\u628a\u6839\u636e\u98df\u9053\u538b\u76d1\u6d4b\u6765\u6ef4\u5b9aPEEP\u7684\u65b9\u6cd5\u4e0e\u6839\u636eFiO2\u7684\u9700\u6c42\u6765\u7ecf\u9a8c\u6027\u8bbe\u7f6ePEEP\u7684\u65b9\u6cd5\u8fdb\u884c\u4e86\u6bd4\u8f83\u3002\u5728\u4ee5\u98df\u9053\u538b\u4e3a\u5bfc\u5411\u7ec4\u4e2d\uff0c\u6839\u636eFiO2\u7684\u9700\u6c42\uff0c\u628aPEEP\u6c34\u5e73\u8bbe\u7f6e\u5728\u98df\u9053\u538b\u4e4b\u4e0a0-6cmH2O\u4e4b\u95f4\u3002\u572828\u5929\u6b7b\u4ea1\u7387\u548c\u975e\u673a\u68b0\u901a\u6c14\u5929\u6570\u4e0a\u7684\u4e3b\u8981\u590d\u5408\u8f6c\u5f52\uff0c\u4e24\u7ec4\u4e4b\u95f4\u5e76\u65e0\u663e\u8457\u5dee\u5f02\u3002<\/p>\n
3.6 \u5f71\u50cf\u5f15\u5bfc\u4e0b\u7684PEEP\u6ef4\u5b9a<\/p>\n
CT\u6210\u50cf\u68c0\u67e5\u53ef\u4ee5\u5206\u6790\u4f5c\u7528\u4e8e\u80ba\u90e8\u7684\u4e0d\u540c\u6c34\u5e73\u7684\u538b\u8feb\u529b\u3002\u7136\u800c\uff0cCT\u6210\u50cf\u6307\u5bfcPEEP\u6ef4\u5b9a\u7684\u6709\u6548\u6027\u5c1a\u672a\u5728\u4e34\u5e8a\u5b9e\u8df5\u4e2d\u5f97\u5230\u8bc1\u5b9e\u3002\u8003\u8651\u5230\u5728\u5371\u91cd\u75c5\u4eba\u4e2d\u53cd\u590d\u884cCT\u68c0\u67e5\u5b58\u5728\u5b9e\u9645\u56f0\u96be\uff0c\u8fd9\u79cd\u65b9\u6cd5\u901a\u5e38\u4e0d\u4f1a\u6709\u524d\u666f\u3002Bouhemad\u56e2\u961f\u4f7f\u7528\u80ba\u90e8\u8d85\u58f0\u6765\u8bc4\u4ef7PEEP\u6240\u5bfc\u81f4\u7684\u80ba\u590d\u5f20\u60c5\u51b5\u3002\u4ed6\u4eec\u89c2\u5bdf\u5230\u8d85\u58f0\u68c0\u67e5\u7684\u518d\u5145\u6c14\u8bc4\u5206\u4e0e\u7528\u538b\u529b-\u5bb9\u79ef\u66f2\u7ebf\u6d4b\u91cf\u7684\u80ba\u590d\u5f20\u6709\u663e\u8457\u76f8\u5173\u6027\u3002\u8d85\u58f0\u68c0\u67e5\u5f88\u5bb9\u6613\u5728\u5371\u91cd\u75c5\u4eba\u5e8a\u65c1\u8fdb\u884c\uff0c\u56e0\u6b64\uff0c\u4e0eCT\u68c0\u67e5\u76f8\u6bd4\uff0c\u8d85\u58f0\u68c0\u67e5\u66f4\u5177\u53ef\u884c\u6027\u3002\u7136\u800c\uff0c\u8d85\u58f0\u68c0\u67e5\u4e5f\u6709\u7740\u5b83\u7684\u5c40\u9650\u6027\uff0c\u5b83\u4e0d\u80fd\u8bc6\u522b\u80ba\u6ce1\u8fc7\u5ea6\u81a8\u80c0\u3002<\/p>\n
