{"id":37175,"date":"2024-06-16T04:01:41","date_gmt":"2024-06-16T04:01:41","guid":{"rendered":"https:\/\/zydq.1006ss.com\/?p=37175"},"modified":"2024-06-16T04:01:41","modified_gmt":"2024-06-16T04:01:41","slug":"%e4%b8%ad%e6%96%87%e7%bf%bb%e8%af%91-esicm%e6%80%a5%e6%80%a7%e5%91%bc%e5%90%b8%e7%aa%98%e8%bf%ab%e7%bb%bc%e5%90%88%e5%be%81%e6%8c%87%e5%8d%97%ef%bc%9a%e5%ae%9a%e4%b9%89%e3%80%81%e8%a1%a8%e5%9e%8b","status":"publish","type":"post","link":"http:\/\/zydq.1006ss.com\/?p=37175","title":{"rendered":"\u4e2d\u6587\u7ffb\u8bd1 | ESICM\u6025\u6027\u547c\u5438\u7a98\u8feb\u7efc\u5408\u5f81\u6307\u5357\uff1a\u5b9a\u4e49\u3001\u8868\u578b\u548c\u547c\u5438\u652f\u6301\u7b56\u7565"},"content":{"rendered":"<p>\u7ffb\u8bd1\u56e2\u961f\uff1a\u738b\u6dd1\u96c5 \u9648\u96e8\u6674 \u738b\u7389\u59b9 \u5f20\u7433\u7433 \u5468\u5efa\u82b3 \u5218\u5e05&nbsp;\u5468\u76ca\u6c11 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maneuvers\uff0cRM\uff09\uff1b\u4fef\u5367\u4f4d\u901a\u6c14\uff1b\u795e\u7ecf\u808c\u8089\u963b\u6ede\u5242\uff1b\u4f53\u5916\u751f\u547d\u652f\u6301\uff08extracorporeal life support\uff0cECLS\uff09\u3002\u6b64\u5916\uff0c\u8be5\u6307\u5357\u8fd8\u5305\u62ec\u4e86\u4e34\u5e8a\u5b9e\u8df5\u7684\u4e13\u5bb6\u610f\u89c1\uff0c\u5e76\u786e\u5b9a\u4e86\u672a\u6765\u7814\u7a76\u7684\u9886\u57df\u3002\u672c\u6587\u5bf9\u8be5\u6307\u5357\u8fdb\u884c\u4e86\u8be6\u7ec6\u7684\u4e2d\u6587\u7ffb\u8bd1\uff0c\u4ee5\u4f9b\u91cd\u75c7\u540c\u9053\u53c2\u8003\u3002<\/p>\n<p>\u3010\u5173\u952e\u8bcd\u3011\u6025\u6027\u4f4e\u6c27\u6027\u547c\u5438\u8870\u7aed\uff1b\u6025\u6027\u547c\u5438\u7a98\u8feb\u7efc\u5408\u5f81\uff1b\u5b9a\u4e49\uff1b\u547c\u5438\u652f\u6301\u7b56\u7565\uff1b\u5b9e\u8df5\u6307\u5357<\/p>\n<p>1 \u524d\u8a00<\/p>\n<p>\u6025\u6027\u547c\u5438\u7a98\u8feb\u7efc\u5408\u5f81\uff08acute respiratory distress syndrome\uff0cARDS\uff09\u662f\u9002\u7528\u4e8e\u4e00\u7cfb\u5217\u75c5\u56e0\u4e0d\u540c\u4f46\u4e34\u5e8a\u75c5\u7406\u7279\u5f81\u76f8\u540c\u7684\u75be\u75c5\u7684\u672f\u8bed\uff0c\u5305\u62ec\uff1a\u2460\u80ba\u6ce1\u6bdb\u7ec6\u8840\u7ba1\u819c\u901a\u900f\u6027\u589e\u52a0\uff0c\u5bfc\u81f4\u708e\u6027\u6c34\u80bf\uff1b\u2461\u975e\u901a\u6c14\u80ba\u7ec4\u7ec7\u589e\u52a0\u5bfc\u81f4\u80ba\u5f39\u6027\u53d8\u5dee\uff08\u987a\u5e94\u6027\u4e0b\u964d\uff09\uff1b\u2462\u80ba\u5185\u5206\u6d41\u548c\u6b7b\u8154\u901a\u6c14\u589e\u52a0\uff0c\u5bfc\u81f4\u4f4e\u6c27\u8840\u75c7\u548c\u9ad8\u78b3\u9178\u8840\u75c7<sup>[1]<\/sup>\u3002\u8fc7\u53bb55\u5e74\u91cc\uff0cARDS\u7684\u5b9a\u4e49\u4e3b\u8981\u96c6\u4e2d\u5728\u8be5\u7efc\u5408\u5f81\u7684\u5f71\u50cf\u5b66\u8868\u73b0\u548c\u6c27\u5408\u969c\u788d\uff08\u4f8b\u5982\uff0c\u6c27\u5408\u6307\u6570PaO2\/FiO2\uff09\u7684\u4e25\u91cd\u7a0b\u5ea6\uff0c\u540c\u65f6\u53cd\u6620\u4e86\u5bf9\u8be5\u7efc\u5408\u5f81\u7684\u539f\u59cb\u63cf\u8ff0\u548c\u6982\u5ff5\u7684\u7406\u89e3<sup>[1-2]<\/sup>\u3002\u76ee\u524d\u7684\u5b9a\u4e49\u662f\u67cf\u6797\u5b9a\u4e49<sup>[3]<\/sup>\uff0c\u5373\u5728\u8bca\u65adARDS\u65f6\uff0c\u60a3\u8005\u63a5\u53d7\u4e86\u81f3\u5c115cmH2O\u7684\u547c\u6c14\u672b\u6b63\u538b\uff08positive end-expiratory pressure\uff0cPEEP\uff09\u3002\u56e0\u6b64\u5728\u5f62\u5f0f\u4e0a\uff0c\u672a\u63a5\u53d7\u6b63\u538b\u901a\u6c14\u7684\u60a3\u8005\u4e0d\u80fd\u88ab\u8ba4\u4e3a\u7f79\u60a3ARDS\u3002\u7136\u800c\uff0c\u8bb8\u591a\u6025\u6027\u4f4e\u6c27\u6027\u547c\u5438\u8870\u7aed\uff08acute hypoxemic respiratory failure\uff0cAHRF\uff09\u60a3\u8005\u6709\u76f8\u540c\u7684\u75c5\u7406\u751f\u7406\u7279\u5f81\uff0c\u7279\u522b\u662f\u7531\u4e8e\u7ec6\u83cc\u6027\u6216\u75c5\u6bd2\u6027\u80ba\u708e\u6216\u8113\u6bd2\u6027\u4f11\u514b\u5f15\u8d77AHRF\u7684\u60a3\u8005\uff0c\u56e0\u6b64\u8fd9\u4e9b\u60a3\u8005\u4e5f\u88ab\u7eb3\u5165\u8be5\u6307\u5357\u3002<\/p>\n<p>ARDS\u60a3\u8005\u7ea6\u5360\u91cd\u75c7\u52a0\u5f3a\u533b\u7597\u75c5\u623f\uff08intensive care unit\uff0cICU\uff09\u4f4f\u9662\u4eba\u6570\u768410%\uff0c\u673a\u68b0\u901a\u6c14\u60a3\u8005\u768423%\uff0c\u91cd\u75c7\u60a3\u8005\u6b7b\u4ea1\u7387\u9ad8\u8fbe45%<sup>[4]<\/sup>\u3002\u4eba\u4eec\u8ba4\u8bc6\u5230ARDS\u60a3\u8005\u6613\u53d1\u751f\u673a\u68b0\u901a\u6c14\u76f8\u5173\u7684\u547c\u5438\u673a\u76f8\u5173\u6027\u80ba\u635f\u4f24\uff08ventilator-induced lung injury\uff0cVILI\uff09<sup>[5]<\/sup>\uff0c\u56e0\u6b64\u5236\u5b9a\u4e86\u65e8\u5728\u51cf\u5c11\u603b\u5e94\u529b\uff08\u8de8\u80ba\u538b\uff09\u548c\u5e94\u53d8\uff08\u6f6e\u6c14\u91cftidal volume\uff0cVT\u4e0e\u529f\u80fd\u6b8b\u6c14\u91cf\u4e4b\u6bd4\uff09\u7684\u80ba\u4fdd\u62a4\u6027\u901a\u6c14\u7b56\u7565<sup>[6]<\/sup>\uff0c\u5305\u62ec\u964d\u4f4eVT\u548c\u5e73\u53f0\u538b\uff08plateau airway pressure\uff0cPplat\uff09\u4ee5\u4fdd\u62a4\u201c\u5a74\u513f\u80ba\u201d<sup>[7]<\/sup>\uff1b\u4f7f\u7528PEEP\u548c\u80ba\u590d\u5f20\uff08recruitment maneuvers\uff0cRM\uff09\u65b9\u6cd5\u4ee5\u51cf\u5c11\u975e\u901a\u6c14\u80ba\u7ec4\u7ec7\uff1b\u4fef\u5367\u4f4d\u901a\u6c14\u4ee5\u6539\u5584\u80ba\u7684\u5747\u5300\u6027\uff0c\u589e\u52a0\u901a\u6c14\/\u8840\u6d41\u6bd4\u4ee5\u53ca\u80ba\/\u80f8\u58c1\u5339\u914d\u7a0b\u5ea6\uff0c\u51cf\u5c11\u8de8\u80ba\u538b\u548c\u5e94\u529b\u4ee5\u964d\u4f4eVILI\u7684\u98ce\u9669<sup>[8]<\/sup>\u3002\u4fef\u5367\u4f4d\u901a\u6c14\u53ef\u6539\u5584\u4e2d\u91cd\u5ea6ARDS\u60a3\u8005\u7684\u9884\u540e<sup>[9-10]<\/sup>\u3002<\/p>\n<p>\u540c\u65f6\uff0c\u4e34\u5e8a\u533b\u751f\u548c\u7814\u7a76\u4eba\u5458\u8bd5\u56fe\u4f7f\u7528\u65e0\u521b\u547c\u5438\u652f\u6301\u65b9\u5f0f\uff08\u5982\u65e0\u521b\u901a\u6c14\u3001\u7ecf\u9f3b\u9ad8\u6d41\u91cf\u6c27\u7597\uff09\u4ee5\u907f\u514d\u5bf9\u65e9\u671fAHRF\u60a3\u8005\u8fdb\u884c\u6709\u521b\u901a\u6c14\u3002\u8fd9\u4e9b\u7597\u6cd5\u65e8\u5728\u6539\u5584\u6c27\u5408\u548c\u51cf\u8f7b\u547c\u5438\u808c\u8d1f\u8377\uff0c\u4ece\u800c\u51cf\u5c11\u5438\u6c14\u52aa\u529b\u548c\u60a3\u8005\u81ea\u6215\u6027\u80ba\u635f\u4f24\uff08patient-self-inflicted lung injury\uff0cP-SILI\uff09\u7684\u98ce\u9669<sup>[11]<\/sup>\uff0c\u5e76\u5728\u4e0d\u9700\u8981\u9547\u9759\u53ca\u6c14\u7ba1\u63d2\u7ba1\u7684\u60c5\u51b5\u4e0b\uff0c\u4e3a\u6cbb\u7597\u539f\u53d1\u75c5\u4e89\u53d6\u65f6\u95f4\u3002\u5bf9\u4e8e\u75c5\u60c5\u66f4\u4e25\u91cd\u7684\u60a3\u8005\uff0c\u7406\u8bba\u4e0a\u53ef\u4ee5\u901a\u8fc7\u4f53\u5916\u652f\u6301\u6280\u672f\u51cf\u5c11VILI<sup>[5]<\/sup>\uff0c\u8be5\u6280\u672f\u4fdd\u8bc1\u90e8\u5206\u6216\u5145\u5206\u6c27\u5408\u548c\/\u6216\u6e05\u9664\u4e8c\u6c27\u5316\u78b3\uff0c\u5e76\u663e\u8457\u964d\u4f4e\u547c\u5438\u673a\u652f\u6301\u529b\u5ea6<sup>[12]<\/sup>\u3002<\/p>\n<p>\u8be5\u6307\u5357\u7684\u76ee\u7684\u662f\u56de\u987e\u548c\u603b\u7ed3\u81ea\u6b27\u6d32\u5371\u91cd\u75c7\u533b\u5b66\u4f1a\uff08the European Society of Intensive Care Medicine\uff0cESICM\uff092017\u7248\u4e34\u5e8a\u5b9e\u8df5\u6307\u5357\uff08clinical practice guideline\uff0cCPG\uff09\u4ee5\u6765\u53d1\u8868\u7684\u6709\u5173ARDS\u548cAHRF\u4e0d\u540c\u65b9\u9762\u7684\u6587\u732e<sup>[13]<\/sup>\uff0c\u5305\u62ecICU\u4e2d\u75312019\u65b0\u578b\u51a0\u72b6\u75c5\u6bd2\u75c5\uff08coronavirus disease 2019\uff0cCOVID\u201119\uff09\u5f15\u8d77\u7684ARDS\u3002\u8be5\u6307\u5357\u7ed3\u5408\u4e86\u5bf9\u4e34\u5e8a\u7814\u7a76\u65b9\u6cd5\u5b66\u7684\u4e25\u683c\u8bc4\u4f30\u548c\u5bf9\u60a3\u8005\u547c\u5438\u7ba1\u7406\u7684\u4e13\u5bb6\u610f\u89c1\uff0c\u9650\u4e8e\u6210\u4eba\u60a3\u8005\u548c\u975e\u836f\u7269\u547c\u5438\u652f\u6301\u7b56\u7565\uff08\u9664\u5916\u4f5c\u4e3a\u673a\u68b0\u901a\u6c14\u8f85\u52a9\u836f\u7269\u7684\u795e\u7ecf\u808c\u8089\u963b\u6ede\u5242\uff09\u3002\u8fd9\u9879\u5de5\u4f5c\u4e0d\u5305\u62ec\u6210\u672c\u6548\u76ca\u5206\u6790\u3002\u672c\u6587\u5bf92023\u7248\u6307\u5357\u8fdb\u884c\u4e86\u4e2d\u6587\u7ffb\u8bd1\uff0c\u4ee5\u4f9b\u91cd\u75c7\u540c\u9053\u53c2\u8003\u3002<\/p>\n<p>2 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ventilation\uff0cNIV\uff09\uff1b\u2464VT\u8bbe\u7f6e\uff1b\u2465PEEP\u548cRM\uff1b\u2466\u4fef\u5367\u4f4d\uff1b\u2467\u795e\u7ecf\u808c\u8089\u963b\u6ede\u5242\uff1b\u2468\u4f53\u5916\u751f\u547d\u652f\u6301\uff08extracorporeal life support\uff0cECLS\uff09\u3002\u6bcf\u4e2a\u9886\u57df\u90fd\u88ab\u5206\u914d\u7ed9\u4e13\u5bb6\u5c0f\u7ec4\u5185\u7684\u4e00\u7ec4\u4e13\u5bb6\uff0c\u5e76\u4e14\u6bcf\u4e2a\u9886\u57df\u90fd\u7531\u4e00\u4e2a\u201c\u9886\u57df\u4e13\u5bb6\u4e3b\u5e2d\u201d\u8fdb\u884c\u534f\u8c03\u3002\u6839\u636e\u5c0f\u7ec4\u6210\u5458\u7684\u79d1\u5b66\u4e13\u4e1a\u77e5\u8bc6\u3001\u5730\u57df\u4ee3\u8868\u6027\u548c\u6240\u8868\u8fbe\u7684\u5174\u8da3\u9080\u8bf7\u5176\u52a0\u5165\u4e00\u4e2a\u6216\u591a\u4e2a\u5de5\u4f5c\u7ec4\u3002\u6307\u5357\u5236\u8ba2\u4e13\u5bb6\u5c0f\u7ec4\u8fd8\u5305\u62ec\u53e6\u5916\u4e24\u540d\u65b9\u6cd5\u5b66\u5bb6\u548c\u516b\u540d\u60a3\u8005\u4ee3\u8868\u3002<\/p>\n<p>2.2\u7814\u7a76\u95ee\u9898\u9009\u62e9\u548c\u6587\u732e\u68c0\u7d22<\/p>\n<p>\u6bcf\u4e2a\u9886\u57df\u7684\u6210\u5458\u6839\u636e\u60a3\u8005\u6216\u4eba\u7fa4\u3001\u5e72\u9884\u3001\u5bf9\u7167\u3001\u7ed3\u5c40\uff08the Patients or Population-Intervention-Comparison-Outcome\uff0cPICO\uff09\u683c\u5f0f\u5236\u5b9a\u95ee\u9898\u3002\u6307\u5357\u4e3b\u5e2d\u3001\u65b9\u6cd5\u5b66\u5bb6\u548c\u4e13\u5bb6\u5c0f\u7ec4\u6210\u5458\u5bf9\u6bcf\u4e2aPICO\u95ee\u9898\u8fdb\u884c\u8ba8\u8bba\u5e76\u8fbe\u6210\u4e00\u81f4\u3002\u4f7f\u7528PubMed\u5bf9\u6bcf\u4e2aPICO\u95ee\u9898\u8fdb\u884c\u6709\u9488\u5bf9\u6027\u7684\u7cfb\u7edf\u6587\u732e\u641c\u7d22\u3002\u9886\u57df1\u672a\u5bf9\u6587\u732e\u8fdb\u884c\u7cfb\u7edf\u8bc4\u4ef7\uff0c\u4ec5\u7531\u4e13\u5bb6\u5c0f\u7ec4\u6210\u5458\u4eec\u5bf9ARDS\u5b9a\u4e49\u8fdb\u884c\u4e86\u8ba8\u8bba\u3002\u9886\u57df2\u5bf9\u6587\u732e\u8fdb\u884c\u4e86\u7cfb\u7edf\u8bc4\u4ef7\u548c\u8bc1\u636e\u603b\u7ed3\uff0c\u4f46\u6ca1\u6709\u5bf9\u8bc1\u636e\u8fdb\u884c\u5206\u7ea7\u3002\u8be5\u9886\u57df\u7684\u5927\u591a\u6570\u7814\u7a76\u96c6\u4e2d\u5728\u4e0d\u540c\u4e9a\u8868\u578b\u7684\u9884\u540e\u4e0a\uff0c\u5c11\u6570\u7814\u7a76\u5bf9\u4e9a\u8868\u578b\u5e72\u9884\u7684\u6709\u6548\u6027\u8fdb\u884c\u7814\u7a76\uff0c\u5176\u76ee\u7684\u4e0d\u4ec5\u4ec5\u662f\u63d0\u4f9b\u652f\u6301\u6cbb\u7597\u7684\u8bc1\u636e\uff0c\u66f4\u662f\u4ea7\u751f\u5047\u8bbe\u4ee5\u5728\u672a\u6765\u8bd5\u9a8c\u4e2d\u8fdb\u884c\u9a8c\u8bc1\u3002\u5bf9\u4e8e\u9886\u57df1\u548c\u9886\u57df2\uff0c\u503e\u5411\u4e8e\u91c7\u7528\u53d9\u8ff0\u6027\u65b9\u5f0f\uff0c\u800c\u4e0d\u662f\u7cfb\u7edf\u5730\u6839\u636e\u63a8\u8350\u610f\u89c1\u7684\u5206\u7ea7\u8bc4\u4f30\u3001\u5236\u8ba2\u53ca\u8bc4\u4ef7\uff08the Grading of Recommendations Assessment\uff0cDevelopment\uff0cand Evaluation\uff0cGRADE\uff09\u65b9\u6cd5\u8fdb\u884c\u5206\u7ea7\u3002<\/p>\n<p>\u6587\u732e\u641c\u7d22\u540e\uff0c\u6765\u81ea\u6bcf\u4e2a\u9886\u57df\u7684\u6210\u5bf9\u5ba1\u7a3f\u4eba\u72ec\u7acb\u5ba1\u9605\u6807\u9898\uff0c\u5e76\u9009\u62e9\u8981\u7eb3\u5165Meta\u5206\u6790\u7684\u6700\u7ec8\u5168\u6587\u7814\u7a76\u5217\u8868\u3002\u65b9\u6cd5\u5b66\u5bb6\u5bf9\u6bcf\u4e2a\u7814\u7a76\u8fdb\u884c\u6570\u636e\u63d0\u53d6\u3001\u603b\u7ed3\u5e76\u8bc4\u4f30\u504f\u501a\u98ce\u9669\u3002<\/p>\n<p>2.3&nbsp;\u5236\u8ba2\u63a8\u8350\u610f\u89c1\u548c\u5171\u8bc6<\/p>\n<p>2.3.1&nbsp;\u65b9\u6cd5\u5b66<\/p>\n<p>\u5728\u56de\u987e\u6587\u732e\u68c0\u7d22\u548cMeta\u5206\u6790\u7684\u7ed3\u679c\u540e\uff0c\u6bcf\u4e2a\u9886\u57df\u7684\u6210\u5458\u5f62\u6210\u4e86\u4e0e\u6bcf\u4e2aPICO\u683c\u5f0f\u6216\u53d9\u4e8b\u6027\u95ee\u9898\u76f8\u5173\u7684\u9648\u8ff0\uff08\u63a8\u8350\u610f\u89c1\uff09\u3002\u63a8\u8350\u610f\u89c1\u662f\u57fa\u4e8e\u4e09\u4e2a\u4e3b\u8981\u6807\u51c6\u7684\u6574\u5408\uff1a\u2460\u8bc1\u636e\u7684\u786e\u5b9a\u6027\uff08\u6839\u636e\u65b9\u6cd5\u5b66\u8bc4\u4f30\uff09\uff1b\u2461GRADE\u65b9\u6cd5<sup>[8]<\/sup>\uff1b\u2462\u4e13\u5bb6\u610f\u89c1\u3002\u5728\u6709\u60a3\u8005\u4ee3\u8868\u53c2\u4e0e\u7684\u56db\u6b21\u4e13\u5bb6\u5c0f\u7ec4\u7f51\u7edc\u4f1a\u8bae\u4e0a\u5bf9\u62df\u63d0\u51fa\u7684\u63a8\u8350\u610f\u89c1\u4ee5\u53ca\u76f8\u5e94\u7684\u8bc1\u636e\u603b\u7ed3\u8fdb\u884c\u4e86\u4ecb\u7ecd\u548c\u8ba8\u8bba\u3002\u4e3a\u65e0\u6cd5\u51fa\u5e2d\u7684\u6210\u5458\uff0c\u4e5f\u4e3a\u4e86\u51c6\u786e\u62a5\u544a\u4e13\u5bb6\u5c0f\u7ec4\u8ba8\u8bba\u7684\u5185\u5bb9\uff0c\u5bf9\u56db\u6b21\u4f1a\u8bae\u8fdb\u884c\u4e86\u8bb0\u5f55\u3002\u5728\u6bcf\u6b21\u4e13\u5bb6\u5c0f\u7ec4\u4f1a\u8bae\u4e4b\u540e\uff0c\u4f1a\u6839\u636e\u6536\u5230\u7684\u53cd\u9988\u610f\u89c1\u4fee\u8ba2\u63a8\u8350\u610f\u89c1\u3002\u6700\u7ec8\u7684\u63a8\u8350\u610f\u89c1\u53d1\u9001\u7ed9\u6bcf\u4f4d\u4e13\u5bb6\u5c0f\u7ec4\u6210\u5458\u8fdb\u884c\u7f51\u7edc\u533f\u540d\u6295\u7968\u3002\u5f3a\u63a8\u8350\u63cf\u8ff0\u4e3a\u201c\u63a8\u8350\u201d\uff0c\u5f31\u63a8\u8350\u63cf\u8ff0\u4e3a\u201c\u5efa\u8bae\u201d\u3002\u81f3\u5c11\u9700\u898180%\u7684\u4e13\u5bb6\u5c0f\u7ec4\u6210\u5458\u540c\u610f\u624d\u80fd\u901a\u8fc7\u8be5\u63a8\u8350\u610f\u89c1\u3002\u8d5e\u540c\u7387\u4f4e\u4e8e80%\u7684\u63a8\u8350\u610f\u89c1\u5c06\u88ab\u91cd\u65b0\u5236\u8ba2\u5e76\u91cd\u65b0\u6295\u7968\uff0c\u76f4\u5230\u83b7\u5f97\u4e86\u8d85\u8fc780%\u7684\u540c\u610f\u4e3a\u6b62\u3002<\/p>\n<p>3 \u9886\u57df1\uff1aARDS\u7684\u5b9a\u4e49<\/p>\n<p>1967\u5e74\uff0cAshbaugh\u56e2\u961f\u9996\u6b21\u572812\u540d\u65b0\u53d1\u4f4e\u6c27\u8840\u75c7\u60a3\u8005\u4e2d\u63cf\u8ff0\u4e86ARDS\uff0c\u8fd9\u4e9b\u60a3\u8005\u5bf9\u6c27\u7597\u4e0d\u654f\u611f\uff0c\u80f8\u7247\u4e0a\u63d0\u793a\u53cc\u4fa7\u6d78\u6da6\u5f71\uff0c\u547c\u5438\u7cfb\u7edf\u987a\u5e94\u6027\u964d\u4f4e\u3002\u6b7b\u4ea1\u60a3\u8005\u7684\u80ba\u90e8\u5747\u51fa\u73b0\u4e86\u708e\u75c7\u3001\u6c34\u80bf\u548c\u900f\u660e\u819c\u7684\u5f62\u6210<sup>[2]<\/sup>\u3002\u968f\u540e\uff0cARDS\u7684\u8bca\u65ad\u7531\u975e\u6b63\u5f0f\u7684\u8bc6\u522b\u6a21\u5f0f\u53d1\u5c55\u4e3a\u6b63\u5f0f\u7684\u4e34\u5e8a\u5b9a\u4e49\u30021994\u5e74\u5728\u7f8e\u56fd-\u6b27\u6d32\u5171\u8bc6\u4f1a\u8bae\uff08American-European Consensus Conference\uff0cAECC\uff09\u4e0a\u80af\u5b9a\u4e861988\u5e74\u63d0\u51fa\u7684\u201c\u80ba\u635f\u4f24\u8bc4\u5206\u201d\u7684\u5b9a\u4e49<sup>[14-15]<\/sup>\uff0c\u5e76\u5728ESICM\u7684\u652f\u6301\u4e0b\u8fdb\u4e00\u6b65\u66f4\u65b0\uff0c\u6700\u7ec8\u5f62\u6210\u4e862012\u5e74\u7684\u201cARDS\u67cf\u6797\u5b9a\u4e49\u201d\uff08\u4ee5\u4e0b\u7b80\u79f0\u67cf\u6797\u5b9a\u4e49\uff09<sup>[1-3]<\/sup>\u3002\u4f5c\u4e3a\u300a2023\u5e74ESICM ARDS\u6cbb\u7597\u6307\u5357\u300b\uff08\u4ee5\u4e0b\u7b80\u79f02023\u5e74\u6307\u5357\uff09\u7684\u4e00\u90e8\u5206\uff0c\u8d1f\u8d23\u5b9a\u4e49\u90e8\u5206\u7684\u4e13\u5bb6\u5c0f\u7ec4\u6839\u636e\u8fc7\u53bb\u5341\u5e74\u7684\u77e5\u8bc6\u79ef\u7d2f\u548c\u5f53\u524dARDS\u5b9a\u4e49\u76f8\u5173\u7684\u4e89\u8bae\uff0c\u91cd\u70b9\u63d0\u51fa\u4e86\u540e\u7eed\u5b9a\u4e49\u4fee\u8ba2\u4e2d\u5e94\u5173\u6ce8\u7684\u95ee\u9898\u3002<\/p>\n<p>\u4e13\u5bb6\u5c0f\u7ec4\u8ba8\u8bba\u4e86\u5173\u4e8e\u6269\u5927ARDS\u5b9a\u4e49\u7684\u8303\u56f4\u53ca\u5176\u5229\u5f0a\u3002\u8fd9\u4e2a\u5b9a\u4e49\u5728\u8d44\u6e90\u532e\u4e4f\u7684\u73af\u5883\u4e2d\u5c24\u4e3a\u91cd\u8981<sup>[16]<\/sup>\u3002\u4f8b\u5982\uff0c\u5728\u8fc7\u53bb\u5341\u5e74\u4e2d\uff0c\u5c24\u5176\u662f\u5728COVID-19\u5927\u6d41\u884c\u671f\u95f4\uff0cHFNO\u7684\u4f7f\u7528\u660e\u663e\u589e\u52a0\u3002\u652f\u6301\u8005\u5efa\u8bae\uff1a\u4fee\u6539ARDS\u5b9a\u4e49\uff0c\u5bf9\u4e8e\u63a5\u53d7HFNO\u7684\u60a3\u8005\uff0c\u5373\u4f7f\u6ca1\u6709\u8fbe\u5230PEEP \u2265 5 cmH2O\u7684\u8981\u6c42\uff08\u6839\u636e\u67cf\u6797\u5b9a\u4e49\u7684\u6807\u51c6\uff09<sup>[17]<\/sup>\uff0c\u4e5f\u5e94\u8be5\u7eb3\u5165\u7b26\u5408ARDS\u7684\u6807\u51c6\u3002\u8fd9\u7c7b\u60a3\u8005\u5177\u6709\u4e25\u91cd\u7684\u4f4e\u6c27\u8840\u75c7\uff0c\u4f46\u4ed6\u4eec\u5927\u90e8\u5206\u63a5\u53d7HFNO\u6cbb\u7597\uff0c\u9700\u8981\u8f83\u9ad8\u7684\u6d41\u901f\u548c\u8f83\u9ad8\u7684\u5438\u6c27\u6d53\u5ea6<sup>[17]<\/sup>\u3002\u751a\u81f3\u6709\u4e00\u4e9b\u652f\u6301\u8005\u8ba4\u4e3a\uff0c\u65e0\u8bba\u4f7f\u7528\u4f55\u79cd\u4f9b\u6c27\u8bbe\u5907\uff0c\u90fd\u5e94\u53d6\u6d88\u5bf9PEEP\u7684\u8981\u6c42\uff0c\u4ee5\u4fbf\u5728\u65e0\u6cd5\u6301\u7eed\u83b7\u5f97HFNO\u6216\u6709\u521b\u673a\u68b0\u901a\u6c14\u7684\u60c5\u51b5\u4e0b\u4e5f\u80fd\u8bca\u65adARDS\u3002\u800c\u53cd\u5bf9\u8005\u8ba4\u4e3a\uff0c\u8fd9\u79cd\u505a\u6cd5\u53ef\u80fd\u4f4e\u4f30ARDS\u60a3\u8005\u7684\u75c5\u60c5\u4e25\u91cd\u7a0b\u5ea6\uff0c\u56e0\u5176\u4f1a\u5c06\u90e8\u5206\u9884\u540e\u8f83\u597d\u7684\u60a3\u8005\u8bca\u65ad\u4e3aARDS<sup>[18]<\/sup>\uff0c\u6216\u5f71\u54cd\u7ec4\u95f4\u6bd4\u8f83\u3002\u540c\u6837\uff0c\u5728\u8fc7\u53bb\u5341\u5e74\u4e2d\u8d8a\u6765\u8d8a\u591a\u7684\u4eba\u4f7f\u7528SpO2\/FiO2\uff08S\/F\uff09\u6bd4\u503c\u800c\u975ePaO2\/FiO2\uff08P\/F\uff09\u6bd4\u503c\u6765\u8861\u91cf\u4f4e\u6c27\u8840\u75c7\u7684\u7a0b\u5ea6<sup>[19-20]<\/sup>\u3002\u652f\u6301\u8005\u8ba4\u4e3a\uff0cS\/F\u6bd4\u503c\u65e0\u521b\u4e14\u66f4\u6613\u83b7\u5f97\uff0c\u5f53\u524d\u6709\u968f\u673a\u5bf9\u7167\u8bd5\u9a8c\uff08randomized controlled trial\uff0cRCT\uff09\u4f7f\u7528S\/F\u6bd4\u503c\u6765\u8bc4\u4f30\u60a3\u8005\u6c27\u5408\u60c5\u51b5\u3002\u7136\u800c\uff0c\u53cd\u5bf9\u8005\u8ba4\u4e3aSpO2\u5e76\u4e0d\u51c6\u786e\uff0c\u5c24\u5176\u662f\u5728\u6df1\u8272\u4eba\u79cd\u3001\u4f11\u514b\u548c\/\u6216\u672b\u68a2\u704c\u6ce8\u4e0d\u826f\u7684\u60a3\u8005\u4e2d<sup>[21]<\/sup>\u3002\u53e6\u5916\uff0c\u8bb8\u591a\u60a3\u8005\u5728\u63a5\u53d7\u6cbb\u7597\u65f6SpO2\u4fdd\u6301\u572897%\u4ee5\u4e0a\uff0c\u8fd9\u53ef\u80fd\u5bfc\u81f4S\/F\u6bd4\u503c\u7f3a\u4e4f\u53c2\u8003\u4ef7\u503c<sup>[22]<\/sup>\u3002\u6700\u540e\uff0c\u9274\u4e8e\u80f8\u7247\u8bca\u65ad\u7684\u8f7b\u5230\u4e2d\u5ea6\u7684\u53ef\u9760\u6027\u4ee5\u53ca\u80f8\u7247\u7684\u53ef\u53ca\u6027<sup>[23-24]<\/sup>\uff0c\u662f\u5426\u5c06\u80f8\u90e8\u5f71\u50cf\u7eb3\u5165ARDS\u7684\u5b9a\u4e49\u4e5f\u4ecd\u662f\u4e00\u4e2a\u9700\u8981\u8003\u8651\u7684\u95ee\u9898\u3002\u6700\u8fd1\u7684\u4e00\u9879RCT\u7814\u7a76\u8868\u660e\uff0c\u5373\u4f7f\u7ecf\u8fc7\u6807\u51c6\u5316\u7684ARDS\u5f71\u50cf\u5b66\u57f9\u8bad\u540e\uff0c\u80f8\u90e8X\u5149\u7247\u5224\u8bfb\u80fd\u529b\u4ecd\u672a\u5f97\u5230\u663e\u8457\u6539\u5584<sup>[25]<\/sup>\u3002\u5728\u8fc7\u53bb\u5341\u5e74\u4e2d\uff0c\u5173\u4e8eARDS\u5f71\u50cf\u5b66\u8bca\u65ad\u7684\u5176\u4ed6\u65b9\u6cd5\u4e00\u76f4\u5b58\u5728\u4e89\u8bae\uff0c\u5176\u4e2d\u5305\u62ec\u5b8c\u5168\u53d6\u6d88\u5f71\u50cf\u5b66\u7684\u8bca\u65ad\u6807\u51c6\uff1b\u6216\u50cf\u513f\u79d1\u91cd\u75c7\u4e00\u6837\u5c06\u5355\u4fa7\u80ba\u4e0d\u5f20\u4e5f\u7eb3\u5165ARDS\u7684\u8bca\u65ad\u6807\u51c6<sup>[26]<\/sup>\uff1b\u6216\u8981\u6c42\u5fc5\u987b\u8fdb\u884c\u8ba1\u7b97\u673a\u65ad\u5c42\u626b\u63cf\uff08computed tomography\uff0cCT\uff09\u624d\u7b26\u5408ARDS\u5b9a\u4e49\uff08\u66f4\u51c6\u786e\u4f46\u53ef\u53ca\u6027\u66f4\u4f4e\uff0c\u5373\u4f7f\u5728\u4e09\u7ea7\u533b\u9662\uff09\uff1b\u6216\u52a0\u5165\u80ba\u90e8\u8d85\u58f0\uff08\u66f4\u6613\u83b7\u5f97\u4f46\u64cd\u4f5c\u7684\u719f\u7ec3\u5ea6\u9700\u8981\u8003\u8651\uff0c\u9700\u8981\u8fdb\u884c\u56fe\u50cf\u91c7\u96c6\u57f9\u8bad\uff09\u4e5f\u80fd\u7b26\u5408\u5b9a\u4e49\u7684\u6807\u51c6\u3002<\/p>\n<p>\u4e13\u5bb6\u5c0f\u7ec4\u8fd8\u8ba8\u8bba\u4e86\u60a3\u8005\u7b26\u5408ARDS\u6807\u51c6\u9700\u8981\u6301\u7eed\u7684\u6700\u77ed\u65f6\u9650\u3002\u4e13\u5bb6\u4eec\u4e00\u81f4\u8ba4\u4e3a\uff0cARDS\u4e0d\u662f\u4e00\u8fc7\u6027\u7684\u75c7\u72b6\uff0c\u800c\u662f\u4e00\u79cd\u6301\u7eed\u6570\u5929\u6216\u6570\u5468\u624d\u80fd\u7f13\u89e3\u7684\u7efc\u5408\u5f81\u3002\u5728ARDS network\u5f00\u5c55\u7684\u516d\u9879\u8bd5\u9a8c\u4e2d\uff0c\u5feb\u901f\u7ea0\u6b63\u7684ARDS\uff08\u5373P\/F\u6bd4\u503c&nbsp;&gt; 300\u6216\u5728\u8bca\u65ad\u540e24\u5c0f\u65f6\u5185\u62d4\u7ba1\uff09\u7684\u53d1\u751f\u7387\u5927\u4e8e10%\uff0c\u5e76\u4e14\u968f\u7740\u65f6\u95f4\u7684\u63a8\u79fb\u800c\u589e\u52a0<sup>[27]<\/sup>\u3002\u5982\u679c\u4e00\u9879\u8bd5\u9a8c\u4e2d\u7684\u53d7\u8bd5\u8005\u5bf9\u4e8e\u8be5\u8bd5\u9a8c\u7684\u5e72\u9884\u63aa\u65bd\u5c06\u9884\u9632\u7684\u60c5\u51b5\u7684\u53d1\u751f\u98ce\u9669\uff08\u5982VILI\uff09\u975e\u5e38\u4f4e\uff0c\u90a3\u4e48\u8bd5\u9a8c\u5c06\u65e0\u6cd5\u9a8c\u8bc1\u5e72\u9884\u63aa\u65bd\u7684\u4ef7\u503c\u3002\u8fd9\u4e9b\u6570\u636e\u63d0\u51fa\u4e86\u8fd9\u6837\u4e00\u4e2a\u95ee\u9898\uff1a\u60a3\u8005\u8fbe\u5230\u8bca\u65ad\u6807\u51c6\u540e\u5fc5\u987b\u6301\u7eed\u591a\u957f\u65f6\u95f4\u624d\u80fd\u88ab\u8bca\u65ad\u4e3aARDS\u3002\u4e13\u5bb6\u4eec\u4e00\u81f4\u8ba4\u4e3a\uff0c\u5728\u8bca\u65adARDS\u4e4b\u524d\uff0c\u81f3\u5c11\u8981\u6709\u4e00\u6bb5\u65f6\u95f4\u7684\u6301\u7eed\u671f\uff1b\u4f46\u662f\uff0c\u8fd9\u6bb5\u65f6\u95f4\u7684\u957f\u77ed\u4ecd\u4e0d\u786e\u5b9a\u3002\u8f83\u957f\u7684\u6301\u7eed\u671f\u53ef\u589e\u52a0\u7279\u5f02\u6027\uff0c\u4f46\u53ef\u80fd\u59a8\u788d\u65e9\u671f\u7684\u6cbb\u7597\u5e72\u9884\u3002\u7531\u4e8e\u6c27\u5408\u53ef\u80fd\u4f1a\u53d7\u5230\u4e34\u5e8a\u5e72\u9884\u548c\u547c\u5438\u673a\u8bbe\u7f6e\u7684\u5f71\u54cd\uff0c\u4e13\u5bb6\u4eec\u4e5f\u8ba8\u8bba\u4e86\u662f\u5426\u5e94\u8be5\u4f7f\u7528\u6807\u51c6\u5316\u7684\u547c\u5438\u673a\u8bbe\u7f6e\u6765\u5224\u65adARDS\u7684\u6c27\u5408\u60c5\u51b5\u4ee5\u8bc6\u522b\u9ad8\u98ce\u9669\u60a3\u8005\uff0c\u4f46\u8fd9\u53ef\u80fd\u4f1a\u5f71\u54cd\u8bd5\u9a8c\u5165\u7ec4<sup>[28-29]<\/sup>\uff0c\u800c\u4e14\u53ef\u80fd\u4e0d\u4f1a\u589e\u52a0\u989d\u5916\u7684\u4e34\u5e8a\u83b7\u76ca\u3002<\/p>\n<p>\u4e13\u5bb6\u5c0f\u7ec4\u6ce8\u610f\u5230\uff0cARDS\u7684\u6982\u5ff5\u6a21\u578b-\u5bf9\u635f\u4f24\u7684\u7279\u5b9a\u7c7b\u578b\u7684\u708e\u75c7\u53cd\u5e94\u548c\u5bbf\u4e3b\u53cd\u5e94-\u4e0eARDS\u5b9a\u4e49\u4e2d\u7f3a\u4e4f\u5bf9\u708e\u75c7\u6307\u6807\u7684\u6d4b\u91cf\u4e4b\u95f4\u5b58\u5728\u8131\u8282<sup>[3]<\/sup>\u3002\u9020\u6210\u8fd9\u79cd\u8131\u8282\u7684\u539f\u56e0\u662f\u53ef\u64cd\u4f5c\u7279\u5f81\u7684\u6570\u636e\u4e0d\u8db3\uff0c\u6216\u5bf9\u80ba\u90e8\u708e\u75c7\u53cd\u5e94\u6216\u514d\u75ab\u53cd\u5e94\u7684\u76f4\u63a5\u6d4b\u91cf\u7684\u65b9\u6cd5\u4e0d\u53ef\u53ca<sup>[1]<\/sup>\u3002\u5c3d\u7ba1\u5728\u8bc6\u522bARDS\u4e9a\u8868\u578b\uff08\u89c1\u9886\u57df2\uff09\u65b9\u9762\u5b9e\u73b0\u4e86\u4e00\u5b9a\u7684\u5e94\u7528\uff0c\u4f46\u4e3a\u534f\u8c03\u4e00\u4e2a\u4e34\u5e8a\u53ef\u884c\u7684ARDS\u75c5\u7406\u751f\u7406\u6982\u5ff5\u6a21\u578b\uff0c\u8fd8\u6709\u5f88\u591a\u5de5\u4f5c\u6709\u5f85\u5f00\u5c55\u3002\u540c\u65f6\uff0c\u4e13\u5bb6\u5c0f\u7ec4\u8fd8\u8ba8\u8bba\u4e86\u6b7b\u4ea1\u7387\u7684\u9884\u6d4b\u6709\u6548\u6027\u662f\u5426\u662f\u8861\u91cfARDS\u5b9a\u4e49\u7684\u6700\u4f73\u6807\u51c6\u3002\u5728\u7f3a\u4e4f\u7edf\u4e00\u7684\u53c2\u8003\u6807\u51c6\u7684\u60c5\u51b5\u4e0b\uff0cARDS\u7684\u8bca\u65ad\u51c6\u786e\u6027\u5177\u6709\u4e00\u5b9a\u7684\u96be\u5ea6\u3002\u672a\u6765\u5b8c\u5584ARDS\u5b9a\u4e49\u7684\u5de5\u4f5c\u5e94\u5145\u5206\u8003\u8651\u5176\u6709\u6548\u6027\u548c\u53ef\u9760\u6027<sup>[30]<\/sup>\u3002\u4e0e\u6b64\u540c\u65f6\uff0c\u672a\u6765\u4e5f\u9700\u8981\u66f4\u591a\u7684\u65b0\u7684\u524d\u77bb\u6027\u89c2\u5bdf\u6027\u7814\u7a76\uff0c\u6839\u636e\u5e7f\u6cdb\u7684\u7279\u5f81\uff08\u5305\u62ec\u5f71\u50cf\u5b66\u548c\u751f\u7269\u6807\u5fd7\u7269\uff09\uff0c\u66f4\u597d\u5730\u5bf9\u6025\u6027\u975e\u5fc3\u6e90\u6027\u4f4e\u6c27\u6027\u547c\u5438\u8870\u7aed\uff08\u5305\u62ecARDS\uff09\u60a3\u8005\u8fdb\u884c\u5206\u7c7b\uff0c\u4ee5\u671f\u5f00\u53d1\u66f4\u4e2a\u6027\u5316\u7684\u6cbb\u7597\u65b9\u6cd5\u3002\u5728\u83b7\u5f97\u8fd9\u7c7b\u4fe1\u606f\u4e4b\u524d\uff0c\u4e34\u5e8a\u533b\u751f\u5728\u51b3\u5b9a\u5b9e\u65bd\u67d0\u4e9b\u6cbb\u7597\u7b56\u7565\u65f6\uff0c\u5c24\u5176\u662f\u90a3\u4e9b\u4e0d\u9488\u5bf9\u7279\u5b9aARDS\u673a\u5236\u7684\u6cbb\u7597\u7b56\u7565\u65f6\uff0c\u53ef\u80fd\u4f1a\u8003\u8651\u4f7f\u7528\u66f4\u5e7f\u6cdb\u7684AHRF\u8fd9\u4e00\u540d\u79f0\u3002<\/p>\n<p>4 \u9886\u57df2\uff1aARDS\u8868\u578b<\/p>\n<p>\u8be5\u4e13\u5bb6\u5c0f\u7ec4\u8d1f\u8d23\u786e\u5b9a\u4e0eARDS\u8868\u578b\u76f8\u5173\u7684\u5173\u952e\u95ee\u9898\uff0c\u8be6\u7ec6\u9605\u8bfb\u548c\u8bc4\u4f30\u5f53\u524d\u6587\u732e\u4ee5\u89e3\u7b54\u8fd9\u4e9b\u95ee\u9898\uff0c\u5e76\u786e\u5b9a\u5728\u672a\u6765\u7814\u7a76\u4e2d\u9700\u8981\u89e3\u51b3\u7684\u77e5\u8bc6\u7a7a\u767d\u3002<\/p>\n<p>\u68c0\u7d22\u6ee1\u8db3\u4ee5\u4e0b\u7eb3\u5165\u6807\u51c6\u7684\u6587\u732e\u8fdb\u884c\u4e86\u7cfb\u7edf\u56de\u987e\u548c\u5206\u6790\uff1a\u2460\u6839\u636e\u672c\u5c0f\u7ec4\u7684\u5b9a\u4e49\u786e\u5b9a\u4e9a\u8868\u578b\uff08\u8be6\u89c1\u4e0b\u6587\uff09\uff1b\u2461\u4fa7\u91cdARDS\u60a3\u8005\u7684\u8868\u578b\u5206\u6790\uff1b\u2462\u4eba\u7c7b\u6837\u672c\u8d44\u6599\uff1b\u2463\u7eb3\u5165\u2265100\u4f8bARDS\u60a3\u8005\uff1b\u2464\u5305\u62ec\u6cbb\u7597\u6548\u679c\u5f02\u8d28\u6027\u6216\u60a3\u8005\u9884\u540e\u5dee\u5f02\u7684\u4e9a\u8868\u578b\u3002\u6700\u7ec8\u7eb3\u516525\u7bc7\u8bba\u6587<sup>[31-55]<\/sup>\u3002<\/p>\n<p>4.1 \u95ee\u98982.1\uff1a\u6211\u4eec\u5982\u4f55\u5b9a\u4e49ARDS\u4e9a\u8868\u578b\uff1f<\/p>\n<p>\u57fa\u4e8e\u73b0\u6709\u7684\u6587\u732e\u548c\u5de5\u4f5c\u7ec4\u8fbe\u6210\u7684\u5171\u8bc6\uff0c\u5236\u5b9a\u4e86\u4ee5\u4e0b\u5b9a\u4e49\uff1a\u2460\u8868\u578b\u662f\u7531\u57fa\u56e0\u578b\u548c\u73af\u5883\u66b4\u9732\u76f8\u4e92\u4f5c\u7528\u4ea7\u751f\u7684\u4e00\u7ec4\u4e34\u5e8a\u53ef\u89c2\u5bdf\u5230\u7684\u7279\u5f81\uff08\u5373ARDS\u662f\u4e00\u79cd\u8868\u578b\uff09\u3002\u2461\u4e9a\u7ec4\u662f\u8868\u578b\u4e2d\u7684\u4e00\u4e2a\u60a3\u8005\u5b50\u96c6\uff0c\u53ef\u4ee5\u6839\u636e\u67d0\u4e00\u53d8\u91cf\u7684\u622a\u70b9\u8fdb\u884c\u5b9a\u4e49\u3002\u800c\u8fd9\u4e00\u4e34\u754c\u503c\u53ef\u80fd\u662f\u4efb\u610f\u7684\uff0c\u5e76\u4e14\u60a3\u8005\u901a\u5e38\u5206\u5e03\u5728\u622a\u70b9\u7684\u4e24\u4fa7\uff0c\u56e0\u6b64\u60a3\u8005\u5212\u5206\u5230\u4e0d\u540c\u4e9a\u7ec4\uff08\u5982\u6839\u636ePaO2\/FiO2\u7684ARDS\u4e25\u91cd\u7a0b\u5ea6\u5206\u7ea7\uff09\u3002\u2462\u4e9a\u8868\u578b\u662fARDS\u60a3\u8005\u4e2d\u4e00\u4e2a\u72ec\u7279\u7684\u4e9a\u7ec4\uff0c\u53ef\u6839\u636e\u4e00\u7ec4\u53ef\u89c2\u5bdf\u6216\u53ef\u6d4b\u91cf\u7684\u7279\u6027\u6216\u6a21\u5f0f\u4e0e\u5176\u4ed6\u4e9a\u7ec4\u8fdb\u884c\u533a\u5206\u3002\u901a\u5e38\uff0c\u8fd9\u79cd\u533a\u5206\u662f\u57fa\u4e8e\u5bf9\u591a\u7ef4\u5ea6\u7684\u7279\u5f81\u63cf\u8ff0\u7684\u6570\u636e\u9a71\u52a8\u7684\u8bc4\u4f30\u6765\u8fdb\u884c\u7684\u3002\u4e9a\u8868\u578b\u5728\u4e0d\u540c\u7684\u4eba\u7fa4\u4e2d\u662f\u53ef\u590d\u5236\u7684\u3002\u2463\u5185\u578b\u662f\u4e00\u79cd\u4e9a\u8868\u578b\uff0c\u5177\u6709\u660e\u786e\u7684\u529f\u80fd\u6216\u75c5\u7406\u751f\u7406\u5b66\u673a\u5236\uff0c\u5bf9\u9776\u5411\u6cbb\u7597\u6709\u4e0d\u540c\u7684\u53cd\u5e94\u3002<\/p>\n<p>4.2 \u95ee\u98982.2\uff1a\u6211\u4eec\u5982\u4f55\u8bc6\u522b\u6216\u5b9e\u65bdARDS\u4e9a\u8868\u578b\uff1f<\/p>\n<p>\u6b63\u5982LIVE\u8bd5\u9a8c\u7684\u7ed3\u679c\u6240\u793a\uff0c\u4e9a\u8868\u578b\u7684\u51c6\u786e\u5206\u7c7b\u81f3\u5173\u91cd\u8981\u3002\u8be5\u8bd5\u9a8c\u5c06\u60a3\u8005\u968f\u673a\u5206\u914d\u5230\u6807\u51c6\u80ba\u4fdd\u62a4\u6027\u901a\u6c14\u7ec4\u6216\u57fa\u4e8e\u5f71\u50cf\u5b66\u4e9a\u8868\u578b\uff08\u80f8\u7247\u4e0a\u7684\u5c40\u7076\u6027\u6216\u5f25\u6f2b\u6027\u75c5\u53d8\uff09\u7684\u4e2a\u6027\u5316\u6cbb\u7597\u7b56\u7565\u7ec4<sup>[38]<\/sup>\u3002\u603b\u4f53\u800c\u8a00\uff0c\u4e2a\u6027\u5316\u6cbb\u7597\u7b56\u7565\u65e0\u76ca\uff1b\u7136\u800c\uff0c\u4e9a\u8868\u578b\u7684\u9519\u8bef\u5206\u7c7b\u5bfc\u81f4\u4e0d\u5408\u9002\u7684\u6cbb\u7597\u7b56\u7565\u662f\u5e38\u89c1\u7684\uff0c\u5f53\u6392\u9664\u9519\u8bef\u5206\u7c7b\u7684\u60a3\u8005\u540e\u7ed3\u679c\u662f\u201c\u9633\u6027\u201d\u7684\uff0c\u5373\u4e2a\u4f53\u5316\u6cbb\u7597\u662f\u6709\u76ca\u7684\u3002\u524d\u77bb\u6027\u7814\u7a76\u4e2d\u7684\u4e9a\u8868\u578b\u5206\u7c7b\u53ef\u80fd\u9700\u8981\u5177\u5907\u5982\u4e0b\u7279\u5f81\uff1a\u2460\u53ef\u73b0\u573a\u3001\u5b9e\u65f6\u6d4b\u8bd5\uff0c\u80fd\u5feb\u901f\u83b7\u5f97\u7ed3\u679c\uff1b\u2461\u53ef\u72ec\u7acb\u64cd\u4f5c\u3002<\/p>\n<p>4.3 \u95ee\u98982.3\uff1a\u4e9a\u8868\u578b\u95f4\u6cbb\u7597\u6548\u679c\u5f02\u8d28\u6027\uff08\u9884\u6d4b\u578b\u5bcc\u96c6\uff09\u6709\u4f55\u8bc1\u636e\uff1f<\/p>\n<p>4.3.1 \u4e9a\u8868\u578b\u662f\u5426\u4f1a\u6539\u53d8ARDS\u60a3\u8005\u5bf9\u6297\u708e\u5e72\u9884\u7684\u53cd\u5e94\uff1f<\/p>\n<p>\u5728HARP-2\u8bd5\u9a8c\u7684\u4e8c\u6b21\u5206\u6790\u4e2d\uff0c\u5c3d\u7ba1\u6cbb\u7597\u6548\u679c\u7684\u5f02\u8d28\u6027\u7684\u4ea4\u4e92\u9879\u6ca1\u6709\u7edf\u8ba1\u5b66\u5dee\u5f02\uff0c\u9ad8\u708e\u75c7\u4e9a\u8868\u578b\u60a3\u8005\u4f3c\u4e4e\u53d7\u76ca\u4e8e\u8f9b\u4f10\u4ed6\u6c40<sup>[35]<\/sup>\u3002\u5728\u5bf9SAILS\u8bd5\u9a8c\u7684\u4e8c\u6b21\u5206\u6790\u4e2d\uff0c\u5728\u4f4e\u708e\u75c7\u548c\u9ad8\u708e\u75c7\u4e9a\u8868\u578b\u4e2d\uff0c\u672a\u53d1\u73b0\u745e\u8212\u4f10\u4ed6\u6c40\u7684\u6cbb\u7597\u6548\u679c\u6709\u5dee\u522b<sup>[36]<\/sup>\u3002\u4f46\u662f\uff0c\u5728\u5bf9SAILS\u8bd5\u9a8c\u7684\u805a\u7c7b\u518d\u5206\u6790\u4e2d\uff0c\u57284\u79cd\u4e9a\u8868\u578b\u4e2d\uff0c\u4ee5\u9ad8\u8840\u5c0f\u677f\u548c\u4f4e\u808c\u9150\u4e3a\u7279\u5f81\u7684\u4e00\u7ec4\uff08n = 66\uff09\u4f3c\u4e4e\u53ef\u4ece\u745e\u8212\u4f10\u4ed6\u6c40\u6cbb\u7597\u4e2d\u83b7\u76ca\uff1b\u7136\u800c\uff0c\u8fc4\u4eca\u8fd9\u4e9b\u4e9a\u8868\u578b\u5206\u6790\u5c1a\u672a\u5728\u5176\u4ed6\u4eba\u7fa4\u4e2d\u91cd\u590d\u51fa\u6765<sup>[43]<\/sup>\u3002<\/p>\n<p>4.3.2 \u4e9a\u8868\u578b\u5212\u5206\u662f\u5426\u4f1a\u6539\u53d8ARDS\u60a3\u8005\u5bf9PEEP\u7684\u53cd\u5e94\uff1f<\/p>\n<p>\u5728ALVEOLI\u8bd5\u9a8c\u7684\u4e8c\u6b21\u5206\u6790\u4e2d\u53d1\u73b0\uff0c\u4f4e\u708e\u75c7\u548c\u9ad8\u708e\u75c7\u4e9a\u8868\u578b\u4e0e\u6240\u91c7\u7528\u7684PEEP\u7b56\u7565\uff08\u9ad8\/\u4f4e\u6c27\u5408\u8868\uff09\u4e4b\u95f4\u7684\u6cbb\u7597\u6548\u679c\u5b58\u5728\u5dee\u522b<sup>[31]<\/sup>\u3002\u5bf9LUNG-SAFE\u7814\u7a76\u7684\u4e8c\u6b21\u5206\u6790\u53d1\u73b0\u4e86\u7c7b\u4f3c\u7684\u7ed3\u679c\uff0c\u4e0e\u4f4e\u708e\u75c7\u4e9a\u8868\u578b\u76f8\u6bd4\uff0c\u9ad8\u708e\u75c7\u4e9a\u8868\u578b\u60a3\u8005\u4f3c\u4e4e\u80fd\u591f\u4ece\u8f83\u9ad8PEEP\u4e2d\u83b7\u76ca<sup>[54]<\/sup>\u3002\u5728LIVE\u8bd5\u9a8c\u4e2d\uff0c\u5f53\u4ec5\u8003\u8651\u6309\u65b9\u6848\u6cbb\u7597\u7684\u60a3\u8005\u65f6\uff0c\u57fa\u4e8e\u5f25\u6f2b\u6027\u4e0e\u5c40\u7076\u6027\u5f71\u50cf\u5b66\u4e9a\u8868\u578b\u800c\u7ed9\u4e88\u7684\u4e2a\u6027\u5316PEEP\u548c\u4fef\u5367\u4f4d\u7b56\u7565\u53ef\u964d\u4f4e90\u5929\u6b7b\u4ea1\u7387<sup>[38]<\/sup>\u3002\u7136\u800c\uff0c\u7531\u4e8e\u80ba\u5f62\u6001\u5b66\u7684\u9519\u8bef\u5206\u7c7b\uff0c\u8fd9\u4e00\u7ed3\u679c\u5728\u610f\u5411\u6027\u5206\u6790\u4e2d\u88ab\u7a00\u91ca\u4e86\u3002<\/p>\n<p>4.3.3 \u4e9a\u8868\u578b\u662f\u5426\u4f1a\u6539\u53d8ARDS\u60a3\u8005\u5bf9\u6db2\u4f53\u7b56\u7565\u7684\u53cd\u5e94\uff1f<\/p>\n<p>FACTT\u8bd5\u9a8c\u7684\u4e8c\u6b21\u5206\u6790\u4e2d\u53d1\u73b0\u4e86\u6cbb\u7597\u6548\u679c\u7684\u5dee\u522b\uff0c\u9ad8\u708e\u75c7\u4e9a\u8868\u578b\u60a3\u8005\u4f3c\u4e4e\u53d7\u76ca\u4e8e\u5f00\u653e\u6027\u6db2\u4f53\u7b56\u7565\uff0c\u800c\u4f4e\u708e\u75c7\u4e9a\u8868\u578b\u5219\u4e0e\u4e4b\u76f8\u53cd<sup>[33]<\/sup>\u3002<\/p>\n<p>4.4 \u95ee\u98982.4\uff1a\u4e9a\u8868\u578b\u4e0e\u60a3\u8005\u9884\u540e\u7684\u5173\u7cfb\uff08\u9884\u540e\u578b\u5bcc\u96c6\uff09\u5982\u4f55?<\/p>\n<p>\u57fa\u4e8e\u4ee5\u4e0b\u7279\u5f81\u7684\u4e9a\u8868\u578b\u7684\u77ed\u671f\uff0890\u5929\uff09\u6b7b\u4ea1\u7387\u5b58\u5728\u5dee\u5f02\uff1a\u2460\u901a\u8fc7\u8840\u6d46\u86cb\u767d\u6d4b\u91cf\u7684\u5168\u8eab\u708e\u75c7\u53cd\u5e94\uff08\u9ad8\u708e\u75c7\u4e9a\u8868\u578b\u6b7b\u4ea1\u7387\u9ad8\u4e8e\u4f4e\u708e\u75c7\u4e9a\u8868\u578b\uff09<sup>[31-34]<\/sup>\uff1b\u2461\u80ba\u90e8\u5f71\u50cf\u5b66\uff08\u975e\u5c40\u7076\u578b\u6b7b\u4ea1\u7387\u9ad8\u4e8e\u5c40\u7076\u578b<sup>[38]<\/sup>\uff09\uff1b\u2462\u590d\u5f20\u6027\uff08\u53ef\u590d\u5f20\u7ec4\u6b7b\u4ea1\u7387\u9ad8\u4e8e\u4e0d\u53ef\u590d\u5f20\u7ec4\uff09<sup>[44-56]<\/sup>\uff1b\u2463\u4e34\u5e8a\u7279\u5f81\uff08\u66f4\u591a\u7684\u5668\u5b98\u8870\u7aed\u548c\/\u6216\u5e76\u53d1\u75c7\u548c\/\u6216\u9178\u4e2d\u6bd2\u4f34\u968f\u66f4\u9ad8\u7684\u6b7b\u4ea1\u7387\uff09<sup>[47]<\/sup>\uff1b\u2464\u547c\u5438\u53c2\u6570\u7684\u7eb5\u5411\u53d8\u5316\uff08\u901a\u6c14\u6bd4\u548c\u673a\u68b0\u80fd\u4e0a\u5347\u8d8b\u52bf\u8f68\u8ff9\u7684\u6b7b\u4ea1\u7387\u9ad8\u4e8e\u7a33\u5b9a\u8d8b\u52bf\u8f68\u8ff9\uff09<sup>[45]<\/sup>\u3002<\/p>\n<p>4.5 \u95ee\u98982.5\uff1a\u672a\u6765\u4e0e\u4e9a\u8868\u578b\u76f8\u5173\u7684\u7814\u7a76\u95ee\u9898\u662f\u4ec0\u4e48\uff1f<\/p>\n<p>\u5728\u672a\u6765\u7684\u7814\u7a76\u4e2d\uff0c\u4ecd\u6709\u51e0\u4e2a\u7814\u7a76\u95ee\u9898\u6709\u5f85\u89e3\u51b3\uff0c\u7279\u522b\u662f\uff1a\u2460\u4e9a\u8868\u578b\u968f\u65f6\u95f4\u7684\u7a33\u5b9a\u6027\uff0c\u4eceARDS\u524d\u671f\u5230\u6062\u590d\u671f\uff1b\u2461\u4e9a\u8868\u578b\u5728\u4e0d\u540c\u4eba\u7fa4\u4e2d\u662f\u5426\u5177\u6709\u53ef\u91cd\u590d\u6027\uff1b\u2462\u5feb\u901f\u4e9a\u8868\u578b\u5206\u7c7b\u7684\u51c6\u786e\u6027\u548c\u53ef\u91cd\u590d\u6027\uff1b\u2463\u9a71\u52a8\u4e9a\u8868\u578b\u53d1\u5c55\u7684\u75c5\u7406\u751f\u7406\u9014\u5f84\uff1b\u2464\u6bcf\u4e2a\u4e9a\u8868\u578b\u7684\u5f52\u56e0\u6b7b\u4ea1\u7387\uff1b\u2465\u57fa\u4e8e\u4e9a\u8868\u578b\u7684\u7cbe\u51c6\u6cbb\u7597\u7b56\u7565\u80fd\u5426\u6539\u5584ICU\u51fa\u9662\u540e\u7ed3\u5c40\u3002<\/p>\n<p>5 \u9886\u57df3\uff1a\u7ecf\u9f3b\u9ad8\u6d41\u91cf\u6c27\u7597\uff08HFNO\uff09<\/p>\n<p>5.1 \u95ee\u9898 3.1\uff1a\u5bf9\u4e8e\u975e\u5fc3\u6e90\u6027\u80ba\u6c34\u80bf\u6216\u6162\u6027\u963b\u585e\u6027\u80ba\u75be\u75c5\u6025\u6027\u52a0\u91cd\uff08acute exacerbation of chronic obstructive pulmonary disease\uff0cAECOPD\uff09\u5bfc\u81f4\u7684AHRF\u7684\u975e\u673a\u68b0\u901a\u6c14\u60a3\u8005\uff0c\u4e0e\u4f20\u7edf\u6c27\u7597\u76f8\u6bd4\uff0c\u7ecf\u9f3b\u9ad8\u6d41\u91cf\u6c27\u7597\u662f\u5426\u80fd\u964d\u4f4e\u6b7b\u4ea1\u7387\u6216\u63d2\u7ba1\u7387\uff1f<\/p>\n<p>5.1.1 \u80cc\u666f<\/p>\n<p>\u7ecf\u9762\u7f69\u6216\u9f3b\u5bfc\u7ba1\u884c\u4f20\u7edf\u6c27\u7597\uff08conventional oxygen therapy\uff0cCOT\uff09\uff08\u5373\u4f4e\u6d41\u91cf\u5438\u6c27\uff09\u53d7\u6c27\u6c14\u6d41\u901f\u4f4e\uff08\u5373\u5c0f\u4e8e15L\/min\uff09\u4ee5\u53ca\u6e7f\u5316\u4e0d\u8db3\u7684\u9650\u5236\uff0c\u53ef\u80fd\u5bfc\u81f4\u60a3\u8005\u4e0d\u8010\u53d7\u3002HFNO\u8010\u53d7\u6027\u826f\u597d\uff0c\u53ef\u4ee5\u63d0\u4f9b\u6696\u6e7f\u6c27\u6c14\uff0c\u4e14\u6d41\u91cf\u53ef\u9ad8\u8fbe60L\/min<sup>[57]<\/sup>\u3002\u5728\u66f4\u9ad8\u7684\u6d41\u901f\u60c5\u51b5\u4e0b\uff0c\u4e0eCOT\u76f8\u6bd4\uff0cHFNO\u63d0\u4f9b\u7684FiO2\u66f4\u52a0\u6052\u5b9a\uff0c\u51cf\u5c11\u89e3\u5256\u6b7b\u8154\uff0c\u5e76\u53ef\u63d0\u4f9b3 ~ 5 cmH2O\u7684PEEP\uff0cPEEP\u7684\u9ad8\u4f4e\u53d6\u51b3\u4e8e\u6d41\u901f\u548c\u547c\u5438\u6a21\u5f0f<sup>[58]<\/sup>\u3002\u81ea2015\u5e74FLORALI\u7814\u7a76\u53d1\u8868\uff0cHFNO\u5728AHRF\u4e2d\u7684\u5e94\u7528\u663e\u8457\u589e\u52a0\uff0c\u5728COVID-19\u5927\u6d41\u884c\u671f\u95f4\uff0c\u5176\u5e94\u7528\u5f97\u5230\u8fdb\u4e00\u6b65\u589e\u52a0<sup>[59]<\/sup>\u3002<\/p>\n<p>5.1.2 \u8bc1\u636e\u6982\u8ff0<\/p>\n<p>\u4e13\u5bb6\u5c0f\u7ec4\u8bc4\u4f30\u4e86HFNO\u5728AHRF\u60a3\u8005\u4e2d\u7684\u5e94\u7528\uff0c\u800c\u4e0d\u662fARDS\u60a3\u8005\uff0c\u56e0\u4e3a\u6839\u636e\u67cf\u6797\u5b9a\u4e49\uff0cARDS\u8bca\u65ad\u8981\u6c42PEEP\u6c34\u5e73\u81f3\u5c11\u8fbe\u52305 cmH2O\uff0c\u8bb8\u591a\u63a5\u53d7HFNO\u6cbb\u7597\u7684\u60a3\u8005\u53ef\u80fd\u5e76\u4e0d\u80fd\u8bca\u65adARDS\u3002\u7136\u800c\uff0c\u5927\u591a\u6570\u4eceHFNO\u8fdb\u5c55\u4e3a\u673a\u68b0\u901a\u6c14\u7684\u60a3\u8005\u6700\u7ec8\u786e\u5b9e\u7b26\u5408ARDS\u7684\u8bca\u65ad\u6807\u51c6\u3002\u5728COVID-19\u5927\u6d41\u884c\u671f\u95f4\uff0c93%\u7684\u63a5\u53d7HFNO\u6cbb\u7597\u540e\u8fdb\u5c55\u4e3a\u6c14\u7ba1\u63d2\u7ba1\u7684\u60a3\u8005\u7b26\u5408\u67cf\u6797\u5b9a\u4e49\u4e2d\u7684ARDS\u8bca\u65ad\u6807\u51c6<sup>[18]<\/sup>\u3002\u9274\u4e8eHFNO\u7684\u5e94\u7528\u589e\u52a0\uff0c\u5c24\u5176\u662f\u5728COVID-19\u5927\u6d41\u884c\u671f\u95f4\uff0c\u76ee\u524d\u8d8a\u6765\u8d8a\u8ba4\u4e3a\uff0cARDS\u7684\u5b9a\u4e49\u4e2d\uff0c\u5e94\u7eb3\u5165AHRF\u63a5\u53d7HFNO\u6cbb\u7597\u7684\u60a3\u8005\uff08\u8be6\u89c1\u9886\u57df1\uff09\u3002\u56e0\u6b64\uff0cPICOs\u53ca\u5176\u5efa\u8bae\u5e94\u9002\u7528\u4e8e\u63a5\u53d7HFNO\u6cbb\u7597\u7684ARDS\u60a3\u8005\u3002\u6211\u4eec\u6392\u9664\u4e86\u7eb3\u5165\u6025\u6027\u5fc3\u6e90\u6027\u80ba\u6c34\u80bf\u3001AECOPD\u3001\u6025\u6027\u9ad8\u78b3\u9178\u8840\u75c7\u547c\u5438\u8870\u7aed\u6216\u62d4\u7ba1\u540e\u4f7f\u7528HFNO\u60a3\u8005\u7684\u7814\u7a76\u3002\u6211\u4eec\u786e\u5b9a\u4e86\u4e03\u9879RCTs\uff0c\u8fd9\u4e9bRCTs\u662f\u6211\u4eec\u63a8\u8350\u610f\u89c1\u7684\u57fa\u7840<sup>[59\u201365]<\/sup>\u3002\u7136\u800c\uff0c\u5bf9\u4e8eBouadma\u53ca\u5176\u5408\u4f5c\u8005\u7684\u7814\u7a76\uff0c\u7531\u4e8e\u5176\u8bbe\u8ba1\u548c\u5176\u7ed3\u679c\u89e3\u8bfb\u7684\u4e0d\u786e\u5b9a\u6027\uff0c\u4ec5\u5c06\u5176\u7eb3\u5165\u4e86\u4e00\u9879\u654f\u611f\u6027\u5206\u6790<sup>[65]<\/sup>\u3002<\/p>\n<p>\u7eb3\u5165\u7684\u516d\u9879\u7814\u7a76\uff0c\u51712769\u540d\u60a3\u8005\uff0c\u517628\u5929\u621630\u5929\u7684\u603b\u4f53\u6b7b\u4ea1\u7387\u4e3a20.5%\uff0cHFNO\u548cCOT\u6cbb\u7597\u7ec4\u6b7b\u4ea1\u7387\u65e0\u7edf\u8ba1\u5b66\u5dee\u5f02[\u76f8\u5bf9\u98ce\u9669\uff08RR\uff090.95\uff0c95%\u7f6e\u4fe1\u533a\u95f4\uff0895% CI\uff090.82 ~ 1.09]\u3002\u6b64\u5916\uff0c\u6ca1\u6709\u8bc1\u636e\u8868\u660e\uff0c\u4e24\u8005\u5728\u514d\u75ab\u529f\u80fd\u4f4e\u4e0b\u6216COVID-19\u4e9a\u7ec4\u4e2d\u7684\u6cbb\u7597\u6548\u679c\u5b58\u5728\u5dee\u5f02\u3002<\/p>\n<p>\u7eb3\u5165\u7684\u516d\u9879\u7814\u7a76\uff0c28\u5929\u621630\u5929\u7684\u603b\u4f53\u63d2\u7ba1\u7387\u4e3a43%\u3002Meta\u5206\u6790\u53d1\u73b0\uff0c\u4e0eCOT\u76f8\u6bd4\uff0cHFNO\u9884\u9632\u63d2\u7ba1\u7684\u6548\u679c\u66f4\u52a0\u663e\u8457\uff08RR 0.89\uff0c95% CI 0.81 ~ 