4 \u6839\u636e\u7535\u963b\u6297\u6210\u50cf\uff08EIT\uff09\u6ef4\u5b9aPEEP<\/p>\n
EIT\u662f\u4e00\u6b3e\u65e0\u521b\u7684\u3001\u53ef\u4ee5\u5728\u5e8a\u8fb9\u6ef4\u5b9aPEEP\u7684\u5de5\u5177\u3002\u4f7f\u7528\u8d34\u5728\u80f8\u58c1\u4e0a\u7684\u4e00\u5bf9\u7535\u6781\u65bd\u52a0\u4ea4\u6d41\u7535\uff0c\u540c\u65f6\u4ece\u5176\u4ed6\u7535\u6781\u6d4b\u91cf\u611f\u5e94\u7535\u538b\u3002\u901a\u8fc7\u7535\u5bfc\u7387\u7684\u5dee\u5f02\u6765\u91cd\u5efa2D\u56fe\u50cf\uff0c\u63cf\u7ed8\u80ba\u7684\u4e0d\u540c\u533a\u57df\u4e4b\u95f4\u7684\u901a\u6c14\u548c\u8840\u6d41\u704c\u6ce8\u5206\u5e03\u3002\u4f7f\u7528EIT\uff0c\u53ef\u4ee5\u8bc4\u4f30\u80ba\u590d\u5f20\u8fc7\u7a0b\u4e2d\u7684\u80ba\u5bb9\u79ef\u53d8\u5316\uff0c\u4ece\u800c\u5b9e\u73b0\u6700\u4f73PEEP\u6c34\u5e73\u7684\u6ef4\u5b9a\u3002\u65e9\u671f\u7814\u7a76\u8868\u660e\uff0cEIT\u53ef\u80fd\u662f\u5e8a\u8fb9\u8bc4\u4f30\u80ba\u7684\u6f5c\u5728\u53ef\u590d\u5f20\u6027\u548c\u4e2a\u4f53\u5316\u8bbe\u7f6ePEEP\u6c34\u5e73\u7684\u6709\u7528\u5de5\u5177\u3002<\/p>\n
5 \u9ad8PEEP vs. \u4f4ePEEP<\/p>\n
\u4e00\u4e9b\u7814\u7a76\u4f7f\u7528PEEP\/FiO2\u8868\u6216\u57fa\u4e8e\u5438\u6c14\u5e73\u53f0\u538b\u529b\u6765\u8bbe\u5b9aPEEP\uff0c\u5bf9\u9ad8PEEP\u4e0e\u4f4ePEEP\u8fdb\u884c\u4e86\u6bd4\u8f83\uff0c\u4e34\u5e8a\u7ed3\u679c\u6ca1\u6709\u5dee\u5f02\u3002<\/p>\n
PHARLAP\u7814\u7a76\u5728\u4e2d-\u91cd\u5ea6ARDS\u60a3\u8005\u5f53\u4e2d\u628a\u5f00\u653e\u80ba\u7684\u901a\u6c14\u7b56\u7565\u8fdb\u884c\u4e86\u6bd4\u8f83\uff0c\u5305\u62ec\u80ba\u590d\u5f20\u624b\u6cd5\u548c\u8fd0\u7528\u4f20\u7edf\u7684\u80ba-\u4fdd\u62a4\u901a\u6c14\u7b56\u7565\u6765\u6ef4\u5b9aPEEP\u3002\u5728\u5f00\u653e\u80ba\u7b56\u7565\u7ec4\u4e2d\uff0c\u5148\u628aPEEP\u589e\u52a0\u523020 cmH2O\uff0c\u7136\u540e\u9010\u6b65\u589e\u52a0\u523030\u548c40 