0.97\uff09\u3002\u5173\u4e8eHFNO\u9884\u9632\u63d2\u7ba1\u7684\u6548\u679c\uff0c\u5927\u591a\u6570\u7eb3\u5165\u7684\u7814\u7a76\u7ed3\u679c\u90fd\u662f\u4e00\u81f4\u7684\uff0c\u4f46\u6709\u4e00\u9879\u7814\u7a76\u4f8b\u5916\uff0c\u4e0d\u8fc7\u8be5\u7814\u7a76\u5728\u7efc\u5408\u8bc4\u4f30\u4e2d\u7684\u6743\u91cd\u4ec5\u53601.6%<sup>[64]<\/sup>\u3002\u5728\u514d\u75ab\u529f\u80fd\u4f4e\u4e0b\u6216COVID-19\u611f\u67d3\u60a3\u8005\uff0c\u5e94\u7528HFNO\u6216COT\u6cbb\u7597\uff0c\u6211\u4eec\u5e76\u672a\u53d1\u73b0\u6c14\u7ba1\u63d2\u7ba1\u7387\u5b58\u5728\u5dee\u5f02\u3002<\/p>\n<p>5.1.3 \u63a8\u8350\u610f\u89c1 3.1<\/p>\n<p>\u5efa\u8bae\u5bf9\u4e8e\u975e\u5fc3\u6e90\u6027\u80ba\u6c34\u80bf\u6216AECOPD\u5bfc\u81f4\u7684AHRF\u7684\u975e\u673a\u68b0\u901a\u6c14\u60a3\u8005\u91c7\u7528HFNO\u4ee5\u964d\u4f4e\u6c14\u7ba1\u63d2\u7ba1\u98ce\u9669\uff0c\u800c\u975eCOT\u3002\uff08\u5f3a\u63a8\u8350\uff1b\u4e2d\u7b49\u8d28\u91cf\u8bc1\u636e\uff09<\/p>\n<p>\u65e0\u6cd5\u63a8\u8350\u6216\u53cd\u5bf9\u91c7\u7528HFNO\u800c\u4e0d\u662fCOT\u6765\u964d\u4f4e\u6b7b\u4ea1\u7387\u3002\uff08\u65e0\u63a8\u8350\uff1b\u9ad8\u8d28\u91cf\u8bc1\u636e\u63d0\u793a\u65e0\u6548\uff09<\/p>\n<p>\u6b64\u63a8\u8350\u610f\u89c1\u4e5f\u9002\u7528\u4e8eCOVID-19\u5bfc\u81f4\u7684AHRF\uff08\u5f3a\u63a8\u8350\uff1b\u4f4e\u8d28\u91cf\u8bc1\u636e\u652f\u6301\u5e94\u7528HFNO\u964d\u4f4e\u6c14\u7ba1\u63d2\u7ba1\u7387\uff1b\u65e0\u63a8\u8350\uff1b\u4e2d\u7b49\u8d28\u91cf\u8bc1\u636e\u63d0\u793a\u5bf9\u95f4\u63a5\u6b7b\u4ea1\u7387\u6ca1\u5f71\u54cd\u3002\uff09<\/p>\n<p>5.1.4 \u4e34\u5e8a\u5e94\u7528\u4e13\u5bb6\u610f\u89c1<\/p>\n<p>\u7814\u7a76\u53d1\u73b0\uff0cHFNO\u5728\u964d\u4f4eAHRF\u60a3\u8005\u6c14\u7ba1\u63d2\u7ba1\u98ce\u9669\u65b9\u9762\u4f18\u4e8eCOT\uff0c\u4f46\u4e0d\u80fd\u964d\u4f4e\u6b7b\u4ea1\u7387<sup>[59-65]<\/sup>\u3002\u673a\u68b0\u901a\u6c14\u662f\u8d44\u6e90\u5bc6\u96c6\u578b\u6cbb\u7597\uff0c\u4e14\u5bf9\u9547\u9759\u548c\u7ea6\u675f\u7684\u9700\u6c42\u66f4\u9ad8\uff0c\u9547\u9759\u548c\u7ea6\u675f\u4e0e\u8c35\u5984\u3001\u533b\u9662\u611f\u67d3\u3001\u6b7b\u4ea1\u7387\u3001\u66f4\u4e25\u91cd\u7684\u957f\u671f\u5e76\u5b58\u75c7\uff08\u5305\u62ec\u8eab\u4f53\u548c\u8ba4\u77e5\u5e76\u53d1\u75c7\uff09\u76f8\u5173\u3002\u6b64\u5916\uff0c\u60a3\u8005\u4ee3\u8868\u7684\u610f\u89c1\u8868\u660e\uff0c\u5373\u4f7fHFNO\u4e0d\u80fd\u663e\u8457\u6539\u5584\u6b7b\u4ea1\u7387\uff0c\u4f46\u67d0\u4e9b\u60c5\u51b5\u4e0b\u80fd\u907f\u514d\u63d2\u7ba1\u7684\u4f5c\u7528\u4e5f\u975e\u5e38\u6709\u610f\u4e49\u3002HFNO\u901a\u5e38\u8010\u53d7\u6027\u826f\u597d\uff0c\u5e76\u4e14\u4e0d\u826f\u4e8b\u4ef6\u53d1\u751f\u7387\u4e0eCOT\u7c7b\u4f3c\u6216\u66f4\u4f4e\u3002\u56e0\u6b64\uff0c\u5bf9\u4e8eAHRF\u60a3\u8005\uff0c\u65e0\u8bba\u662f\u5426\u4e3a\u514d\u75ab\u529f\u80fd\u4f4e\u4e0b\u6216COVID-19\u611f\u67d3\u60a3\u8005\uff0c\u4e0eCOT\u76f8\u6bd4\uff0c\u6211\u4eec\u66f4\u63a8\u8350\u5e94\u7528HFNO\u3002<\/p>\n<p>5.1.5 \u672a\u89e3\u51b3\u7684\u95ee\u9898\u548c\u7814\u7a76\u7a7a\u767d<\/p>\n<p>\u63a2\u8ba8HFNO\u5728\u6025\u6027\u547c\u5438\u8870\u7aed\u60a3\u8005\u5e94\u7528\u7684RCT\u8bd5\u9a8c\u4e2d\uff0c\u957f\u671f\u529f\u80fd\u7ed3\u5c40\u6570\u636e\u5b58\u5728\u7f3a\u5931\u3002\u56e0\u6b64\uff0c\u76ee\u524d\u5c1a\u4e0d\u6e05\u695a\u9884\u9632\u63d2\u7ba1\u662f\u5426\u80fd\u51cf\u5c11AHRF\u5e78\u5b58\u8005\u7684\u4e0d\u9002\u75c7\u72b6\u548c\u957f\u671f\u529f\u80fd\u969c\u788d\u3002\u6b64\u5916\uff0c\u5c1a\u4e0d\u6e05\u695aHFNO\u6cbb\u7597\u5e94\u6301\u7eed\u591a\u957f\u65f6\u95f4\uff0c\u4e5f\u4e0d\u6e05\u695a\u662f\u5426\u5e94\u4f7f\u7528ROX\u6307\u6570\u6216\u5176\u4ed6\u6307\u6807\u6765\u63d0\u793aHFNO\u6cbb\u7597\u5931\u8d25\u548c\u63d2\u7ba1\u9700\u6c42<sup>[66]<\/sup>\u3002\u4e8b\u5b9e\u4e0a\uff0c\u5728\u4e00\u4e9b\u7814\u7a76\u4e2d\uff0cHFNO\u6cbb\u7597\u5931\u8d25\u7684\u60a3\u8005\u6b7b\u4ea1\u7387\u9ad8\u4e8e\u5e38\u89c4\u6c27\u7597\u60a3\u8005<sup>[59, 67]<\/sup>\u3002\u76ee\u524d\u5c1a\u4e0d\u6e05\u695a\u8fd9\u662f\u7531\u4e8e\u63d2\u7ba1\u5ef6\u8fdf\u5bfc\u81f4\u8fd8\u662f\u4ec5\u4ec5\u63d0\u793a\u75be\u75c5\u66f4\u4e25\u91cd\u3002\u9274\u4e8eCOVID-19\u5927\u6d41\u884c\u540eHFNO\u7684\u4f7f\u7528\u589e\u52a0\uff0c\u7531\u4e8e\u4ea4\u4e92\u4f5c\u7528\u7684\u5b58\u5728\uff0c\u672a\u6765\u63a2\u8ba8HFNO\u4e0eCOT\u6cbb\u7597\u5bf9\u6b7b\u4ea1\u7387\u7684\u5f71\u54cd\u7684\u5927\u578b\u7814\u7a76\u5728\u5b9e\u65bd\u548c\u7ed3\u679c\u89e3\u8bfb\u65b9\u9762\u5747\u9762\u4e34\u56f0\u96be\u3002\u672a\u6765\u7684\u4e34\u5e8a\u7814\u7a76\u5e94\u805a\u7126\u4e8e\u4f7f\u60a3\u8005\u83b7\u76ca\u6700\u5927\u5316\u7684\u6700\u4f73HFNO\u5e94\u7528\u7b56\u7565\uff0c\u4ece\u800c\u6307\u5bfc\u4e34\u5e8a\u533b\u5e08\u5982\u4f55\u5e94\u7528\u6216\u505c\u7528HFNO\u3002\u6b64\u5916\uff0c\u9700\u8981\u8bbe\u7f6e\u957f\u671f\u7ed3\u5c40\u6307\u6807\uff08\u5982\u8ba4\u77e5\u3001\u529f\u80fd\u7ed3\u5c40\u548c\u751f\u6d3b\u8d28\u91cf\uff09\u6765\u786e\u5b9aHFNO\u7684\u957f\u671f\u5f71\u54cd\u3002<\/p>\n<p>5.2 \u95ee\u98983.2\uff1a\u5bf9\u4e8e\u975e\u5fc3\u6e90\u6027\u80ba\u6c34\u80bf\u6216AECOPD\u7684\u975e\u673a\u68b0\u901a\u6c14AHRF\u60a3\u8005\uff0c\u4e0eNIV\u76f8\u6bd4\uff0cHFNO\u662f\u5426\u80fd\u964d\u4f4e\u6b7b\u4ea1\u7387\u6216\u63d2\u7ba1\u7387\uff1f<\/p>\n<p>5.2.1 \u80cc\u666f<\/p>\n<p>NIV\u53ef\u6539\u5584\u7ed3\u5c40\uff0c\u63a8\u8350\u7528\u4e8eAECOPD\u6240\u81f4\u6025\u6027\u9ad8\u78b3\u9178\u8840\u75c7\u6027\u547c\u5438\u8870\u7aed\u60a3\u8005\u6216\u5fc3\u6e90\u6027\u80ba\u6c34\u80bf\u60a3\u8005<sup>[68]<\/sup>\u3002\u7531\u4e8e\u8bc1\u636e\u4e0d\u8db3\uff0c\u65e2\u5f80\u5927\u591a\u6570\u6307\u5357\u5c1a\u672a\u5bf9NIV\u5728\u5176\u4ed6\u75c5\u56e0\u5bfc\u81f4\u7684AHRF\u60a3\u8005\u4e2d\u7684\u4f7f\u7528\u63d0\u51fa\u5177\u4f53\u5efa\u8bae\u3002\u6b64\u5916\uff0cNIV\u7684\u8010\u53d7\u6027\u3001\u60a3\u8005\u75f0\u6db2\u5ed3\u6e05\u7684\u80fd\u529b\u3001\u5927VT\u5bfc\u81f4\u7684\u80ba\u635f\u4f24\u6076\u5316\uff08\u7279\u522b\u662fAHRF\u7684\u9ad8\u5438\u6c14\u9700\u6c42\uff09\uff0c\u4ee5\u53ca\u5ef6\u8fdf\u63d2\u7ba1\u53ef\u80fd\u5bfc\u81f4\u7684\u4e0d\u826f\u540e\u679c\u90fd\u662f\u5e94\u7528NIV\u65f6\u9700\u8981\u8003\u8651\u7684\u95ee\u9898\u3002<\/p>\n<p>\u5728COVID-19\u5927\u6d41\u884c\u65e9\u671f\uff0cNIV\u5e94\u7528\u5f88\u5e38\u89c1\uff08\u6b66\u6c49ICU\u60a3\u8005NIV\u5e94\u7528\u9ad8\u8fbe47%\uff09<sup>[69]<\/sup>\u3002\u7f8e\u56fd\u56fd\u7acb\u536b\u751f\u7814\u7a76\u9662\u548c\u62ef\u6551\u8113\u6bd2\u75c7\u8fd0\u52a8\u7684\u521d\u59cb\u4e34\u5e8a\u5b9e\u8df5\u6307\u5357\u5747\u63d0\u51fa\u4e86\u4f4e\u8d28\u91cf\u7684\u63a8\u8350\u610f\u89c1\uff0c\u63a8\u8350\u91c7\u7528HFNO\u6cbb\u7597COVID-19\u80ba\u708e\u60a3\u8005\uff0cHFNO\u4e0d\u53ef\u7528\u6216\u6cbb\u7597\u5931\u8d25\u65f6\uff0c\u53ef\u4f7f\u7528NIV<sup>[70-71]<\/sup>\u3002\u8be5\u63a8\u8350\u610f\u89c1\u662f\u57fa\u4e8e\u975eCOVID-19\u76f8\u5173AHRF\u6570\u636e\u7684\u5916\u63a8\u3001\u4ee5\u53ca\u9488\u5bf9MERS\u60a3\u8005\u7684\u7814\u7a76\u7ed3\u679c\uff0c\u8fd9\u4e9b\u7814\u7a76\u6570\u636e\u663e\u793aNIV\u4e0d\u8010\u53d7\u4e14\u5931\u8d25\u7387\u8f83\u9ad8\uff0cNIV\u5931\u8d25\u8005\u7684\u6b7b\u4ea1\u7387\u8f83\u9ad8<sup>[59-72]<\/sup>\u3002\u6b64\u5916\uff0cNIV\u53ef\u80fd\u4f1a\u589e\u52a0\u75c5\u6bd2\u7684\u6c14\u6eb6\u80f6\u4f20\u64ad<sup>[73]<\/sup>\u3002<\/p>\n<p>5.2.2 \u8bc1\u636e\u6982\u8ff0<\/p>\n<p>\u7eb3\u5165AHRF\u60a3\u8005\uff0c\u5e76\u6392\u9664\u4e86\u90a3\u4e9b\u7eb3\u5165\u6025\u6027\u5fc3\u6e90\u6027\u80ba\u6c34\u80bf\u3001AECOPD\u3001\u6025\u6027\u9ad8\u78b3\u9178\u8840\u75c7\u6027\u547c\u5438\u8870\u7aed\u3001\u62d4\u7ba1\u540e\u5e8f\u8d2fNIV\u6216\u5e94\u7528NIV\u6765\u5e2e\u52a9\u673a\u68b0\u901a\u6c14\u60a3\u8005\u62d4\u7ba1\u7684\u7814\u7a76\u3002\u7ed3\u679c\u7eb3\u5165\u56db\u9879\u62a5\u544a\u4e86\u6b7b\u4ea1\u7387\u7684RCT<sup>[59,74-76]<\/sup>\uff0c\u5176\u4e2d\u5305\u62ec2\u9879\u7eb3\u5165COVID-19\u60a3\u8005\u7684RCT\u3002\u5728\u5176\u5b83\u7814\u7a76\u4e2d\uff0c\u6392\u9664\u4e86\u4e00\u9879\u4e09\u81c2\u7814\u7a76\uff0c\u8fd9\u9879\u7814\u7a76\u5bf9\u5171\u540c\u5bf9\u7167\u7ec4\u7684\u5e72\u9884\u63aa\u65bd\u662fCOT\uff0c\u4e14\u672a\u5c06\u60a3\u8005\u76f4\u63a5\u968f\u673a\u5206\u914d\u5230HFNO\u4e0eNIV\u7ec4<sup>[60]<\/sup>\u3002<\/p>\n<p>\u5728\u7eb3\u5165\u975eCOVID-19\u60a3\u8005\u7684\u4e24\u9879RCT\u4e2d\uff0c\u4e00\u9879\u7eb3\u5165\u4e86\u514d\u75ab\u529f\u80fd\u4f4e\u4e0b\u60a3\u8005<sup>[76]<\/sup>\uff0c\u53e6\u4e00\u9879\u7814\u7a76\u7eb3\u5165\u4e86\u975e\u514d\u75ab\u529f\u80fd\u4f4e\u4e0b\u60a3\u8005<sup>[59]<\/sup>\u3002\u6709\u4e00\u9879\u7814\u7a76\u4ec5\u62a5\u544a\u4e867\u5929\u63d2\u7ba1\u7ed3\u5c40\uff0c\u56e0\u6b64\u672a\u5c06\u5176\u7eb3\u5165\u63d2\u7ba1\u7684\u6c47\u603b\u5206\u6790<sup>[74]<\/sup>\u3002\u6700\u7ec8Meta\u5206\u6790\u672a\u53d1\u73b0HFNO\u4e0eNIV\u7ec4\u5728\u6b7b\u4ea1\u7387\uff08RR 0.75\uff0c95% CI 0.51 ~ 1.11\uff09\u6216\u63d2\u7ba1\u7387\uff08RR 1.09\uff0c95% CI 0.71 ~ 1.68\uff09\u65b9\u9762\u5b58\u5728\u663e\u8457\u5dee\u5f02\u3002<\/p>\n<p>\u5728\u6b7b\u4ea1\u7387\u65b9\u9762\uff0cMeta\u5206\u6790\u63d0\u793a\u514d\u75ab\u529f\u80fd\u4f4e\u4e0b\u6216COVID-19\u4e9a\u7ec4\u60a3\u8005\uff0c\u5e94\u7528HFNO\u4e0eNIV\u6b7b\u4ea1\u7387\u5e76\u65e0\u663e\u8457\u5dee\u5f02\u3002\u5173\u4e8e\u6c14\u7ba1\u63d2\u7ba1\uff0cGrieco\u7b49\u7684\u8bd5\u9a8c\u663e\u793a\uff0c\u4e0e\u5e94\u7528NIV\u76f8\u6bd4\uff0c\u5e94\u7528HFNO\u7684COVID-19\u60a3\u800528\u65e5\u63d2\u7ba1\u7387\u663e\u8457\u589e\u52a0\uff08RR 1.72\uff0c95% CI 1.06 ~ 2.79\uff09<sup>[75]<\/sup>\u3002\u7136\u800c\uff0cNair\u7b49\u7684\u8bd5\u9a8c\uff08\u56e0\u5176\u4ec5\u62a5\u544a\u4e867\u5929\u63d2\u7ba1\u7387\u800c\u672a\u7eb3\u5165\u4e3bMeta\u5206\u6790\uff0c\uff09\u7ed3\u679c\u4e0e\u4e4b\u76f8\u53cd\uff08HFNO\u7ec4\u7684\u7edd\u5bf9\u98ce\u9669\u964d\u4f4e\u4e8619%\uff09<sup>[74]<\/sup>\u3002<\/p>\n<p>5.2.3 \u63a8\u8350\u610f\u89c13.2<\/p>\n<p>\u5bf9\u4e8e\u975e\u5fc3\u6e90\u6027\u80ba\u6c34\u80bf\u6216AECOPD\u5f15\u8d77\u7684\u672a\u7ecf\u9009\u62e9\u7684AHRF\u60a3\u8005\uff0c\u4e0e\u6301\u7eed\u6c14\u9053\u6b63\u538b\u901a\u6c14\uff08continuous positive airway pressure, CPAP\uff09\/ NIV\u76f8\u6bd4\uff0c\u65e0\u6cd5\u63a8\u8350\u6216\u53cd\u5bf9\u91c7\u7528HFNO\u4ee5\u51cf\u5c11\u63d2\u7ba1\u7387\u6216\u6b7b\u4ea1\u7387\u3002\uff08\u65e0\u63a8\u8350\uff1b\u6b7b\u4ea1\u7387\u4e2d\u7b49\u8d28\u91cf\u8bc1\u636e\uff0c\u63d2\u7ba1\u7387\u4f4e\u8d28\u91cf\u8bc1\u636e\uff0c\u4e0d\u63a8\u8350\u4e5f\u4e0d\u53cd\u5bf9\u3002\uff09<\/p>\n<p>\u5efa\u8bae\u53ef\u4ee5\u8003\u8651\u7528CPAP\/NIV\u4ee3\u66ffHFNO\u6cbb\u7597COVID-19\u5f15\u8d77\u7684AHRF\uff0c\u4ee5\u964d\u4f4e\u63d2\u7ba1\u98ce\u9669\u3002\uff08\u5f31\u63a8\u8350\uff0c\u9ad8\u8d28\u91cf\u8bc1\u636e\uff09\uff0c\u4f46\u5bf9\u4e8eCPAP\/NIV\u4e0eHFNO\u76f8\u6bd4\uff0c\u662f\u5426\u53ef\u4ee5\u964d\u4f4eCOVID-19\u60a3\u8005\u7684\u6b7b\u4ea1\u7387\uff0c\u65e0\u63a8\u8350\u610f\u89c1\u3002\uff08\u65e0\u63a8\u8350\uff1b\u9ad8\u8d28\u91cf\u8bc1\u636e\u63d0\u793a\u65e0\u6548\u3002\uff09<\/p>\n<p>5.2.4 \u4e34\u5e8a\u5e94\u7528\u4e13\u5bb6\u610f\u89c1<\/p>\n<p>\u4e13\u5bb6\u5c0f\u7ec4\u5efa\u8bae\uff0c\u7ba1\u7406\u63a5\u53d7\u6301\u7eedCPAP\/NIV\u6cbb\u7597\u7684AHRF\u60a3\u8005\u7684\u4e34\u5e8a\u533b\u751f\u5e94\u5177\u6709\u9002\u5f53\u7684\u7ecf\u9a8c\u548c\u4e13\u4e1a\u77e5\u8bc6\uff0c\u5e76\u4e14\u7ed9\u4e88\u60a3\u8005\u6070\u5f53\u7684\u76d1\u6d4b\uff08\u4f8b\u5982\u547c\u5438\u7a98\u8feb\u7684\u4e34\u5e8a\u4f53\u5f81\u3001\u547c\u5438\u6a21\u5f0f\u3001VT\u3001\u547c\u5438\u9891\u7387\u4ee5\u53ca\u5438\u6c14\u52aa\u529b\uff09\u4ee5\u907f\u514dP-SILI\u3002\u6b64\u5916\uff0c\u4e34\u5e8a\u533b\u751f\u5e94\u8003\u8651\u60a3\u8005\u4e2a\u4f53\u5bf9NIV\u7684\u8010\u53d7\u7a0b\u5ea6\u548c\u53d1\u751f\u4e0d\u826f\u4e8b\u4ef6\u7684\u98ce\u9669\u3002<\/p>\n<p>5.2.5 \u672a\u89e3\u51b3\u7684\u95ee\u9898\u548c\u7814\u7a76\u7a7a\u767d<\/p>\n<p>\u8feb\u5207\u9700\u8981RCT\u6765\u6bd4\u8f83HFNO\u6216NIV\/CPAP\u5bf9AHRF\u60a3\u8005\u6b7b\u4ea1\u7387\u3001\u63d2\u7ba1\u7387\u548c\u673a\u68b0\u901a\u6c14\u65f6\u957f\u7b49\u91cd\u8981\u7ec8\u70b9\u7684\u5f71\u54cd\u3002\u5bf9\u60a3\u8005\u8fdb\u884c\u957f\u671f\u968f\u8bbf\u4ee5\u53ca\u8ba4\u77e5\u548c\u529f\u80fd\u7ed3\u5c40\u8bc4\u4f30\uff0c\u5c06\u6709\u52a9\u4e8e\u660e\u786e\u89c2\u5bdf\u5230\u7684\u77ed\u671f\u7ed3\u5c40\u5dee\u5f02\uff08\u4f8b\u5982\u63d2\u7ba1\u7387\uff09\u662f\u5426\u4e0e\u5e78\u5b58\u8005\u7684\u957f\u671f\u635f\u5bb3\u6709\u5173\u3002<\/p>\n<p>6 \u9886\u57df 4\uff1aCPAP\/NIV<\/p>\n<p>6.1 \u95ee\u98984.1\uff1a\u5bf9\u4e8e\u975e\u7531\u5fc3\u6e90\u6027\u80ba\u6c34\u80bf\u3001\u80a5\u80d6\u6027\u901a\u6c14\u4e0d\u8db3\u6216AECOPD\u5bfc\u81f4AHRF\u7684\u975e\u673a\u68b0\u901a\u6c14\u60a3\u8005\uff0c\u4e0eCOT\u76f8\u6bd4\uff0cCPAP\/NIV\u662f\u5426\u80fd\u964d\u4f4e\u6b7b\u4ea1\u7387\u6216\u63d2\u7ba1\u7387\uff1f<\/p>\n<p>6.1.1 \u80cc\u666f<\/p>\n<p>\u867d\u7136AHRF\u60a3\u8005\u7684\u4f4e\u6c27\u8840\u75c7\u548c\u901a\u6c14\u529f\u80fd\u969c\u788d\u53ef\u4ee5\u901a\u8fc7\u4e0d\u540c\u7684\u975e\u4fb5\u5165\u6027\u65b9\u6cd5\u6765\u89e3\u51b3\uff0c\u4f46\u4e0d\u540c\u7684\u65b9\u6cd5\u5bf9\u547c\u6c14\u672b\u80ba\u6ce1\u538b\u548c\/\u6216\u5438\u6c14\u52aa\u529b\u7684\u5f71\u54cd\u4e0d\u540c<sup>[77]<\/sup>\u3002\u5728\u4f7f\u7528CPAP\/NIV\u65f6\uff0c\u9700\u8981\u8003\u8651\u6f5c\u5728\u7684\u63d2\u7ba1\u5ef6\u8fdf\u53ef\u80fd\u5bfc\u81f4\u66f4\u5dee\u7684\u7ed3\u5c40\uff0c\u5305\u62ec\u6b7b\u4ea1\u7387\u7684\u589e\u52a0\u3002\u6b64\u5916\uff0c\u5728NIV\u671f\u95f4\u53ef\u89c2\u5bdf\u5230\u8f83\u9ad8\u8de8\u80ba\u538b\uff08\u7531\u4e8e\u9ad8\u652f\u6301\u6c34\u5e73\u3001\u5f3a\u5438\u6c14\u52aa\u529b\u6216\u4e24\u8005\u90fd\u6709\uff09\uff0c\u800c\u8fd9\u53ef\u80fd\u4f1a\u5bfc\u81f4P-SILI\uff0cCPAP\/NIV\u5f15\u8d77\u7684P-SILI\u7c7b\u4f3c\u4e8e\u6709\u521b\u63a7\u5236\u901a\u6c14\u65f6\u7684VILI<sup>[11]<\/sup>\u3002\u5728\u9009\u62e9\u975e\u4fb5\u5165\u6027\u65b9\u6cd5\u6cbb\u7597AHRF\u65f6\uff0c\u9700\u8981\u8003\u8651\u5176\u7279\u5b9a\u7684\u751f\u7406\u6548\u5e94\u3002\u503c\u5f97\u6ce8\u610f\u7684\u662f\uff0c\u672a\u63a5\u53d7\u6b63\u538b\u7684AHRF\u60a3\u8005\uff0c\u7531\u4e8e\u4ed6\u4eec\u6ca1\u6709\u63a5\u53d7\u81f3\u5c115 cmH2O\u7684PEEP\uff0c\u56e0\u6b64\u6839\u636e\u5f53\u524d\u7684\u67cf\u6797\u5b9a\u4e49\uff0c\u4e0d\u80fd\u5f52\u7c7b\u4e3aARDS\u60a3\u8005\u3002\u5982\u524d\u6240\u8ff0\uff0cARDS\u7684\u5b9a\u4e49\u53ef\u80fd\u9700\u8981\u5305\u62ec\u8fd9\u4e9b\u4ece\u75c5\u7406\u751f\u7406\u5b66\u89d2\u5ea6\u5177\u6709\u76f8\u540c\u75be\u75c5\u7684\u60a3\u8005\u3002<\/p>\n<p>6.1.2 \u8bc1\u636e\u6982\u8ff0<\/p>\n<p>\u5171\u7eb3\u5165\u4e86\u5341\u9879RCT\uff0c\u5305\u62ec\u975eCOVID-19\u548cCOVID-19 AHRF\u60a3\u8005\uff0c\u514d\u75ab\u529f\u80fd\u6b63\u5e38\u548c\u514d\u75ab\u529f\u80fd\u4f4e\u4e0b\u60a3\u8005<sup>[59, 60, 78-85]<\/sup>\u3002\u5176\u4e2d\u516d\u9879\u7814\u7a76\u5bf9\u6bd4\u4e86NIV\u4e0eCOT\u7684\u6548\u679c<sup>[59, 81-85]<\/sup>\uff0c\u56db\u9879\u7814\u7a76\u5bf9\u6bd4\u4e86CPAP\u4e0eCOT\u7684\u6548\u679c<sup>[60, 78-80]<\/sup>\u3002\u4e00\u9879\u9488\u5bf9COVID-19\u60a3\u8005\u8fdb\u884c\u7684CPAP\u8bd5\u9a8c\uff0c\u5c06\u60a3\u8005\u968f\u673a\u5206\u4e3a\u4e24\u7ec4\uff0c\u6cbb\u7597\u7ec4\u63a5\u53d7CPAP\u6216HFNO\u6cbb\u7597\uff0c\u5bf9\u7167\u7ec4\u63a5\u53d7COT\u6cbb\u7597<sup>[60]<\/sup>\u3002\u6211\u4eec\u5408\u5e76\u4e86\u6240\u6709\u5341\u9879\u7814\u7a76\u8fdb\u884c\u4e3b\u8981\u5206\u6790\uff0c\u672a\u8fdb\u884c\u4e9a\u7ec4\u6bd4\u8f83\u3002\u5047\u8bbeNIV\u548cCPAP\u540c\u6837\u6709\u6548\uff0c\u56e0\u6b64\u7eb3\u5165\u4e86\u91c7\u7528\u5176\u4e2d\u4efb\u4e00\u5e72\u9884\u63aa\u65bd\u7684\u7814\u7a76\u8fdb\u884cMeta\u5206\u6790\u3002\u5f53\u5e72\u9884\u4e3aNIV\u65f6\uff0c\u5047\u5b9a\u547c\u5438\u673a\u7c7b\u578b\uff08ICU\uff0c\u4e13\u7528NIV\u6216\u5bb6\u7528\u547c\u5438\u673a\uff09\u548c\u6240\u4f7f\u7528\u7684\u7ba1\u8def\u7c7b\u578b\uff08\u5355\u6216\u53cc\u56de\u8def\uff09\u5bf9\u7ed3\u5c40\u4e0d\u4ea7\u751f\u5f71\u54cd\u3002<\/p>\n<p>\u6211\u4eec\u8fdb\u884c\u4e86\u4e00\u9879\u4e3b\u8981Meta\u5206\u6790\uff0c\u91cd\u70b9\u5173\u6ce8\u4e94\u9879\u504f\u501a\u98ce\u9669\u4f4e\u3001\u4e2d\u7b49\u81f3\u9ad8\u8d28\u91cf\u7684RCT<sup>[59, 60, 78, 81, 82]<\/sup>\u3002\u7136\u800c\uff0c\u7531\u4e8e\u672a\u5b9e\u65bd\u76f2\u6cd5\uff0c\u5f53\u7ed3\u5c40\u53d8\u91cf\u4e3a\u63d2\u7ba1\u65f6\uff0c\u504f\u501a\u98ce\u9669\u589e\u52a0\u3002\u8be5Meta\u5206\u6790\u7ed3\u679c\u663e\u793a\uff0c\u4e0eCOT\u76f8\u6bd4\uff0cCPAP\/NIV\u5bf9\u63d2\u7ba1\uff08RR 0.89\uff0c95% CI 0.77 ~ 1.03\uff09\u6216\u4f4f\u9662\u6b7b\u4ea1\u7387\uff08RR 0.89\uff0c95% CI 0.75 ~ 1.05\uff09\u65e0\u663e\u8457\u5f71\u54cd\u3002\u5bf9\u6240\u6709\u7814\u7a76\u8fdb\u884c\u4e86\u4e8c\u6b21\u5206\u6790\uff0c\u4e8c\u6b21\u5206\u6790\u672a\u8003\u8651\u7814\u7a76\u7684\u504f\u501a\u8bc4\u4f30\u98ce\u9669\u548c\u7814\u7a76\u7684\u8d28\u91cf\u3002\u8be5\u4e8c\u6b21\u5206\u6790\u7ed3\u679c\u663e\u793a\uff0cCPAP\/NIV\u5728\u63d2\u7ba1\u7387\u548c\u6b7b\u4ea1\u7387\u65b9\u9762\u5b58\u5728\u4fdd\u62a4\u4f5c\u7528\u3002\u4f46\u662f\uff0c\u6839\u636e\u6211\u4eec\u9884\u5b9a\u7684\u7edf\u8ba1\u8ba1\u5212\uff0c\u5f53\u4e3b\u8981\u548c\u4e8c\u6b21\u5206\u6790\u7684\u7ed3\u679c\u4e0d\u4e00\u81f4\u65f6\uff0c\u4ee5\u4e3b\u8981\u5206\u6790\u7ed3\u679c\u4e3a\u91cd\u3002<\/p>\n<p>\u8fc4\u4eca\uff0c\u4ec5\u4e00\u9879\u7814\u7a76\u9488\u5bf9\u7684\u662fCOVID-19\u60a3\u8005\uff0c\u7ed3\u679c\u63d0\u793a\uff0c\u4e0e\u5e38\u89c4\u6c27\u7597\u76f8\u6bd4\uff0cCPAP\u7684\u63d2\u7ba1\u7387\u66f4\u4f4e\uff0c\u4f46\u6b7b\u4ea1\u7387\u6ca1\u6709\u5dee\u5f02<sup>[60]<\/sup>\u3002<\/p>\n<p>6.1.3 \u63a8\u8350\u610f\u89c14.1<\/p>\n<p>\u4e0eCOT\u76f8\u6bd4\uff0c\u65e0\u6cd5\u63a8\u8350\u6216\u53cd\u5bf9\u4f7f\u7528CPAP\/NIV\u6cbb\u7597AHRF\uff08\u4e0e\u5fc3\u6e90\u6027\u80ba\u6c34\u80bf\u6216AECOPD\u65e0\u5173\uff09\u4ee5\u964d\u4f4e\u6b7b\u4ea1\u7387\u6216\u9884\u9632\u63d2\u7ba1\u3002\uff08\u65e0\u63a8\u8350\uff1b\u6b7b\u4ea1\u7387\u9ad8\u8d28\u91cf\u8bc1\u636e\uff0c\u63d2\u7ba1\u7387\u4e2d\u7b49\u8d28\u91cf\u8bc1\u636e\u3002\uff09<\/p>\n<p>\u5efa\u8bae\u4f7f\u7528CPAP\u800c\u4e0d\u662fCOT\u6765\u964d\u4f4eCOVID-19\u6240\u81f4AHRF\u60a3\u8005\u7684\u63d2\u7ba1\u98ce\u9669\u3002\uff08\u5f31\u63a8\u8350\uff1b\u4f4e\u8d28\u91cf\u652f\u6301\u8bc1\u636e\u3002\uff09<\/p>\n<p>\u5728\u8be5\u60a3\u8005\u4eba\u7fa4\uff0c\u65e0\u6cd5\u63a8\u8350\u6216\u53cd\u5bf9\u4f7f\u7528CPAP\u800c\u4e0d\u662fCOT\u6765\u964d\u4f4e\u6b7b\u4ea1\u7387\u3002\uff08\u65e0\u63a8\u8350\uff1b\u4e2d\u7b49\u8d28\u91cf\u8bc1\u636e\u63d0\u793a\u6ca1\u6709\u6548\u679c\u3002\uff09<\/p>\n<p>6.1.4 \u672a\u89e3\u51b3\u7684\u95ee\u9898\u548c\u7814\u7a76\u7a7a\u767d<\/p>\n<p>\u5bf9\u73b0\u6709\u79d1\u5b66\u8bc1\u636e\u7684\u5206\u6790\uff0c\u65e0\u6cd5\u5f97\u51faCPAP\/NIV\u5728\u9884\u9632\u63d2\u7ba1\u6216\u964d\u4f4e\u975eCOVID-19\u76f8\u5173AHRF\u60a3\u8005\u6b7b\u4ea1\u7387\u65b9\u9762\u4f18\u4e8eCOT\u7684\u7ed3\u8bba\u3002\u4e13\u5bb6\u5c0f\u7ec4\u5efa\u8bae\u672a\u6765\u7684\u7814\u7a76\u5e94\u66f4\u597d\u5730\u63cf\u8ff0\u7eb3\u5165\u60a3\u8005\u7684\u7279\u5f81\uff0c\u4ee5\u786e\u5b9aCPAP\/NIV\u5728AHRF\u6cbb\u7597\u4e2d\u7684\u6700\u4f73\u9002\u5e94\u75c7\u3002\u9274\u4e8e\u6700\u8fd1\u7684\u751f\u7406\u5b66\u8bc1\u636e<sup>[86]<\/sup>\uff0c\u4e13\u5bb6\u5c0f\u7ec4\u5efa\u8bae\u91cd\u70b9\u5173\u6ce8\u9ad8\u547c\u5438\u9a71\u52a8\u4e0e\u4f4e\u547c\u5438\u9a71\u52a8\u5728\u786e\u5b9aNIV\u7684\u9002\u7528\u6027\u548c\u6cbb\u7597\u6210\u529f\u53ef\u80fd\u6027\u65b9\u9762\u7684\u6f5c\u5728\u4f5c\u7528\u3002<\/p>\n<p>6.2 \u95ee\u98984.2\uff1a\u5728\u63a5\u53d7CPAP\/NIV\u6cbb\u7597\u7684AHRF\u60a3\u8005\uff0c\u4e0e\u9762\u7f69\u76f8\u6bd4\uff0c\u4f7f\u7528\u5934\u76d4\u662f\u5426\u4f1a\u51cf\u5c11\u63d2\u7ba1\u7387\u6216\u6b7b\u4ea1\u7387\uff1f<\/p>\n<p>6.2.1 \u80cc\u666f<\/p>\n<p>\u6025\u8bca\u533b\u7597\u5e38\u4f7f\u7528\u9762\u7f69\u5b9e\u65bdNIV\u6cbb\u7597\uff0c\u5176\u8010\u53d7\u6027\u53ef\u80fd\u8f83\u5dee\uff0c\u5e76\u53ef\u5bfc\u81f4NIV\u5931\u8d25\u7684\u98ce\u9669\u589e\u52a0\u3002\u5934\u76d4\u4ea6\u53ef\u7528\u4e8eNIV\u5b9e\u65bd\u3002\u51e0\u9879\u7814\u7a76\u62a5\u9053\u901a\u8fc7\u5934\u76d4\u5b9e\u65bdNIV\u8010\u53d7\u6027\u826f\u597d\uff0c\u5e76\u53ef\u51cf\u5c11\u76ae\u80a4\u538b\u529b\u6027\u635f\u4f24<sup>[87-88]<\/sup>\u3002\u7136\u800c\uff0c\u5728\u5934\u76d4\u578bNIV\u671f\u95f4\uff0c\u4eba\u673a\u540c\u6b65\u7684\u7ba1\u7406\u53ef\u80fd\u5177\u6709\u6311\u6218\u6027<sup>[89-90]<\/sup>\uff0c\u9700\u8981\u7279\u5b9a\u7684\u4e13\u4e1a\u77e5\u8bc6\u6765\u4f18\u5316\u901a\u6c14\u8bbe\u7f6e\u3002<\/p>\n<p>6.2.2 \u8bc1\u636e\u6982\u8ff0<\/p>\n<p>\u4ec5\u68c0\u7d22\u51fa\u4e00\u9879\u5c0f\u578b\u5355\u4e2d\u5fc3RCT<sup>[91]<\/sup>\u300283\u4f8b\u9700\u8981NIV\u7684\u4f4e\u6c27\u6027\u547c\u5438\u8870\u7aed\u60a3\u8005\u88ab\u968f\u673a\u5206\u914d\u5230\u9762\u7f69\u6216\u5934\u76d4\u7ec4\u3002\u4f7f\u7528\u5934\u76d4\u7ec4\u6b7b\u4ea1\u7387\u964d\u4f4e\u4e8622.3%\uff0895% CI ~ 41.1\u81f3-1\uff09\uff0c\u63d2\u7ba1\u7387\u964d\u4f4e\u4e8643.4%\uff0895% CI ~ 59.5\u81f3 ~ 22.5\uff09\u3002\u53e6\u5916\uff0c\u8fd8\u6709\u8fd9\u7ec4\u6570\u636e\u7684\u968f\u8bbf\u7814\u7a76\uff0c\u91cd\u70b9\u5173\u6ce8\u529f\u80fd\u7ed3\u5c40<sup>[92]<\/sup>\u3002\u5c3d\u7ba1\u8be5\u7814\u7a76\u53ea\u6709\u4e2d\u5ea6\u7684\u5c40\u9650\u6027\uff0c\u4f46\u4e13\u5bb6\u5c0f\u7ec4\u4ecd\u62c5\u5fc3\u6837\u672c\u91cf\u5c0f\u4e14\u63d0\u524d\u7ec8\u6b62\u53ef\u80fd\u4f1a\u9ad8\u4f30\u6cbb\u7597\u6548\u679c\uff0c\u5355\u4e2d\u5fc3\u7814\u7a76\u53ef\u80fd\u5b58\u5916\u63a8\u6027\u65b9\u9762\u7684\u95ee\u9898\u3002\u603b\u4e4b\uff0c\u4e13\u5bb6\u5c0f\u7ec4\u8ba4\u4e3a\u8fd9\u9879\u7814\u7a76\u63d0\u51fa\u4e86\u5047\u8bbe\uff0c\u4e0d\u80fd\u6839\u636e\u8be5\u7814\u7a76\u5f97\u51fa\u5934\u76d4\u4f18\u4e8e\u9762\u7f69\u7684\u7ed3\u8bba\u3002<\/p>\n<p>6.2.3 \u63a8\u8350\u610f\u89c14.2<\/p>\n<p>\u4e0e\u9762\u7f69\u76f8\u6bd4\uff0c\u65e0\u6cd5\u63a8\u8350\u6216\u53cd\u5bf9\u4f7f\u7528\u5934\u76d4\u8fdb\u884cCPAP\/NIV\u4ee5\u51cf\u5c11\u63d2\u7ba1\u6216\u964d\u4f4eAHRF\u60a3\u8005\u7684\u6b7b\u4ea1\u7387\u3002\uff08\u65e0\u63a8\u8350\uff1b\u6781\u4f4e\u8d28\u91cf\u652f\u6301\u8bc1\u636e\uff09<\/p>\n<p>6.2.4 \u672a\u89e3\u51b3\u7684\u95ee\u9898\u548c\u7814\u7a76\u7a7a\u767d<\/p>\n<p>\u9700\u8981\u8fdb\u4e00\u6b65\u7814\u7a76\u6765\u6bd4\u8f83\u5934\u76d4\u548c\u9762\u7f69\u5bf9\u7ed3\u5c40\u7684\u5f71\u54cd\u624d\u80fd\u5bf9\u8fd9\u5176\u4e2d\u4e00\u79cd\u505a\u51fa\u8fdb\u4e00\u6b65\u7684\u63a8\u8350\u610f\u89c1\u3002<\/p>\n<p>6.3 \u95ee\u98984.3\uff1a\u5728AHRF\u60a3\u8005\u4e2d\uff0c\u4e0eCPAP\u76f8\u6bd4\uff0cNIV\u662f\u5426\u4f1a\u964d\u4f4e\u6b7b\u4ea1\u7387\u6216\u63d2\u7ba1\u7387\uff1f<\/p>\n<p>6.3.1 \u80cc\u666f<\/p>\n<p>\u5f53\u547c\u5438\u9a71\u52a8\u548c\u5438\u6c14\u52aa\u529b\u504f\u9ad8\u65f6\uff0cNIV\u53ef\u4ea7\u751f\u8f83\u9ad8\u7684\u8de8\u80ba\u538b\u3002\u5438\u6c14\u65f6\u5e94\u7528\u989d\u5916\u7684\u6b63\u538b\u8f85\u52a9\u53ef\u80fd\u5bfc\u81f4\u8de8\u80ba\u538b\u548c\u4f5c\u7528\u4e8e\u80ba\u7684\u603b\u538b\u529b\u8fdb\u4e00\u6b65\u589e\u9ad8\uff0c\u7279\u522b\u662f\u5f53\u547c\u5438\u9a71\u52a8\u529b\u9ad8\u65f6\u3002\u56e0\u6b64\uff0cCPAP\u53ef\u80fd\u6709\u76ca\u4e8eAHRF\u60a3\u8005\uff0c\u4e0eNIV\u76f8\u6bd4\uff0c\u53ef\u80fd\u4f1a\u964d\u4f4e\u8de8\u80ba\u538b\u7684\u6ce2\u52a8\u3002<\/p>\n<p>6.3.2 \u8bc1\u636e\u6982\u8ff0<\/p>\n<p>\u672a\u68c0\u7d22\u5230\u9488\u5bf9\u8be5PICO\u95ee\u9898\u7684\u968f\u673a\u7814\u7a76\uff0c\u56e0\u6b64\u65e0\u6cd5\u63d0\u51fa\u652f\u6301\u6216\u53cd\u5bf9\u4f7f\u7528NIV\u4e0eCPAP\u6cbb\u7597ARDS\u7684\u5efa\u8bae\u3002<\/p>\n<p>6.3.3 \u63a8\u8350\u610f\u89c14.3<\/p>\n<p>\u4e0eCPAP\u76f8\u6bd4\uff0c\u65e0\u6cd5\u63a8\u8350\u6216\u53cd\u5bf9\u4f7f\u7528NIV\u6cbb\u7597AHRF\u7684\u5efa\u8bae\u3002\uff08\u65e0\u63a8\u8350\uff1b\u65e0\u8bc1\u636e\u3002\uff09<\/p>\n<p>6.3.4 \u4e34\u5e8a\u5e94\u7528\u4e13\u5bb6\u610f\u89c1<\/p>\n<p>\u4ece\u6982\u5ff5\u4e0a\u8bb2\uff0c\u5728AHRF\u7684\u60c5\u51b5\u4e0b\uff0c\u4f7f\u7528CPAP\u662f\u6709\u610f\u4e49\u7684\uff0c\u4f46\u6ca1\u6709\u6570\u636e\u5c06\u5176\u4e0eNIV\u8fdb\u884c\u6bd4\u8f83\u3002<\/p>\n<p>6.3.5 \u672a\u89e3\u51b3\u7684\u95ee\u9898\u548c\u7814\u7a76\u7a7a\u767d<\/p>\n<p>\u4e0eCPAP\u76f8\u6bd4\uff0cNIV\u662f\u5426\u80fd\u964d\u4f4e\u63d2\u7ba1\u98ce\u9669\u6216\u964d\u4f4e\u6b7b\u4ea1\u7387\uff0c\u9700\u8981\u8fdb\u4e00\u6b65\u7684\u968f\u673a\u7814\u7a76\u6765\u8fdb\u884c\u8bc4\u4f30\u3002<\/p>\n<p>7 \u9886\u57df5:\u5c0f\u6f6e\u6c14\u91cf\u901a\u6c14<\/p>\n<p>7.1 \u95ee\u9898 5.1\uff1a\u5728\u6210\u4ebaARDS\u548cCOVID-19\u76f8\u5173ARDS\u7684\u60a3\u8005\u4e2d\uff0c\u76f8\u6bd4\u4f20\u7edf\u7684\u901a\u6c14\u8bbe\u7f6e\uff0c\u5355\u72ec\u4f7f\u7528\u5c0f\u6f6e\u6c14\u91cf\u901a\u6c14\uff08low tidal volume ventilation, LTV\uff09\u80fd\u5426\u964d\u4f4e\u6b7b\u4ea1\u7387\uff1f<\/p>\n<p>7.1.1 \u80cc\u666f<\/p>\n<p>20\u4e16\u7eaa60\u5e74\u4ee3\u521d\uff0c\u7814\u7a76\u4eba\u5458\u548c\u4e34\u5e8a\u533b\u751f\u53d1\u73b0\uff0cLTV\u4f1a\u5bfc\u81f4\u80ba\u5bb9\u79ef\u9010\u6e10\u51cf\u5c11\uff0c\u540c\u65f6\u7531\u4e8e\u901a\u6c14\u4e0d\u826f\u533a\u57df\u5bfc\u81f4\u7684\u53f3\u5411\u5de6\u5206\u6d41\u800c\u51fa\u73b0\u4f4e\u6c27\u8840\u75c7\u3002\u56e0\u6b64\uff0c\u63a8\u8350\u4f7f\u752812 ~ 15 