cmH2O\uff0c\u5404\u6301\u7eed2\u5206\u949f\u3002\u7136\u540e\u5c06PEEP\u964d\u4f4e\u81f325cmH2O\uff0c\u5e76\u6bcf3\u5206\u949f\u4ee52.5cmH2O\u7684\u5e45\u5ea6\u4e0b\u8c03\u6ef4\u5b9a\uff0c\u76f4\u5230\u9971\u548c\u5ea6\u4e0b\u964d\u8d85\u8fc72%\u6216\u964d\u81f315cmH2O\u7684\u6700\u5c0fPEEP\u6c34\u5e73\u3002\u5728\u5bf9\u7167\u7ec4\u4e2d\uff0c\u60a3\u8005\u63a5\u53d7\u5c0f\u6f6e\u6c14\u901a\u6c14\uff084-6 mL\/kg\u9884\u6d4b\u4f53\u91cd\uff09\uff0c\u4fdd\u6301\u5e73\u53f0\u538b\u5c0f\u4e8e30 cmH2O\uff0c\u6839\u636eARDS-net\u4f4ePEEP\u8868\u6765\u8bbe\u5b9aPEEP\u3002\u5728\u4e3b\u8981\u7ed3\u5c4028\u5929\u6b7b\u4ea1\u7387\u65b9\u9762\uff0c\u4e24\u7ec4\u4e4b\u95f4\u5e76\u65e0\u663e\u8457\u5dee\u5f02\u3002\u6b21\u8981\u7ed3\u679c\uff08\u5305\u62ecICU\u6b7b\u4ea1\u7387\u3001\u4f4f\u9662\u6b7b\u4ea1\u7387\u300190\u5929\u548c6\u4e2a\u6708\u65f6\u7684\u6b7b\u4ea1\u7387\uff0c\u4ee5\u53caICU\u4f4f\u9662\u65f6\u95f4\u548c\u6574\u4e2a\u4f4f\u9662\u65f6\u95f4\uff09\uff0c\u4e24\u7ec4\u4e4b\u95f4\u4e5f\u6ca1\u6709\u663e\u8457\u5dee\u5f02\u3002\u5f00\u653e\u80ba\u7b56\u7565\u4e0e\u5fc3\u8840\u7ba1\u4e0d\u826f\u4e8b\u4ef6\u53d1\u751f\u7387\u7684\u589e\u52a0\u76f8\u5173\uff1b\u7136\u800c\uff0c\u5bf9\u96be\u6cbb\u6027\u4f4e\u6c27\u8840\u75c7\u7684\u60a3\u8005\u6765\u8bf4\uff0c\u5f00\u653e\u80ba\u7b56\u7565\u7ec4\u7684\u62a2\u6551\u6027\u6cbb\u7597\u9700\u6c42\u5219\u8f83\u4f4e\u3002<\/p>\n
\u4e00\u9879\u591a\u4e2d\u5fc3\u7684ART\u8bd5\u9a8c\uff0c\u5728\u4e2d-\u91cd\u5ea6ARDS\u60a3\u8005\u4e2d\uff0c\u628a\u80ba\u590d\u5f20\u540e\u8054\u5408\u4ee5\u6700\u4f73\u987a\u5e94\u6027\u4e3a\u5bfc\u5411\u7684PEEP\u6ef4\u5b9a\u4e0e\u4f4ePEEP\u7b56\u7565\u8fdb\u884c\u4e86\u6bd4\u8f83\u3002\u8bd5\u9a8c\u4e2d\u80ba\u590d\u5f20\u7684\u65b9\u6cd5\u662f\u5148\u628aPEEP\u4e0a\u8c03\u81f325 cmH2O\u7ef4\u63011 min\uff0c\u968f\u540e\u518d\u4e0a\u8c03PEEP\u81f335 cmH2O\u7ef4\u63011 min\uff0c45 cmH2O \u7ef4\u63012 min\uff0c\u7136\u540e\u6839\u636e\u6700\u4f73\u7684\u80ba\u987a\u5e94\u6027\u6ef4\u5b9aPEEP\u6c34\u5e73\u3002\u5728\u51fa\u73b03\u4f8b\u5fc3\u810f\u9aa4\u505c\u540e\uff0c\u88ab\u8feb\u6539\u4e3a\u4f7f\u7528\u76f8\u5bf9\u8f83\u4f4e\u6c34\u5e73PEEP\u7684\u65b9\u6cd5\u3002\u5728\u80ba\u590d\u5f20\u8054\u5408PEEP\u6ef4\u5b9a\u7ec4\u4e2d\uff0c28\u5929\u6b7b\u4ea1\u7387\u663e\u8457\u9ad8\u4e8e\u4f4ePEEP\u7ec4\uff0855.3% vs. 49.3%; HR: 1.20\uff0c95%CI:1.01-1.42\uff1bP=0.041\uff09\u3002<\/p>\n
Kacmarek\u56e2\u961f\u5c06\u5f00\u653e\u80ba\u901a\u6c14\u7b56\u7565\u4e0e\u57fa\u4e8eARDS-net\u4f4ePEEP\u6d41\u7a0b\u7684\u7b56\u7565\u8fdb\u884c\u4e86\u6bd4\u8f83\u3002\u5f00\u653e\u80ba\u7b56\u7565\uff0c\u5728\u5b9e\u65bd\u80ba\u590d\u5f20\u540e\uff0c\u4e0b\u8c03\u6ef4\u5b9aPEEP\u6c34\u5e73\u3002\u4e24\u7ec4\u95f460\u5929\u6b7b\u4ea1\u7387\u65e0\u663e\u8457\u5dee\u5f02;\u6b64\u5916\uff0cICU\u6b7b\u4ea1\u7387\u548c\u975e\u673a\u68b0\u901a\u6c14\u5929\u6570\u7684\u7ed3\u679c\u76f8\u4f3c\u3002\u4f46\u5728\u5f00\u653e\u80ba\u7b56\u7565\u7ec4\uff0c\u6c27\u5408\u3001\u80ba\u529b\u5b66\u548c\u9a71\u52a8\u538b\u5747\u6709\u663e\u8457\u6539\u5584\u3002<\/p>\n
PEEP\u7684\u83b7\u76ca\u6548\u679c\u4ec5\u53d1\u751f\u5728\u80ba\u6ce1\u5177\u5907\u53ef\u590d\u5f20\u6f5c\u80fd\u7684\u60a3\u8005\u4e2d\u3002\u6ca1\u6709\u5bf9\u80ba\u7684\u53ef\u590d\u5f20\u6027\u8fdb\u884c\u8bc4\u4f30\uff0c\u5c31\u8fdb\u884c\u7ecf\u9a8c\u6027\u80ba\u590d\u5f20\uff0c\u53ef\u80fd\u4f1a\u5bf9\u5b58\u5728\u80ba\u53ef\u590d\u5f20\u6027\u7684\u60a3\u8005\u4ea7\u751f\u83b7\u76ca\u6548\u679c\uff1b\u4f46\u662f\uff0c\u5bf9\u4e8e\u6ca1\u6709\u80ba\u90e8\u53ef\u590d\u5f20\u6027\u7684\u60a3\u8005\u7ed3\u679c\u6070\u6070\u76f8\u53cd\uff0c\u53ef\u80fd\u4f1a\u5bfc\u81f4\u80ba\u8fc7\u5ea6\u81a8\u80c0\u76f8\u5173\u7684\u8d1f\u9762\u6548\u679c\u4ea7\u751f\u3002\u5728\u80ba\u90e8\u6ca1\u6709\u53ef\u590d\u5f20\u7684\u60a3\u8005\u4e2d\uff0c\u4efb\u4f55\u9ad8PEEP\u76f8\u5173\u76ca\u5904\u90fd\u53ef\u80fd\u88ab\u5bb3\u5904\u6240\u62b5\u6d88\u3002\u56e0\