ml\/kg\u7684\u5927VT\u8fdb\u884c\u673a\u68b0\u901a\u6c14<sup>[93]<\/sup>\u3002\u968f\u7740\u5bf9\u751f\u7406\u5b66\u6982\u5ff5\u8ba4\u8bc6\u7684\u4e0d\u65ad\u6df1\u5165\uff0c\u4f7f\u7528LTV\u7684\u80ba\u4fdd\u62a4\u6027\u901a\u6c14\u7b56\u7565\u65f6\u4ee3\u76ee\u524d\u5df2\u88ab\u666e\u904d\u63a5\u53d7\uff1a\u2460\u5982\u679c\u60a3\u8005\u6c27\u5408\u826f\u597d\uff0c\u5219\u53ef\u4ee5\u8f83\u597d\u7684\u8010\u53d7\u9ad8\u78b3\u9178\u8840\u75c7\u548c\u547c\u5438\u6027\u9178\u4e2d\u6bd2\uff1b\u2461\u673a\u68b0\u901a\u6c14\u4f1a\u5bfc\u81f4\u80ba\u6ce1\u7684\u590d\u5f20\u548c\u53bb\u590d\u5f20\uff0c\u548c\/\u6216\u4e0e\u8de8\u80ba\u538b\u8fc7\u9ad8\u76f8\u5173\u7684\u80ba\u6ce1\u8fc7\u5ea6\u81a8\u80c0\uff0c\u8fd9\u53ef\u80fd\u4f1a\u52a0\u91cd\u5df2\u6709\u7684\u80ba\u635f\u4f24\u6216\u5bfc\u81f4\u65b0\u53d1\u7684\u80ba\u635f\u4f24\uff1b\u2462ARDS\u60a3\u8005\u7684\u6709\u6548\u6c14\u4f53\u4ea4\u6362\u7684\u80ba\u5bb9\u79ef\u51cf\u5c11\uff08\u5a74\u513f\u80ba\uff09\uff0c\u56e0\u6b64\u5373\u4f7f\u662f\u201c\u6b63\u5e38VT\u201d\u901a\u6c14\u4e5f\u4f1a\u5bfc\u81f4\u8fc7\u5ea6\u81a8\u80c0\u548cVILI\u3002\u5728\u4e25\u91cdARDS\u60a3\u8005\u4e2d\uff0c\u5373\u4f7f\u5e94\u7528\u8f83\u5c0f\u7684VT\u901a\u6c14\uff0c\u4e5f\u4f1a\u51fa\u73b0\u533a\u57df\u6027\u80ba\u8fc7\u5ea6\u81a8\u80c0<sup>[94]<\/sup>\u3002\u968f\u7740\u5bf9VILI\u7684\u8ba4\u8bc6\u7684\u6df1\u5165\uff0c\u4ea7\u751f\u4e86\u201c\u80ba\u4fdd\u62a4\u6027\u901a\u6c14\u201d\u7684\u6982\u5ff5\uff0c\u5176\u539f\u56e0\u662fVILI\u7684\u8bb8\u591a\u75c5\u7406\u751f\u7406\u8fc7\u7a0b\u4e0eARDS\u76f8\u4f3c\u3002\u56e0\u6b64\uff0cLTV\u548c\u9002\u5f53\u6c34\u5e73\u7684PEEP\u7684\u901a\u6c14\u7b56\u7565\u88ab\u7528\u4e8e\u9650\u5236\u80ba\u8fc7\u5ea6\u81a8\u80c0\u548c\u80ba\u6ce1\u584c\u9677\u3002<\/p>\n<p>\u52a8\u7269\u548c\u4eba\u4f53\u7814\u7a76\u8868\u660e\uff0c\u4f7f\u7528LTV\u7b56\u7565\u53ef\u964d\u4f4eVILI\u3002\u5728\u4e34\u5e8a\u8bbe\u7f6e\u4e2d\uff0cLTV\u662f\u901a\u8fc7\u63d0\u4f9b4 ~ 8 mL\/kg\u9884\u6d4b\u516c\u65a4\u4f53\u91cd\uff08predicted body weight\uff0cPBW\uff09\u8303\u56f4\u5185\u7684VT\u6765\u5b9e\u73b0\u7684\uff0c\u5e76\u4e0d\u4ee5\u6700\u4f73\u6c14\u4f53\u4ea4\u6362\u4e3a\u76ee\u6807\uff0c\u800c\u662f\u63a5\u53d7\u4e00\u5b9a\u7684\u5b89\u5168\u53c2\u6570\u8303\u56f4\u5185\u7684\u6c14\u4f53\u4ea4\u6362\u3002\u4f20\u7edf\u7684\u6709\u521b\u673a\u68b0\u901a\u6c14\u65b9\u6cd5\u5e76\u6ca1\u6709\u4f18\u5148\u8003\u8651\u9650\u5236VILI\uff0c\u800c\u662f\u4fa7\u91cd\u4e8e\u4f7f\u52a8\u8109\u8840\u6c14\u5206\u6790\u7ed3\u679c\u6b63\u5e38\u5316\u3002<\/p>\n<p>7.1.2 \u8bc1\u636e\u6982\u8ff0<\/p>\n<p>\u672c\u6307\u5357\u7eb3\u5165\u4e86\u4e03\u9879RCT\u7814\u7a76\uff0c\u8fd9\u4e9b\u8bd5\u9a8c\u7b26\u5408\u7eb3\u5165\u6807\u51c6<sup>[28, 95-100]<\/sup>\uff0c\u6784\u6210\u4e86\u5173\u4e8eLTV\u63a8\u8350\u5efa\u8bae\u7684\u57fa\u7840\u3002<\/p>\n<p>\u7eb3\u5165\u7684\u7814\u7a76\u4e2d\u5bf9ARDS\u7684\u8bca\u65ad\u6807\u51c6\u5404\u4e0d\u76f8\u540c\u3002\u4e00\u9879\u8bd5\u9a8c\u7eb3\u5165\u4e86\u80ba\u635f\u4f24\u8bc4\u5206\uff08Lung Injury Score\uff0cLIS\uff09\u2265 2.5\u4e14\u5b58\u5728ARDS\u5371\u9669\u56e0\u7d20\u7684\u60a3\u8005<sup>[96]<\/sup>\uff0c\u800c\u53e6\u4e00\u9879\u8bd5\u9a8c\u5219\u7eb3\u5165\u4e86LIS &gt; 2.5 \u4e14\u6301\u7eed\u65f6\u95f4 &lt; 72 h\u3001\u53cc\u80ba\u6d78\u6da6\u548c\u81f3\u5c11\u51fa\u73b0\u4e00\u4e2a\u5668\u5b98\u7cfb\u7edf\u8870\u7aed\u7684\u60a3\u8005<sup>[95]<\/sup>\u3002\u5176\u4ed6\u7814\u7a76\u5305\u62ec\uff1aPaO2\/FiO2 \u2264 150 mmHg\uff0c\u80f8\u7247\u4e0a\u63d0\u793a4\u4e2a\u8c61\u9650\u4e2d\u81f3\u5c113\u4e2a\u6709\u6d78\u6da6\uff0c\u4e14\u6709ARDS\u5371\u9669\u56e0\u7d20\u7684\u60a3\u8005<sup>[100]<\/sup>\uff1bPaO2\/FiO2 \u2264 200 mmHg\u4f34\u53cc\u4fa7\u80ba\u6d78\u6da6<sup>[98]<\/sup>\uff1b\u5728PEEP\u4e3a5 cmH2O\uff0cVT\u4e3a5 ml\/kg\u65f6\uff0cPaO2\/FiO2\u4ecd \u2264 200 mmHg\u4e14\u6301\u7eed24\u5c0f\u65f6\u4ee5\u4e0a<sup>[28]<\/sup>\uff1b\u5728PEEP\u4e3a5 cmH2O\u65f6\uff0cPaO2\/FiO2 &lt; 250 mmHg\uff0c\u4f34\u6709ARDS\u5371\u9669\u56e0\u7d20<sup>[97]<\/sup>\uff0c\u6216PaO2\/FiO2 &lt; 300 mmHg\uff0c\u4f34\u6709\u53cc\u4fa7\u80ba\u6d78\u6da6<sup>[99]<\/sup>\u3002<\/p>\n<p>\u7eb3\u5165\u7814\u7a76\u7684\u5e72\u9884\u7ec4\u548c\u5bf9\u7167\u7ec4\u7684\u76ee\u6807VT\u548c\u6c14\u9053\u538b\u529b\u9608\u503c\u5b9a\u4e49\u5404\u4e0d\u76f8\u540c\uff08\u89c1\u88681\uff09\u3002\u91cd\u8981\u7684\u662f\uff0c\u6709\u4e94\u9879\u7814\u7a76\u63d0\u524d\u7ec8\u6b62<sup>[28, 95, 96, 98, 99]<\/sup>\u3002\u672a\u68c0\u7d22\u5230\u4e13\u95e8\u9488\u5bf9COVID-19\u60a3\u8005\u7684\u547c\u5438\u673a\u8bbe\u7f6e\u7684RCT\u7814\u7a76\u3002<\/p>\n<p>\u88681 \u6bd4\u8f83\u5c0f\u6f6e\u6c14\u91cf\u548c\u5927\u6f6e\u6c14\u91cf\u7684\u7814\u7a76\u603b\u7ed3<\/p>\n<\/p>\n<p>\u6839\u636eGRADE\u65b9\u6cd5\uff0c\u8be5\u6307\u5357\u5bf9\u4e2d\u9ad8\u8bc1\u636e\u8d28\u91cf\u7ea7\u522b\u7684\u7814\u7a76\u8fdb\u884c\u4e86\u521d\u6b65\u7684\u5206\u6790\uff0c\u5e76\u5bf9\u6240\u6709\u7814\u7a76\u8fdb\u884c\u4e86\u4e8c\u6b21\u5206\u6790\u3002<\/p>\n<p>\u521d\u6b65\u5206\u6790\u4e2d\u6709\u5173\u6b7b\u4ea1\u7387\u7684\u5206\u6790\u5305\u62ec\u4e09\u9879\u7814\u7a76<sup>[95, 97, 99]<\/sup>\uff0c\u7ed3\u679c\u663e\u793a\uff0cLTV\u7b56\u7565\u4e0e\u5927VT\u7b56\u7565\u76f8\u6bd4\uff0c\u4e8c\u8005\u7684\u6b7b\u4ea1\u7387\u6ca1\u6709\u5dee\u5f02\uff08RR 0.96 95% CI 0.72 ~ 1.28\uff0cP\u503c\u4e3a0.768\uff09\u3002\u5f02\u8d28\u6027\u5206\u6790\u91c7\u7528I2\u8868\u793a\uff0cI2\u4e3a61%\uff0895% CI\u4ecb\u4e8e0\u548c89%\u4e4b\u95f4\uff0cCochran&#8217;s Q\u68c0\u9a8cp = 0.08\uff09\uff0c\u9ad8\u5f02\u8d28\u6027\u3002<\/p>\n<p>\u4e8c\u6b21\u5206\u6790\u7ed3\u679c\u4e0e\u521d\u6b65\u5206\u6790\u7ed3\u679c\u4e00\u81f4\uff0cRR\u4e3a0.82\uff0895% CI 0.66 ~ 1.02\uff09\uff0cp\u503c\u4e3a0.069\u3002\u5f02\u8d28\u6027\u5206\u6790\u7ed3\u679c\u8868\u660e\u7531\u4e8e\u5176\u4e0d\u7cbe\u786e\uff0c\u5176\u7ed3\u679c\u4e0d\u786e\u5b9a\uff0cI2 = 47%\uff0c95% CI\u57280 ~ 78%\u4e4b\u95f4\uff0cCochran&#8217;s Q\u68c0\u9a8cp = 0.08\u3002<\/p>\n<p>\u5728\u8fd9\u4e9b\u7814\u7a76\u63d0\u4f9b\u7684\u76f8\u5173\u4fe1\u606f\u4e2d\uff0c\u5728\u673a\u68b0\u901a\u6c14\u65f6\u95f4\u548c\u6c14\u538b\u4f24\u7684\u7ed3\u679c\u4e2d\u672a\u53d1\u73b0\u7edf\u8ba1\u5b66\u5dee\u5f02\u3002<\/p>\n<p>\u5c3d\u7ba1\u6b7b\u4ea1\u7387\u6c47\u603b\u5728\u7edf\u8ba1\u5b66\u4e0a\u65e0\u660e\u663e\u5dee\u5f02\uff0c\u4f46\u5728\u5236\u5b9a\u6307\u5357\u8fc7\u7a0b\u4e2d\uff0c\u6839\u636e\u52a8\u7269\u548c\u4eba\u4f53\u7814\u7a76\u7684\u7ed3\u679c\uff0c\u4e13\u5bb6\u5c0f\u7ec4\u8ba4\u4e3a\u4f7f\u7528LTV\u6709\u6781\u5f3a\u7684\u751f\u7406\u5b66\u5408\u7406\u6027\u3002\u4e13\u5bb6\u5c0f\u7ec4\u964d\u4f4e\u4e86\u4e00\u9879\u6ca1\u6709\u5168\u6587\u53d1\u8868\u7684\u8bd5\u9a8c\u7684\u8bc1\u636e\u7b49\u7ea7<sup>[100]<\/sup>\u3002\u8fd8\u5bf9\u4e24\u9879\u8bd5\u9a8c\u7684\u8bc1\u636e\u8fdb\u884c\u4e86\u964d\u7ea7\uff0c\u8fd9\u4e24\u9879\u8bd5\u9a8c\u91c7\u7528\u660e\u786e\u7684\u65b9\u6848\u5c06\u5e72\u9884\u7ec4\u7684PEEP\u8bbe\u7f6e\u5728\u538b\u529b-\u5bb9\u79ef\u66f2\u7ebf\u4f4e\u4f4d\u62d0\u70b9\u4ee5\u4e0a2 cmH2O\u6216\u5728\u4e00\u9879\u8bd5\u9a8c\u4e2d\u4fdd\u630113 cmH2O<sup>[28, 96]<\/sup>\uff0c\u5e76\u5141\u8bb8\u4f7f\u7528RM<sup>[96]<\/sup>\u3002\u8fd9\u4e24\u9879\u8bd5\u9a8c\u7684\u6837\u672c\u91cf\u90fd\u4e0d\u5927\uff0c\u5176\u4e2d\u6b7b\u4ea1\u4e8b\u4ef6\u5f88\u5c11\uff0c\u800c\u4e14\u90fd\u56e0\u4e34\u5e8a\u83b7\u76ca\u800c\u63d0\u524d\u7ec8\u6b62\u3002\u5728\u5236\u5b9a\u8fd9\u4e00\u5efa\u8bae\u65f6\uff0c\u4e13\u5bb6\u5c0f\u7ec4\u8fd8\u8003\u8651\u5230\u81ea2006\u5e74\u4ee5\u540e\uff0c\u5173\u4e8eLTV\u7684\u9886\u57df\u6ca1\u6709\u53d1\u8868\u65b0\u7684\u8bd5\u9a8c\uff0c\u800c\u7eb3\u5165\u7684\u7814\u7a76\u4e2dVT\u7684\u8ba1\u7b97\u65b9\u6cd5\u5404\u4e0d\u76f8\u540c\uff0c\u8bbe\u8ba1\u6821\u6b63\u4f53\u91cd\uff08adjusted body weight\uff0cABW\uff09\u3001\u7406\u60f3\u4f53\u91cd\uff08ideal body weight\uff0cIBW\uff09\u548c\u9884\u6d4b\u4f53\u91cd\uff08predicted body weight\uff0cPBW\uff09\uff0c\u5e76\u4e14\u4e0d\u540c\u7814\u7a76\u8fbe\u5230\u7684\u6807\u51c6\u4e0d\u540c\u3002\u4e13\u5bb6\u5c0f\u7ec4\u8fd8\u8ba4\u4e3a\uff0cLTV\u7b56\u7565\u53ef\u80fd\u9700\u8981\u589e\u52a0\u9547\u9759\u548c\/\u6216\u808c\u677e\uff1b\u8fd9\u4e9b\u5f71\u54cd\u4ee5\u53ca\u4e0e\u5141\u8bb8\u6027\u9ad8\u78b3\u9178\u8840\u75c7\u76f8\u5173\u7684\u5f71\u54cd\u5e76\u672a\u7ed9\u51fa\u660e\u786e\u7684\u8bc4\u4f30\u3002<\/p>\n<p>\u7531\u4e8e\u7f3a\u4e4f\u5728COVID-19\u60a3\u8005\u4e2d\u4f7f\u7528\u5176\u4ed6\u901a\u6c14\u7b56\u7565\u7684\u76f4\u63a5\u76f8\u5173\u8bc1\u636e\uff0c\u4e13\u5bb6\u5c0f\u7ec4\u56e0\u6ca1\u6709\u76f4\u63a5\u7684\u8bc1\u636e\u800c\u964d\u4f4e\u4e86\u63a8\u8350\u7b49\u7ea7\u3002\u4f46\u4e13\u5bb6\u5c0f\u7ec4\u8ba4\u4e3a\u652f\u6301COVID-19\u4e0e\u975eCOVID-19 ARDS\u60a3\u8005\u4f7f\u7528\u5c0f\u6f6e\u6c14\u91cf\u7684\u57fa\u672c\u751f\u7406\u539f\u7406\u662f\u76f8\u540c\u7684\u3002\u5728\u5236\u5b9a\u8fd9\u4e00\u5efa\u8bae\u65f6\uff0c\u8003\u8651\u4e86\u60a3\u8005\u7684\u4ef7\u503c\u89c2\u548c\u504f\u597d\u3001\u671f\u671b\u548c\u4e0d\u671f\u671b\u7684\u6548\u679c\u3001\u8d44\u6e90\u4f7f\u7528\u3001\u76f8\u5173\u5229\u76ca\u65b9\u7684\u63a5\u53d7\u7a0b\u5ea6\u3001\u53ef\u884c\u6027\u548c\u516c\u5e73\u6027\u4e4b\u95f4\u7684\u5e73\u8861\u3002<\/p>\n<p>7.1.3 \u63a8\u8350\u610f\u89c15.1<\/p>\n<p>\u5efa\u8bae\u4f7f\u7528LTV\u7b56\u7565\uff08\u53734 ~ 8 ml\/kg PBW\uff09\uff0c\u800c\u975e\u5927VT\u901a\u6c14\u7b56\u7565\uff08\u4f20\u7edf\u4e0a\u7528\u4e8e\u4f7f\u8840\u6c14\u503c\u6b63\u5e38\u5316\uff09\uff0c\u4ee5\u964d\u4f4e\u975eCOVID-19\u6240\u81f4ARDS\u60a3\u8005\u7684\u6b7b\u4ea1\u7387\u3002\uff08\u57fa\u4e8e\u4e13\u5bb6\u610f\u89c1\u7684\u5f3a\u63a8\u8350\uff0c\u4f46\u7f3a\u4e4f\u7edf\u8ba1\u610f\u4e49\uff1b\u9ad8\u8d28\u91cf\u8bc1\u636e\u3002\uff09<\/p>\n<p>\u6b64\u63a8\u8350\u610f\u89c1\u4e5f\u9002\u7528\u4e8eCOVID-19\u5f15\u8d77\u7684ARDS\u3002\uff08\u5f3a\u63a8\u8350\uff1b\u4e2d\u7b49\u8d28\u91cf\u95f4\u63a5\u8bc1\u636e\u3002\uff09<\/p>\n<p>7.1.4 \u4e34\u5e8a\u5e94\u7528\u4e13\u5bb6\u610f\u89c1<\/p>\n<p>\u5728\u8003\u8651RCT\u7814\u7a76\u65f6\uff0c\u91cd\u8981\u7684\u662f\u8981\u5f3a\u8c03\uff0c\u5f53\u8fbe\u5230\u6c14\u9053\u538b\u9608\u503c\u65f6\uff08\u7531\u6bcf\u4e2a\u7814\u7a76\u7684\u5e72\u9884\u7ec4\u548c\u5bf9\u7167\u7ec4\u89c4\u5b9a\uff09\uff0cVT\u4f1a\u964d\u4f4e\u3002\u540c\u6837\u9700\u8981\u5f3a\u8c03\u7684\u662f\uff0c\u5bf9\u7167\u7ec4\u6240\u4f7f\u7528\u7684VT\u4e0d\u518d\u88ab\u89c6\u4e3a\u662f\u201c\u5e38\u89c4\u201d\uff0c\u800c\u4e14\u5341\u591a\u5e74\u6765\u5728\u8fd9\u4e00\u9886\u57df\u5e76\u6ca1\u6709\u5f00\u5c55\u8fdb\u4e00\u6b65\u7684\u7814\u7a76\u3002\u6b64\u5916\uff0c\u9274\u4e8e\u8be5\u9886\u57df\u5728\u8fd9\u4e00\u95ee\u9898\u4e0a\u666e\u904d\u7f3a\u4e4f\u5747\u52bf\u6027\uff0c\u4eca\u540e\u4e5f\u4e0d\u592a\u53ef\u80fd\u8fdb\u884c\u5176\u4ed6RCT\u7814\u7a76\u3002\u76ee\u524d\uff0c\u5173\u4e8eARDS\u60a3\u8005\u7684\u673a\u68b0\u901a\u6c14\u7b56\u7565\u5305\u62ec\u5c06VT\u8bbe\u7f6e\u4e3a 4 ~ 8 mL\/kg PBW\uff0c\u5e76\u4fdd\u6301\uff08Pplat\uff09&lt; 30 cmH2O\u3002\u5c3d\u7ba1\u4e00\u4e9b\u7814\u7a76\u8005\u4f1a\u91c7\u7528IBW\u6216PBW\uff0c\u4f46\u4e13\u5bb6\u5c0f\u7ec4\u8fd8\u662f\u5e94\u8be5\u6b64\u91c7\u7528PBW\u53bb\u8bbe\u7f6eVT\u3002<\/p>\n<p>\u540c\u6837\u5730\uff0c\u5bf9COVID-19\u76f8\u5173ARDS\u60a3\u8005\u518d\u8fdb\u884cLTV\u7684RCT\u7814\u7a76\u4f3c\u4e4e\u4e5f\u4e0d\u592a\u53ef\u80fd\u3002\u5c3d\u7ba1COVID-19\u60a3\u8005\u672a\u88ab\u7eb3\u5165\u5236\u5b9a\u8fd9\u4e9b\u5efa\u8bae\u57fa\u7840\u7684RCT\uff0c\u4f46\u5728\u8fd9\u4e9b\u60a3\u8005\u4e2d\u4f7f\u7528LTV\u5177\u6709\u751f\u7406\u5b66\u5408\u7406\u6027\uff0c\u56e0\u4e3a\u4e8c\u8005\u7684\u547c\u5438\u529b\u5b66\u7279\u70b9\u662f\u76f8\u4f3c\u7684<sup>[101]<\/sup>\uff0c\u800c\u4e14\u5728\u975eCOVID-19 ARDS\u60a3\u8005\u4e2d\u4f7f\u7528LTV\u7684\u751f\u7406\u673a\u5236\u4e5f\u662f\u76f8\u4f3c\u7684\u3002\u7136\u800c\uff0c\u4e25\u91cd\u548c\u6301\u4e45\u7684\u591a\u7ef4\u5ea6\u5931\u80fd\u7684\u53d1\u751f\u7387\uff08\u5c24\u5176\u662fCOVID-19\u60a3\u8005\uff09\u53ef\u80fd\u662f\u91cd\u8981\u7684\uff0c\u5e76\u4e14\u53ef\u80fd\u4f1a\u56e0\u9700\u8981\u957f\u65f6\u95f4\u6df1\u9547\u9759\uff08\u6709\u6216\u65e0\u808c\u677e\uff09\u800c\u8fdb\u4e00\u6b65\u6076\u5316\u3002<\/p>\n<p>7.1.5 \u672a\u89e3\u51b3\u7684\u95ee\u9898\u548c\u7814\u7a76\u7a7a\u767d<\/p>\n<p>\u672a\u6765\u7684\u7814\u7a76\u53ef\u80fd\u9700\u8981\u5173\u6ce8\u7684\u95ee\u9898\u5305\u62ec\u80ba\u4fdd\u62a4\u7b56\u7565\uff08\u5982\u9650\u5236\u9a71\u52a8\u538b\u6216Pplat\u3001\u6309PBW\u6807\u51c6\u5316\u7684\u5f39\u6027\u3001\u5408\u9002\u7684PEEP\uff09\u548c\u4e2a\u4f53\u5316\u7684\u547c\u5438\u673a\u76ee\u6807\uff0c\u7279\u522b\u662fVT\u548c\u547c\u5438\u9891\u7387\u4e4b\u95f4\u7684\u6743\u8861\uff0c\u4ee5\u63a7\u5236\u673a\u68b0\u901a\u6c14\u7684\u603b\u4f53\u5f3a\u5ea6<sup>[102]<\/sup>\uff0c\u4ee5\u53ca\u5e73\u8861\u80ba\u5f39\u6027\u8f83\u4f4e\u60a3\u8005\u7684\u6781\u4f4eVT\u98ce\u9669\uff08\u4f8b\u5982\u9547\u9759\u3001\u4eba\u673a\u5931\u8c03\u7b49\uff09\u3002\u5e94\u5c06\u957f\u671f\u9884\u540e\u7eb3\u5165\u7814\u7a76\u8303\u56f4\uff0c\u5e76\u5c06\u60a3\u8005\u548c\u62a4\u7406\u4eba\u5458\u7684\u610f\u89c1\u4f5c\u4e3a\u786e\u5b9a\u672a\u6765\u7814\u7a76\u95ee\u9898\u548c\u7ed3\u679c\u7684\u6838\u5fc3\u3002<\/p>\n<p>\u672a\u6765\u8bd5\u9a8c\u4e2d\u9700\u8981\u89e3\u51b3\u7684\u5173\u952e\u7814\u7a76\u95ee\u9898\u5305\u62ec\uff1a\u2460\u8bc4\u4f30\u7279\u5b9a\u901a\u6c14\u7b56\u7565\u662f\u5426\u53ef\u80fd\u5bfc\u81f4\u52a0\u91cdVILI\u7684\u6700\u4f73\u65b9\u5f0f\uff0c\u2461\u786e\u5b9a\u6700\u4f73VT\u7684\u65b9\u5f0f\uff08\u5982\u57fa\u4e8ePBW\u3001\u9a71\u52a8\u538b\u6216\u5176\u4ed6\u65b9\u6cd5\uff09\uff0c\u2462\u57fa\u4e8e\u60a3\u8005\u751f\u7406\u7684\u4e2a\u4f53\u5316\u80ba\u4fdd\u62a4\u6027\u901a\u6c14\u7b56\u7565\uff0c\u2463\u5982\u679c\u5f53\u524d\u7684\u901a\u6c14\u7b56\u7565\u6781\u6709\u53ef\u80fd\u52a0\u91cdVILI\uff0c\u53ef\u91c7\u7528\u7684\u6e05\u9664PaCO2\u7684\u5176\u4ed6\u65b9\u6cd5\u3002<\/p>\n<p>8 \u9886\u57df6\uff1aPEEP\u548cRM\u7b56\u7565<\/p>\n<p>8.1 \u95ee\u98986.1:\u5728\u63a5\u53d7\u6709\u521b\u673a\u68b0\u901a\u6c14\u7684ARDS\u60a3\u8005\u4e2d\uff0c\u4e0e\u4f4ePEEP\/FiO2\u7b56\u7565\u76f8\u6bd4\uff0c\u5e38\u89c4\u4f7f\u7528\u9ad8PEEP\/FiO2\u7b56\u7565\u6ef4\u5b9aPEEP\uff0c\u80fd\u5426\u964d\u4f4e\u6b7b\u4ea1\u7387?