u6b64\uff0c\u60a3\u8005\u7684\u5f02\u8d28\u6027\u53ef\u80fd\u4f1a\u6df7\u6dc6\u4f7f\u7528\u56fa\u5b9aPEEP\u6c34\u5e73\u7684\u8bd5\u9a8c\uff0c\u8fd9\u4e9b\u60a3\u8005\u5728\u590d\u5f20\u7684\u53ef\u80fd\u6027\u4e0a\u7684\u53d8\u5f02\u5f88\u5927\u3002\u88682\u6c47\u603b\u4e86\u628a\u4e0d\u540cPEEP\u6c34\u5e73\u8fdb\u884c\u6bd4\u8f83\u7684\u5bf9\u7167\u7814\u7a76\u3002<\/p>\n
\u88682. \u5728ARDS\u60a3\u8005\u4e2d\u628a\u4e0d\u540cPEEP\u6c34\u5e73\u8fdb\u884c\u6bd4\u8f83\u7684\u7814\u7a76<\/p>\n
\u8981\u70b9<\/p>\n
\u25ce \u9002\u5f53\u7684PEEP\u6c34\u5e73\u5fc5\u987b\u662f\u6839\u636e\u60a3\u8005\u80ba\u90e8\u7684\u53ef\u590d\u5f20\u6027\u800c\u4e2a\u4f53\u5316\u8bbe\u5b9a\u7684\u3002<\/p>\n
\u25ce \u7ecf\u9a8c\u6027\u4f7f\u7528\u9ad8PEEP\u4e0d\u592a\u53ef\u80fd\u83b7\u76ca\u3002<\/p>\n
\u25ce \u5bf9\u589e\u52a0PEEP\u6c34\u5e73\u800c\u51fa\u73b0\u7684\u6c27\u5408\u53cd\u5e94\u53ef\u80fd\u662f\u4e00\u4e2a\u5408\u9002\u7684\u751f\u7406\u5b66\u7ec8\u70b9\uff0c\u5e76\u5df2\u88ab\u8bc1\u660e\u53ef\u4ee5\u6539\u5584\u751f\u5b58\u7387\u3002<\/p>\n
\u25ce \u968f\u7740PEEP\u6c34\u5e73\u7684\u5347\u9ad8\uff0c\u51fa\u73b0\u987a\u5e94\u6027\u7684\u6539\u5584\u548c\u9a71\u52a8\u538b\u7684\u4e0b\u964d\uff0c\u8fd9\u53ef\u80fd\u662f\u4e00\u4e2a\u63d0\u793a\u7740\u80ba\u5df2\u590d\u5f20\u7684\u6709\u7528\u4e34\u5e8a\u6307\u6807\u3002<\/p>\n
\u25ce \u5c3d\u7ba1\u4ee5\u8de8\u80ba\u538b\u4e3a\u5bfc\u5411\u7684PEEP\u5e94\u7528\u8bbe\u5b9a\u6709\u7740\u5f88\u5f3a\u7684\u751f\u7406\u5b66\u57fa\u7840\uff0c\u4f46\u4e34\u5e8a\u7ed3\u679c\u5374\u4ee4\u4eba\u5931\u671b\u3002<\/p>\n
\u25ce \u672a\u6765\u7684\u7814\u7a76\u5e94\u4fa7\u91cd\u4e8e\u6539\u8fdb\u53ef\u7528\u4e8e\u8bc4\u4f30\u80ba\u90e8\u53ef\u590d\u5f20\u6027\u7684\u65b9\u6cd5\uff0c\u4ece\u800c\u66f4\u7cbe\u786e\u7684\u6ef4\u5b9aPEEP\u6c34\u5e73\u3002<\/p>\n","protected":false},"excerpt":{"rendered":"
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