<\/p>\n<p>8.1.1 \u80cc\u666f<\/p>\n<p>\u5728ARDS\u60a3\u8005\u4e2d\uff0c\u8868\u9762\u6d3b\u6027\u7269\u8d28\u4e27\u5931\u3001\u91cd\u529b\u4f5c\u7528\u4ee5\u53ca\u80ba\u635f\u4f24\u7684\u5f02\u8d28\u6027\u5bfc\u81f4\u5c40\u90e8\u80ba\u6ce1\u584c\u9677\u548c\u5c0f\u6c14\u9053\u9677\u95ed\uff0c\u6700\u7ec8\u9020\u6210\u533a\u57df\u6027\u53bb\u590d\u5f20<sup>[103]<\/sup>\u3002\u7531\u6b64\u5bfc\u81f4\u4e0d\u540c\u533a\u57df\u80ba\u987a\u5e94\u6027\u548c\u5e94\u529b\u7b49\u547c\u5438\u7cfb\u7edf\u529b\u5b66\u7279\u5f81\u7684\u5dee\u5f02\uff0c\u88ab\u8ba4\u4e3a\u662fARDS\u60a3\u8005VILI\u7684\u91cd\u8981\u9a71\u52a8\u56e0\u7d20<sup>[104-105]<\/sup>\u3002PEEP\u53ef\u4ee5\u62b5\u6d88\u8fd9\u4e9b\u4f5c\u7528\uff0c\u4ece\u800c\u4fc3\u8fdbRM\u548c\u51cf\u8f7b\u547c\u5438\u7cfb\u7edf\u529b\u5b66\u5f02\u8d28\u6027\u3002PEEP\u4e5f\u5e38\u7528\u4e8e\u6539\u5584\u6c27\u5408\u3002\u7136\u800c\uff0c\u8fc7\u9ad8\u7684PEEP\u4f1a\u52a0\u5267\u8fc7\u5ea6\u81a8\u80c0\uff0c\u8bf1\u53d1\u80ba\u5bb9\u79ef\u4f24\u548c\u8840\u6d41\u52a8\u529b\u5b66\u635f\u5bb3\u3002\u4ee5\u4e0b\u5206\u6790\u8bc4\u4f30\u4e86RCT\u7814\u7a76\u4e2d\u4e0d\u540cPEEP\u6ef4\u5b9a\u7b56\u7565\u5bf9\u6b7b\u4ea1\u7387\u3001\u65e0\u673a\u68b0\u901a\u6c14\u5929\u6570\u3001\u6c14\u538b\u4f24\u548c\u8840\u6d41\u52a8\u529b\u5b66\u7684\u5f71\u54cd\u3002<\/p>\n<p>8.1.2 \u8bc1\u636e\u6982\u8ff0<\/p>\n<p>\u4e09\u9879\u591a\u4e2d\u5fc3RCT\u6bd4\u8f83\u4e86\u9ad8PEEP\/FiO2\u548c\u4f4ePEEP\/FiO2\u7b56\u7565:\uff1aALVEOLI[106]\u3001LOVS[107]\u548cEXPRESS<sup>[108]<\/sup>\u3002ALVEOLI\uff08n = 549\uff09\u548cLOVS\uff08n = 983\uff09\u7814\u7a76\u5206\u522b\u6bd4\u8f83\u4e86\u9ad8\u3001\u4f4ePEEP\u6c27\u5408\u8868\u6cd5\uff0c\u5176\u4e2d\u9ad8\u3001\u4f4e\u6c27\u5408\u8868\u5206\u522b\u89c4\u5b9a\u4e86PEEP\u548cFiO2\u7684\u7ec4\u5408\u8868\u683c\uff0c\u6ef4\u5b9a\u76ee\u6807\u662f\u5728\u6c27\u5408\u8fbe\u6807\u7684\u60c5\u51b5\u4e0b\u9009\u62e9\u6700\u4f4e\u7ec4\u5408\u3002EXPRESS\u7814\u7a76\uff08n =767\uff09\u6bd4\u8f83\u4e86\u9ad8PEEP\u7b56\u7565\uff08\u6ef4\u5b9aPEEP\u4ee5\u5b9e\u73b0Pplat 28 ~ 30 cmH2O\u4e3a\u76ee\u6807\uff09\u4e0e\u4f4ePEEP\u7b56\u7565\uff08\u5c06PEEP\u8c03\u6574\u57285 ~ 9 cmH2O\u4e4b\u95f4\u7684\u6700\u5c0f\u590d\u5f20\u7b56\u7565\uff09\u3002\u8bc1\u636e\u6574\u5408\u8fc7\u7a0b\u4e2d\u5305\u542b\u56db\u4e2a\u7ec8\u70b9:\u7597\u6548\u7ec8\u70b9\uff08\u6b7b\u4ea1\u7387\u548c\u65e0\u673a\u68b0\u901a\u6c14\u5929\u6570\uff09\u548c\u5b89\u5168\u6027\u7ec8\u70b9\uff08\u6c14\u538b\u4f24\u548c\u8840\u6d41\u52a8\u529b\u5b66\u4e0d\u7a33\u5b9a\uff09\u3002<\/p>\n<p>\u4e09\u9879\u7814\u7a76\u7684\u4e3b\u8981\u4e34\u5e8a\u7ec8\u70b9\u5747\u662f\u6b7b\u4ea1\u7387\uff0c\u5176\u5728\u4e09\u9879\u7814\u7a76\u4e2d\u5747\u65e0\u7edf\u8ba1\u5b66\u5dee\u5f02\uff0cMeta\u5206\u6790\u4ea6\u65e0\u7edf\u8ba1\u5b66\u5dee\u5f02\uff08\u5408\u5e76RR 0.93\uff0c95% CI\uff1a0.83-1.04\uff09\u3002\u7531\u4e8e\u53ea\u6709\u4e24\u9879\u7814\u7a76\u62a5\u544a\u4e86\u65e0\u673a\u68b0\u901a\u6c14\u65f6\u95f4\uff08ventilator-free days\uff0cVFD\uff09\uff0c\u5176\u4e2d\u4e00\u9879\u7814\u7a76\u4f7f\u7528\u4e2d\u4f4d\u6570\uff0c\u53e6\u4e00\u9879\u7814\u7a76\u4f7f\u7528\u5747\u6570\uff0c\u56e0\u6b64\u8be5\u7ec8\u70b9\u6307\u6807\u672a\u505a\u6c47\u603b\u3002ALVEOLI\u7814\u7a76\u4e2dVFD\u5728\u4e24\u7ec4\u5185\u65e0\u663e\u8457\u5dee\u5f02\u3002\u867d\u7136\u5728LOVS\u7814\u7a76\u4e2d\u6ca1\u6709\u62a5\u544aVFD\uff0c\u4f46\u4e24\u7ec4\u5e78\u5b58\u8005\u7684\u673a\u68b0\u901a\u6c14\u65f6\u95f4\u6ca1\u6709\u663e\u8457\u5dee\u5f02\u3002\u5728EXPRESS\u7814\u7a76\u4e2d\uff0c\u9ad8PEEP\u7ec4\u7684VFD\u660e\u663e\u9ad8\u4e8e\u4f4ePEEP\u7ec4\u3002\u4e09\u9879\u7814\u7a76\u548cMeta\u5206\u6790\u4e2d\u6c14\u538b\u4f24\u7684\u53d1\u751f\u7387\u5747\u65e0\u663e\u8457\u5dee\u5f02\uff08\u5408\u5e76RR 1.17\uff1b95% CI 0.90 ~ 1.52\uff09\u3002\u7531\u4e8e\u62a5\u544a\u7684\u8840\u6d41\u52a8\u529b\u5b66\u4e0d\u7a33\u5b9a\u7684\u6307\u6807\u5728\u5404\u7814\u7a76\u4e2d\u5b58\u5728\u5dee\u5f02\uff0c\u56e0\u6b64\u8be5\u5b89\u5168\u6027\u6307\u6807\u672a\u8fdb\u884cMeta\u5206\u6790\u3002\u5728ALVEOLI\u7814\u7a76\u4e2d\uff0c\u8840\u6d41\u52a8\u529b\u5b66\u4e0d\u7a33\u5b9a\u6307\u6807\u5e76\u672a\u76f4\u63a5\u62a5\u9053\u3002\u5728LOVS\u7814\u7a76\u4e2d\uff0c\u8840\u6d41\u52a8\u529b\u5b66\u4e0d\u7a33\u5b9a\u4ee5\u8840\u7ba1\u6d3b\u6027\u836f\u4f7f\u7528\u5929\u6570\u548c\u5355\u65e5\u8840\u7ba1\u6d3b\u6027\u836f\u4f7f\u7528\u5242\u91cf\u5f62\u5f0f\u62a5\u544a\uff0c\u4e14\u4e24\u7ec4\u95f4\u5b58\u5728\u7edf\u8ba1\u5b66\u5dee\u5f02\u3002\u5728EXPRESS\u7814\u7a76\u4e2d\uff0c\u9ad8PEEP\u7ec4\u4e2d\u524d72\u5c0f\u65f6\u5185\u9700\u8981\u6db2\u4f53\u590d\u82cf\u7684\u60a3\u8005\u66f4\u591a\uff0875.3 vs 66.8%\uff1bP = 0.01\uff09\uff0c\u4f46\u5728\u8840\u7ba1\u6d3b\u6027\u836f\u4f7f\u7528\u65b9\u9762\u65e0\u663e\u8457\u5dee\u5f02\u3002<\/p>\n<p>8.1.3 \u63a8\u8350\u610f\u89c16.1<\/p>\n<p>\u5c31\u964d\u4f4eARDS\u60a3\u8005\u6b7b\u4ea1\u7387\u800c\u8a00\uff0c\u65e0\u6cd5\u5728\u9ad8\u3001\u4f4ePEEP\/FiO2\u6ef4\u5b9a\u7b56\u7565\u95f4\u505a\u51fa\u63a8\u8350\u3002\uff08\u65e0\u63a8\u8350\uff1b\u9ad8\u8d28\u91cf\u8bc1\u636e\u3002\uff09<\/p>\n<p>\u6b64\u63a8\u8350\u610f\u89c1\u4e5f\u9002\u7528\u4e8eCOVID-19\u5bfc\u81f4\u7684ARDS\u3002\uff08\u65e0\u63a8\u8350\uff1b\u4e2d\u7b49\u8d28\u91cf\u8bc1\u636e\u3002\uff09<\/p>\n<p>8.2 \u95ee\u98986.2\uff1a\u5728\u63a5\u53d7\u6709\u521b\u673a\u68b0\u901a\u6c14\u7684ARDS\u60a3\u8005\u4e2d\uff0c\u4e0e\u6807\u5316\u7684PEEP\/FiO2\u8868\u6bd4\u8f83\uff0c\u57fa\u4e8e\u547c\u5438\u529b\u5b66\u7684PEEP\u6ef4\u5b9a\u7b56\u7565\u80fd\u5426\u964d\u4f4e\u6b7b\u4ea1\u7387\uff1f<\/p>\n<p>8.2.1 \u8bc1\u636e\u6982\u8ff0<\/p>\n<p>EPVent\u3001EPVent-2\u3001Pintado\u7b49\u548cART\u8fd9\u56db\u9879RCT\u6bd4\u8f83\u4e86\u57fa\u4e8e\u529b\u5b66\u7684PEEP\u6ef4\u5b9a\u7b56\u7565\u4e0e\u6807\u5316\u7684\u6c27\u5408\u8868\u6cd5<sup>[109-112]<\/sup>\u3002EPVent\uff08n = 61\uff09\u662f\u4e00\u9879\u5355\u4e2d\u5fc3RCT\uff0c\u6bd4\u8f83\u4e86\u547c\u6c14\u672b\u8de8\u80ba\u538b\uff08transpulmonary pressure\uff0cPL\uff09\/FiO2\u8868\u683c\u6cd5\u4e0e\u4f4ePEEP\/FiO2\u8868\u6cd5\u6ef4\u5b9aPEEP\u7b56\u7565\u7684\u5dee\u5f02<sup>[109]<\/sup>\u3002EPVent-2\uff08n = 200\uff09\u662f\u4e00\u9879\u591a\u4e2d\u5fc3RCT\uff0c\u6bd4\u8f83\u4e86PL\/FiO2\u8868\u548c\u9ad8PEEP\/FiO2\u8868\u6ef4\u5b9aPEEP\u7b56\u7565\u7684\u5dee\u5f02<sup>[110]<\/sup>\u3002\u5728EPVent\u548cEPVent-2\u4e2d\uff0c\u80f8\u8154\u5185\u538b\u7531\u98df\u9053\u538b\u4f30\u7b97\uff0cPL\u7b49\u4e8e\u6c14\u9053\u538b\u51cf\u53bb\u80f8\u8154\u5185\u538b\u3002Pintado\u7b49\u4eba\u5b8c\u6210\u4e86\u4e00\u9879\u5355\u4e2d\u5fc3RCT\uff08n = 70\uff09\uff0c\u6bd4\u8f83\u4e86\u6700\u4f73\u547c\u5438\u7cfb\u7edf\u987a\u5e94\u6027\u6cd5\uff08\u5373\u6700\u4f4e\u9a71\u52a8\u538b\uff0c\u5b9a\u4e49\u4e3aPplat\u51cf\u53bb\u603bPEEP\uff09\u4e0e\u4f4ePEEP\/FiO2\u8868\u6ef4\u5b9aPEEP\u7b56\u7565\u7684\u5dee\u5f02<sup>[111]<\/sup>\u3002ART\u662f\u4e00\u9879\u591a\u4e2d\u5fc3RCT\uff08n = 1010\uff09\uff0c\u5c06\u6700\u4f73PEEP\u5b9a\u4e49\u4e3a\u6700\u4f73\u547c\u5438\u7cfb\u7edf\u987a\u5e94\u6027\u5bf9\u5e94\u7684PEEP\u503c+2 cmH2O\uff0c\u5e76\u4e0e\u4f4ePEEP\/FiO2\u8868\u8fdb\u884c\u6bd4\u8f83\u3002\u503c\u5f97\u6ce8\u610f\u7684\u662f\uff0c\u5728ART\u7814\u7a76\u4e2d\uff0c\u987a\u5e94\u6027\u5bfc\u5411\u7684PEEP\u6ef4\u5b9a\u7b56\u7565\u7ec4\u60a3\u8005\u5728PEEP\u6ef4\u5b9a\u524d\u4e5f\u7ecf\u5386\u4e86\u6301\u7eed\u6570\u5206\u949f\u7684\u957f\u65f6\u95f4\u9ad8\u538b\u529bRM\uff0c\u8fd9\u76f4\u63a5\u5bfc\u81f4\u81f3\u5c11\u4e09\u540d\u8bd5\u9a8c\u53c2\u4e0e\u8005\u5fc3\u810f\u9aa4\u505c<sup>[112]<\/sup>\u3002<\/p>\n<p>EPVent\u3001EPVent-2\u6216Pintado\u7b49\u4eba\u7684\u7814\u7a76\u4e2d\u4e24\u7ec4\u95f4\u7684\u6b7b\u4ea1\u7387\u6ca1\u6709\u7edf\u8ba1\u5b66\u5dee\u5f02\u3002\u7136\u800c\uff0c\u5728ART\u7814\u7a76\u4e2d\uff0c\u57fa\u4e8e\u547c\u5438\u529b\u5b66\u7684PEEP\u6ef4\u5b9a\u7b56\u7565\u7ec4\u60a3\u8005\u7684\u6b7b\u4ea1\u7387\u66f4\u9ad8\uff08RR 1.12\uff1b95% CI 1.00 ~ 1.26\uff09\u3002<\/p>\n<p>Meta\u5206\u6790\u7ed3\u679c\u663e\u793a\u5408\u5e76\u6b7b\u4ea1\u7387\u5728\u57fa\u4e8e\u547c\u5438\u529b\u5b66\u7684PEEP\u6ef4\u5b9a\u7b56\u7565\u4e0e\u57fa\u4e8ePEEP\/FiO2\u8868\u7684PEEP\u6ef4\u5b9a\u7b56\u7565\u4e4b\u95f4\u65e0\u663e\u8457\u5dee\u5f02\uff08\u5408\u5e76RR 0.85\uff1b95% CI 0.57 ~ 1.29\uff09\u3002EPVent\u3001EPVent-2\u6216Pintado\u7b49\u4eba\u7684\u7814\u7a76\u4e2d\u7ec4\u95f4\u7684\u6c14\u538b\u4f24\u53d1\u751f\u7387\u65e0\u5dee\u5f02\u3002\u7136\u800c\uff0c\u5728ART\u7814\u7a76\u4e2d\uff0c\u4ee5\u57fa\u4e8e\u547c\u5438\u529b\u5b66\u7684PEEP\u6ef4\u5b9a\u7b56\u7565\u5bfc\u81f4\u6c14\u538b\u4f24\u53d1\u751f\u7387\u663e\u8457\u5347\u9ad8\uff08RR 3.56\uff1b95% CI 1.64 ~ 7.73\uff09\u3002\u5728Meta\u5206\u6790\u4e2d\uff0c\u6c14\u538b\u4f24\u53d1\u751f\u7387\u65e0\u663e\u8457\u5dee\u5f02\uff08\u5408\u5e76RR 1.76\uff1b95% CI 0.76 ~ 4.06\uff09\u3002<\/p>\n<p>\u65e0\u673a\u68b0\u901a\u6c14\u5929\u6570\u5206\u6790\u7ed3\u679c\u5c1a\u65e0\u5b9a\u8bba\u3002ART\u7814\u7a76\u53d1\u73b0\u57fa\u4e8e\u547c\u5438\u529b\u5b66\u7684PEEP\u6ef4\u5b9a\u7b56\u7565\u4f7f\u5f97VFD\u51cf\u5c11\u4e86\u4e00\u5929\uff0c\u8fd9\u4e00\u53d1\u73b0\u5728EPVent-2\u4e2d\u672a\u5f97\u5230\u8bc1\u5b9e\u3002\u6211\u4eec\u4f7f\u7528\u57fa\u4e8e\u4e2d\u4f4d\u6570\u7684Meta\u5206\u6790\u7ed3\u679c\u4ea6\u672a\u53d1\u73b0\u663e\u8457\u5dee\u5f02\u3002<\/p>\n<p>\u7531\u4e8e\u5404\u7814\u7a76\u4e4b\u95f4\u62a5\u544a\u7684\u5dee\u5f02\uff0c\u6ca1\u6709\u5bf9\u8840\u6d41\u52a8\u529b\u5b66\u4e0d\u7a33\u5b9a\u8fdb\u884cMeta\u5206\u6790\u3002EPVent\u672a\u62a5\u544a\u8840\u6d41\u52a8\u529b\u5b66\u4e0d\u7a33\u5b9a\u7684\u76f8\u5173\u7ed3\u679c\u3002\u5728EPVent-2\u7814\u7a76\u4e2d\uff0c\u65e0\u4f11\u514b\u5929\u6570\u5728\u7ec4\u95f4\u65e0\u663e\u8457\u5dee\u5f02\u3002\u5728Pintado\u7b49\u4eba\u7684\u7814\u7a76\u4e2d\uff0c\u57fa\u4e8e\u547c\u5438\u529b\u5b66\u7684PEEP\u6ef4\u5b9a\u7ec4\u8840\u6d41\u52a8\u529b\u5b66\u4e0d\u7a33\u5b9a\u53d1\u751f\u7387\u663e\u8457\u964d\u4f4e\uff08\u65e0\u5faa\u73af\u8870\u7aed\u5929\u6570\uff0c\u5faa\u73af\u8870\u7aed\u5b9a\u4e49\u4e3a\u5fc3\u8840\u7ba1SOFA\u8bc4\u5206&gt; 2\uff09\u3002\u4e0e\u4e4b\u76f8\u53cd\uff0c\u5728ART\u7814\u7a76\u4e2d\uff0c\u57fa\u4e8e\u547c\u5438\u529b\u5b66\u7684PEEP\u6ef4\u5b9a\u7ec4\u8840\u6d41\u52a8\u529b\u5b66\u4e0d\u7a33\u5b9a\u4e8b\u4ef6\u663e\u8457\u589e\u591a\uff08\u9700\u8981\u5728\u7b2c\u4e00\u4e2a\u5c0f\u65f6\u5185\u542f\u52a8\u6216\u589e\u52a0\u8840\u7ba1\u6d3b\u6027\u836f\uff0c\u6216\u5e73\u5747\u52a8\u8109\u538b &lt; 65 mmHg\u4e8b\u4ef6\u589e\u591a\uff09\u3002<\/p>\n<p>8.2.2 \u63a8\u8350\u610f\u89c16.2<\/p>\n<p>\u5c31\u964d\u4f4eARDS\u60a3\u8005\u6b7b\u4ea1\u7387\u800c\u8a00\uff0c\u65e0\u6cd5\u5728\u57fa\u4e8e\u547c\u5438\u529b\u5b66\u7684PEEP\u6ef4\u5b9a\u7b56\u7565\u4e0e\u57fa\u4e8e\u6807\u5316\u7684PEEP\/FiO2\u7684PEEP\u6ef4\u5b9a\u7b56\u7565\u95f4\u505a\u51fa\u63a8\u8350\u3002\uff08\u65e0\u63a8\u8350\uff1b\u9ad8\u8d28\u91cf\u8bc1\u636e\u3002\uff09<\/p>\n<p>\u6b64\u63a8\u8350\u610f\u89c1\u4e5f\u9002\u7528\u4e8eCOVID-19\u5bfc\u81f4\u7684ARDS\u3002\uff08\u65e0\u63a8\u8350\uff1b\u4e2d\u7b49\u8d28\u91cf\u8bc1\u636e\u3002\uff09<\/p>\n<p>8.2.3\u4e34\u5e8a\u5e94\u7528\u4e13\u5bb6\u610f\u89c1\uff1aPEEP\u6ef4\u5b9a\u5728ARDS\u4e2d\u7684\u5e94\u7528<\/p>\n<p>PEEP\u6ef4\u5b9a\u662f\u5f71\u54cdARDS\u60a3\u8005\u9884\u540e\u7684\u6f5c\u5728\u7684\u91cd\u8981\u56e0\u7d20\uff0c\u5176\u6700\u4f73\u7b56\u7565\u4ecd\u6709\u5f85\u786e\u5b9a\u3002Meta\u5206\u6790\u7eb3\u5165\u7684\u7814\u7a76\u8868\u660e\uff0cPEEP\u6ef4\u5b9a\u65b9\u6848\u65e2\u6709\u6f5c\u5728\u7684\u76ca\u5904\uff0c\u4e5f\u6709\u6f5c\u5728\u7684\u5371\u5bb3\u3002\u4e3a\u4e86\u9884\u9632\u8fdb\u884c\u6027\u7684\u53bb\u590d\u5f20\uff0c\u4e00\u5b9a\u6c34\u5e73\u7684PEEP\u88ab\u8ba4\u4e3a\u662f\u5fc5\u8981\u7684\uff0c\u4f46\u5c1a\u4e0d\u6e05\u695a\u5982\u4f55\u9009\u62e9\u7406\u60f3\u7684PEEP\u6c34\u5e73\u4ee5\u51cf\u8f7b\u80ba\u635f\u4f24\u540c\u65f6\u907f\u514d\u8fc7\u5ea6\u81a8\u80c0\u3002\u5148\u524d\u7684Meta\u5206\u6790\u53d1\u73b0\uff0c\u5728\u66f4\u4e25\u91cd\u7684\u4f4e\u6c27\u8840\u75c7\u60a3\u8005\u4e2d\uff0c\u8f83\u9ad8\u7684PEEP\u6c34\u5e73\u53ef\u80fd\u6709\u5229\u4e8e\u60a3\u8005\u5b58\u6d3b<sup>[113-114]<\/sup>\u3002\u7136\u800c\uff0c\u5c3d\u7ba1\u201c\u8fc7\u9ad8\u7684PEEP\u201d\u7684\u5b9a\u4e49\u5e76\u4e0d\u660e\u786e\uff0c\u4f46\u8fc7\u9ad8\u7684PEEP\u65e0\u7591\u4f1a\u5bfc\u81f4\u6c14\u538b\u4f24\u548c\u8840\u6d41\u52a8\u529b\u5b66\u4e0d\u7a33\u5b9a\uff08\u5bfc\u81f4\u989d\u5916\u7684\u6db2\u4f53\u590d\u82cf\u6216\u8840\u7ba1\u6d3b\u6027\u836f\u7684\u4f7f\u7528\uff0c\u5bfc\u81f4\u4e0d\u826f\u540e\u679c\uff09\u3002<\/p>\n<p>8.2.4 \u672a\u89e3\u51b3\u7684\u95ee\u9898\u548c\u7814\u7a76\u7a7a\u767d\uff1a\u5173\u4e8eARDS\u7684PEEP\u6ef4\u5b9a<\/p>\n<p>\u80ba\u635f\u4f24\u7684\u4e25\u91cd\u7a0b\u5ea6\u548c\u539f\u56e0\u3001\u80ba\u548c\u80f8\u58c1\u529b\u5b66\u7279\u6027\u3001VT\u3001\u4f53\u4f4d\u3001\u81ea\u4e3b\u547c\u5438\u52aa\u529b\u3001\u5fc3\u529f\u80fd\u3001\u8840\u7ba1\u5185\u5bb9\u79ef\u548c\u8840\u7ba1\u5f20\u529b\u7684\u4e0d\u540c\u90fd\u53ef\u80fd\u5bfc\u81f4PEEP\u6548\u5e94\u4e0d\u540c\u3002\u4e0d\u540cPEEP\u6c34\u5e73\u5bf9\u4e2a\u4f53\u7684\u5f71\u54cd\u53ef\u80fd\u9700\u8981\u66f4\u591a\u7684\u7814\u7a76\uff0c\u5728\u968f\u673a\u5316\u524d\uff0c\u91c7\u7528\u53ef\u590d\u5f20\u6027\u8bd5\u9a8c\u9009\u62e9RM\u5bb9\u79ef\u9ad8\u7684\u60a3\u8005\u8bc4\u4f30PEEP\u7684\u5f71\u54cd\u3002\u6b64\u5916\uff0c\u9ad8PEEP\u7684\u8840\u6d41\u52a8\u529b\u5b66\u4ee3\u4ef7\uff0c\u5305\u62ec\u5bf9\u6db2\u4f53\u91cf\u7684\u5f71\u54cd\uff0c\u9700\u8981\u8fdb\u4e00\u6b65\u7684\u6570\u636e\u3002\u540c\u6837\uff0c\u4f7f\u7528\u98df\u9053\u538b\u6307\u5bfcPEEP\u548c\u9a71\u52a8\u538b\u529b\u7684\u9009\u62e9\u9700\u8981\u8fdb\u4e00\u6b65\u7684\u7814\u7a76\uff0c\u4ee5\u5e73\u8861\u91cd\u529b\u4f9d\u8d56\u533a\u7684\u80ba\u590d\u5f20\uff0c\u540c\u65f6\u9650\u5236\u5168\u80ba\u7684\u8fc7\u5ea6\u81a8\u80c0\u548c\u975e\u91cd\u529b\u4f9d\u8d56\u533a\u7684\u5e94\u529b\u548c\u5e94\u53d8\u3002\u5728\u7f3a\u4e4f\u8fd9\u4e9b\u6570\u636e\u7684\u60c5\u51b5\u4e0b\uff0c\u5982\u4f55\u5728\u4e34\u5e8a\u5b9e\u8df5\u4e2d\u4e2a\u4f53\u5316\u7684\u9009\u62e9\u6700\u4f73PEEP\u4ecd\u4e0d\u6e05\u695a\u3002\u6700\u540e\uff0c\u5f71\u50cf\u5b66\u4e0a\u6d78\u6da6\u5f71\u7684\u5206\u5e03\u3001\u53ef\u590d\u5f20\u6027\u3001\u4f53\u4f4d\u548cPEEP\u6c34\u5e73\u4e4b\u95f4\u7684\u76f8\u4e92\u4f5c\u7528\u4ecd\u9700\u8fdb\u4e00\u6b65\u9610\u660e\u3002<\/p>\n<p>8.3 \u95ee\u9898 6.3\uff1a\u5728\u63a5\u53d7\u6709\u521b\u673a\u68b0\u901a\u6c14\u7684ARDS\u60a3\u8005\u4e2d\uff0c\u4e0e\u4e0d\u4f7f\u7528\u957f\u7a0b\u9ad8\u538bRM\u76f8\u6bd4\uff0c\u4f7f\u7528\u957f\u7a0b\u9ad8\u538bRM\u80fd\u5426\u964d\u4f4e\u6b7b\u4ea1\u7387\uff1f<\/p>\n<p>8.3.1 \u80cc\u666f<\/p>\n<p>\u4ece\u5e7f\u4e49\u4e0a\u8bb2\uff0cRM\u64cd\u4f5c\u5305\u62ec\u77ed\u6682\u589e\u52a0\u6c14\u9053\u538b\u548cPL\uff0c\u4f7f\u5176\u9ad8\u4e8e\u6f6e\u5f0f\u901a\u6c14\u65f6\u7684\u6570\u503c\uff0c\u4fc3\u4f7f\u5148\u524d\u65e0\u901a\u6c14\u80ba\u7ec4\u7ec7\u518d\u901a\u6c14\uff0c\u5373RM<sup>[115]<\/sup>\u3002\u7531\u4e8e\u6253\u5f00\u584c\u9677\u80ba\u6ce1\u6240\u9700\u7684\u538b\u529b\u901a\u5e38\u8d85\u8fc7\u95ed\u5408\u538b\u529b<sup>[116-118]<\/sup>\uff0c\u7406\u8bba\u4e0aRM\u7684\u77ed\u6682\u538b\u529b\u5347\u9ad8\u8db3\u4ee5\u4f7f\u5f97\u547c\u6c14\u672b\u80ba\u5bb9\u79ef\u5728RM\u5b8c\u6210\u540e\u589e\u52a0\u3002RM\u5e26\u6765\u7684\u547c\u6c14\u672b\u80ba\u5bb9\u79ef\u589e\u52a0\u53ef\u4ee5\u6539\u5584\u6c14\u4f53\u4ea4\u6362\uff0c\u6539\u5584\u80ba\u901a\u6c14\u5747\u4e00\u6027\uff0c\u51cf\u5c11\u80ba\u5e94\u529b\u548c\u5e94\u53d8<sup>[105-119]<\/sup>\uff0c\u5c3d\u7ba1\u8fd9\u4e9b\u4f5c\u7528\u7684\u53d1\u751f\u548c\u6301\u7eed\u65f6\u95f4\u4e0d\u5c3d\u76f8\u540c<sup>[115-119]<\/sup>\u3002\u4f5c\u4e3a\u4e00\u79cd\u9ad8\u538b\u64cd\u4f5c\uff0cRM\u4e5f\u53ef\u80fd\u5b58\u5728\u8fc7\u5ea6\u81a8\u80c0\u76f8\u5173\u5e76\u53d1\u75c7\uff0c\u5305\u62ec\u6c14\u538b\u4f24\u3001\u9759\u8109\u56de\u6d41\u51cf\u5c11\u3001\u80ba\u8840\u7ba1\u963b\u529b\u589e\u52a0\u3001\u53f3\u5fc3\u5ba4\u8870\u7aed-\u5bfc\u81f4\u8840\u6d41\u52a8\u529b\u5b66\u53d8\u5316\u3002\u76ee\u524d\u62a5\u9053\u4e86\u51e0\u79cdRM\u65b9\u6cd5\uff0c\u8fd9\u4e9b\u65b9\u6cd5\u5728\u6301\u7eed\u65f6\u95f4\u3001\u538b\u529b\u76ee\u6807\u3001\u9891\u7387\u548c\u547c\u5438\u673a\u64cd\u4f5c\u65b9\u9762\u6709\u6240\u4e0d\u540c\u3002<\/p>\n<p>8.3.2 \u75c5\u7406\u751f\u7406\u56e0\u7d20<\/p>\n<p>RM\u6709\u6548\u7684\u5148\u51b3\u6761\u4ef6\u662f\u5b58\u5728\u584c\u9677\u4f46\u529f\u80fd\u6b63\u5e38\u7684\u80ba\u6ce1\uff0c\u5982\u7531\u4e8e\u5916\u529b\u538b\u7f29\u6216\u80ba\u6ce1\u584c\u9677\u800c\u5bfc\u81f4\u7684\u201c\u7a7a\u201d\u4e14\u65e0\u6c14\u4f53\u7684\u80ba\u6ce1\u3002\u7136\u800c\uff0cRM\u662f\u4e00\u4e2a\u6982\u8ff0\u6027\u7684\u672f\u8bed\uff0c\u5305\u542b\u4e86\u51e0\u79cd\u4e0d\u540c\u7684\u6982\u5ff5\u5b9a\u4e49\u3002\u4e8b\u5b9e\u4e0a\uff0cRM\u7684\u5b9a\u4e49\u5305\u62ec\uff1a\u2460\u5148\u524d\u65e0\u901a\u6c14\u80ba\u6ce1\u7684\u518d\u901a\u6c14\uff08CT\u626b\u63cf\uff09<sup>[120]<\/sup>\uff1b\u2461\u5148\u524d\u65e0\u901a\u6c14\u548c\u901a\u6c14\u4e0d\u826f\u80ba\u6ce1\u7684\u518d\u901a\u6c14\uff08CT\u626b\u63cf\uff09<sup>[121]<\/sup>\uff1b\u2462PEEP\u5347\u9ad8\u540e\u9884\u671f\u547c\u5438\u7cfb\u7edf\u987a\u5e94\u6027\u4e0e\u6d4b\u91cf\u503c\u7684\u5dee\u5f02\uff08\u53cc\u538b\u529b-\u5bb9\u79ef\u66f2\u7ebf\uff0cpressure-volume\u66f2\u7ebf\uff0cP-V\u66f2\u7ebf\uff09<sup>[122]<\/sup>\uff1b\u2463\u6539\u826f\u80ba\u8d85\u58f0\u8bc4\u5206\uff08lung ultrasound score\uff0cLUS\uff09\uff0c\u901a\u8fc7\u534a\u5b9a\u91cf\u8bc4\u5206\u8fdb\u884c\u8bc4\u4f30<sup>[123]<\/sup>\u3002<\/p>\n<p>\u8fd9\u4e9b\u5b9a\u4e49\u63d0\u4f9b\u4e86\u4e0d\u540c\u7684\u80baRM\u8bc4\u4f30\u65b9\u6cd5\uff0c\u7279\u522b\u662f\u57fa\u4e8e\u5f71\u50cf\u7684\u65b9\u6cd5\u548c\u57fa\u4e8eP-V\u66f2\u7ebf\u7684\u65b9\u6cd5<sup>[124]<\/sup>\u3002\u7136\u800c\uff0c\u65e0\u8bba\u91c7\u7528\u4f55\u79cd\u65b9\u6cd5\uff0c\u5176\u5171\u540c\u76ee\u7684\u662f\u5b9e\u73b0\u584c\u9677\u80ba\u6ce1\u7684\u7a33\u5b9a\u5f00\u653e\uff0c\u5e76\u91cf\u5316\u7531\u6b64\u4ea7\u751f\u7684\u89e3\u5256\u6216\u529f\u80fd\u7684\u53d8\u5316\u3002PEEP\u53ea\u662f\u901a\u8fc7\u66f4\u9ad8\u7684\u5f00\u653e\u538b\u7ef4\u6301\u5df2\u7ecf\u5f00\u653e\u7684\u80ba\u6ce1\u6301\u7eed\u5f00\u653e\u3002\u5c11\u6570\u5173\u4e8eARDS\u60a3\u8005\u7684\u7814\u7a76\u4e2d\u62a5\u9053\u4e86\u5f00\u653e\u80ba\u6ce1\u6240\u9700\u7684\u538b\u529b<sup>[116-117]<\/sup>\u3002\u901a\u8fc7CT\u626b\u63cf\u8bc4\u4f30\uff0c\u62a5\u9053\u7684\u5f00\u653e\u538b\u4e2d\u4f4d\u6570\u572820 ~ 30 cmH2O\u4e4b\u95f4\uff0c\u8303\u56f4\u572810 ~ 50 cmH2O\u4e4b\u95f4\uff0c\u6570\u636e\u63a5\u8fd1\u9ad8\u65af\u5206\u5e03\u3002\u7136\u800c\uff0c\u53ea\u6709\u4e00\u5c0f\u90e8\u5206\u80ba\u6ce1\uff08\u7ea610%\uff09\u7684\u5f00\u653e\u538b\u5927\u4e8e45 cmH2O\uff0c\u8fd9\u8868\u660e\u65bd\u52a0\u9ad8\u4e8e45 cmH2O\u7684\u538b\u529b\u65f6\u529f\u80fd\u83b7\u76ca\u6709\u9650\uff1b\u8fc7\u9ad8\u7684\u538b\u529b\u8fd8\u4f1a\u4ea7\u751f\u8840\u6d41\u52a8\u529b\u5b66\u7684\u4ee3\u4ef7\uff0c\u5176\u4ee3\u4ef7\u901a\u5e38\u53ef\u80fd\u662f\u8f93\u6ce8\u5927\u91cf\u6db2\u4f53\u800c\u5bfc\u81f4\u989d\u5916\u7684\u5fc3\u8840\u7ba1\u5e94\u529b\uff0c\u53d1\u75c5\u7387\u548c\u6b7b\u4ea1\u7387\u3002\u95ed\u5408\u538b\u7684\u4e2d\u4f4d\u6570\u7ea6\u4e3a10 cmH2O\uff0c\u4f46\u5728\u8d85\u8fc7\u538b\u529b20 ~ 25 cmH2O\u7684\u60c5\u51b5\u4e0b\uff0c\u4e5f\u53ef\u4ee5\u89c2\u5bdf\u5230\u80ba\u6ce1\u584c\u9677<sup>[125-126]<\/sup>\u3002<\/p>\n<p>\u4e0a\u8ff0\u89c2\u5bdf\u7ed3\u679c\u5e26\u6765\u4ee5\u4e0b\u8003\u8651\uff1a\u2460\u5982\u679cPplat\u7ef4\u6301\u572830 cmH2O\uff0c\u5728\u9ad8\u4e8ePplat\u7684\u538b\u529b\u4e0b\uff0c\u590d\u5f20\u8fc7\u7a0b\u4e2d\u90e8\u5206\u5f00\u653e\u7684\u80ba\u6ce1\u5c06\u4e0d\u53ef\u907f\u514d\u5730\u518d\u6b21\u584c\u9677\u3002\u8fd9\u4e2a\u8fc7\u7a0b\u4f34\u968f\u7740\u6c14\u4f53\u4ea4\u6362\u529f\u80fd\u7684\u6076\u5316\u548c\u80ba\u840e\u9677\u4f24\uff0c\u76f4\u5230\u8be5\u90e8\u5206\u80ba\u6ce1\u5b8c\u5168\u584c\u9677\u3002\u4e3a\u4e86\u4fdd\u6301\u80ba\u6ce1\u5b8c\u5168\u5f00\u653e\uff0c\u572845 cmH2O\u538b\u529b\u4e0b\u8fdb\u884cRM\u540e\uff0cPEEP\u9700\u8981\u7ef4\u6301\u572820-25 cmH2O\u4ee5\u4e0a<sup>[125-126]<\/sup>\u3002\u2461\u8d85\u4fdd\u62a4\u6027\u80ba\u901a\u6c14\u8981\u6c42Pplat\u4f4e\u4e8e30 cmH2O\uff0c\u8fd9\u53ef\u80fd\u4f1a\u5bfc\u81f4\u4e4b\u524d\u5728\u5927\u4e8e30 cmH2O\u538b\u529b\u4e0b\u8fdb\u884cRM\u6253\u5f00\u7684\u80ba\u6ce1\u518d\u6b21\u584c\u9677\u3002\u2462\u5728\u751f\u7406\u5b66\u7814\u7a76\u4e2d\uff0c\u95f4\u6b47\u6027\u7684\u201c\u53f9\u6c14\u201d\u6837\u547c\u5438\u5df2\u88ab\u8bc1\u660e\u53ef\u4ee5\u62b5\u6d88\u80ba\u4fdd\u62a4\u7b56\u7565\u4e2d\u53d1\u751f\u7684\u80ba\u6ce1\u584c\u9677<sup>[127]<\/sup>\u3002<\/p>\n<p>\u4ee5\u4e0a\u6240\u6709\u6570\u636e\u5747\u6307\u7684\u662f\u6574\u4e2a\u547c\u5438\u7cfb\u7edf\uff0c\u66f4\u7cbe\u786e\u7684\u65b9\u6cd5\u9700\u533a\u5206\u548c\u91cf\u5316\u80ba\u548c\u80f8\u58c1\u7684\u529b\u5b66\u7279\u6027\u3002\u5728\u4e0d\u540c\u80f8\u58c1\u5f39\u6027\u72b6\u6001\u4e0b\uff0c\u76f8\u540c\u6c14\u9053\u538b\u7684\u590d\u5f20\u6548\u679c\u662f\u4e0d\u540c\u7684\u3002<\/p>\n<p>\u8be5\u5206\u6790\u7eb3\u5165\u4e86\u5c06\u60a3\u8005\u968f\u673a\u5206\u4e3a\u63a5\u53d7RM\u4e0e\u4e0d\u63a5\u53d7RM\u7684RCT\u7814\u7a76\uff0c\u8bc4\u4f30\u4e86RM\u5bf9\u6b7b\u4ea1\u7387\u3001VFD\u3001\u6c14\u538b\u4f24\u548c\u8840\u6d41\u52a8\u529b\u5b66\u7684\u5f71\u54cd\u3002<\/p>\n<p>8.3.3 \u8bc1\u636e\u6982\u8ff0<\/p>\n<p>\u957f\u7a0b\u9ad8\u538bRM\u5b9a\u4e49\u4e3a\u6c14\u9053\u538b\u529b \u2265 35 cmH2O\u6301\u7eed\u65f6\u95f41\u5206\u949f\u4ee5\u4e0a\u7684RM\u65b9\u6cd5\u3002\u6709\u4e94\u9879\u7814\u7a76\u8bc4\u4f30\u4e86\u957f\u7a0b\u9ad8\u538bRM\u4e0e\u65e0\u6b64\u7c7b\u64cd\u4f5c\u5bf9\u4f4f\u9662\u6b7b\u4ea1\u7387\u7684\u5f71\u54cd\u3002Hodgson\u7b49\u4eba\u57282011\u5e74\uff08n = 20\uff09\u548c2019\u5e74\uff08PHARLAP\u8bd5\u9a8c\uff0cn = 115\uff09\u91c7\u7528\u4e86\u4e00\u79cd\u957f\u7a0b\u3001\u201c\u9636\u68af\u5f0f\u201dRM\u65b9\u6cd5\uff0c\u5c06PEEP\u8bbe\u7f6e\u4e3a20\u300130\u300140 cmH2O\uff0c\u6bcf\u4e2a\u6c34\u5e732\u5206\u949f\uff0c\u7136\u540e\u5c06PEEP\u9010\u6b65\u51cf\u81f315 cmH2O\u6216\u6c27\u5408\u4e0d\u80fd\u7ef4\u6301\uff1b\u5bf9\u7167\u7ec4\u4e0d\u7ed9\u4e88RM\uff0c\u91c7\u7528\u4f4ePEEP\/FiO2\u7b56\u7565\u8bbe\u5b9aPEEP<sup>[128-129]<\/sup>\u3002Kung\u7b49\u4eba\uff08n = 120\uff09\u91c7\u7528\u7684RM\u65b9\u6cd5\u5c06PEEP\u8bbe\u7f6e\u4e3a35 cmH2O\uff0c\u6301\u7eed\u4e24\u5206\u949f\uff0c\u7136\u540e\u9010\u6e10\u4e0b\u8c03PEEP\uff0c\u76f4\u5230\u786e\u5b9a\u6700\u5927\u987a\u5e94\u6027\uff1b\u5bf9\u7167\u7ec4\u4e0d\u7ed9\u4e88RM\uff0c\u91c7\u7528\u4f4ePEEP\/FiO2\u7b56\u7565<sup>[130]<\/sup>\u3002Chung\u7b49\u4eba\uff08n = 24\uff09\u91c7\u7528RM\u65b9\u6cd5\uff1a\u4ee55 cmH2O\u7684\u589e\u91cf\u5c06PEEP\u4ece10\u63d0\u9ad8\u523040 cmH2O\uff0c\u6bcf\u6b21\u7ef4\u630140\u79d2\uff0c\u7136\u540e\u8fdb\u884c\u964d\u9636\u68afPEEP\u6ef4\u5b9a\uff1b\u5bf9\u7167\u7ec4\u4e0d\u7ed9\u4e88RM<sup>[131]<\/sup>\u3002ART\u8bd5\u9a8c\uff08n = 1010\uff09\u65e9\u671f\u91c7\u7528\u4e86\u4e00\u79cd\u201c\u9636\u68af\u5f0f\u201dRM\uff0c\u4f9d\u6b21\u5c06PEEP\u8bbe\u7f6e\u4e3a25 cmH2O \u7ef4\u63011\u5206\u949f\uff0c35 cmH2O \u7ef4\u63011\u5206\u949f\uff0c45 cmH2O \u7ef4\u63012\u5206\u949f\uff0c\u7136\u540e\u8fdb\u884c\u964d\u9636\u68afPEEP\u6ef4\u5b9a\uff1b\u5bf9\u7167\u7ec4\u4e0d\u7ed9\u4e88RM\uff0c\u91c7\u7528\u4f4ePEEP\/FiO2\u7b56\u7565<sup>[112]<\/sup>\u3002\u7531\u4e8eRM\u5bfc\u81f4\u7684\u4e09\u6b21\u5fc3\u810f\u9aa4\u505c\u4e8b\u4ef6\uff0cART\u7814\u7a76\u7684RM\u7b56\u7565\u5728\u5165\u7ec4\u8fc7\u7a0b\u4e2d\u4fee\u6539\u6210\u4e86\u66f4\u4fdd\u5b88\u7684\u7b56\u7565\u3002ART\u7814\u7a76\u662f\u7eb3\u5165\u7814\u7a76\u4e2d\u8d28\u91cf\u6700\u9ad8\u7684\u4e00\u9879\u7814\u7a76\u3002\u53e6\u5916\u4e00\u9879\u53ef\u80fd\u7b26\u5408\u6761\u4ef6\u7684\u8bd5\u9a8c\u88ab\u6392\u9664\uff0c\u539f\u56e0\u5728\u4e8e\u5b83\u53ea\u62db\u52df\u4e86\u60a3\u6709ARDS\u7684\u70e7\u4f24\u60a3\u8005\uff0c\u8fd9\u4e00\u4eba\u7fa4\u7684\u4ee3\u8868\u6027\u4e0d\u8db3<sup>[132]<\/sup>\u3002\u5728\u8bc4\u4f30RM\u5bf9ICU\u6b7b\u4ea1\u7387\u7684\u5f71\u54cd\u65f6\uff0c\u7eb3\u5165\u4e86\u4e94\u9879\u8bd5\u9a8c\uff1bChung\u7684\u8bd5\u9a8c\u56e0\u672a\u62a5\u544aICU\u6b7b\u4ea1\u7387\u88ab\u6392\u9664\uff0c\u800cHuh\u7b49\u4eba\u7684\u7814\u7a76\u672a\u62a5\u544a\u4f4f\u9662\u6b7b\u4ea1\u7387\u3001\u672a\u7eb3\u5165\u4f4f\u9662\u6b7b\u4ea1\u7387\u7684Meta\u5206\u6790\uff0c\u4f46\u7eb3\u5165\u4e86ICU\u6b7b\u4ea1\u7387Meta\u5206\u6790\u3002<\/p>\n<p>ART\u662f\u552f\u4e00\u7b26\u5408\u4e2d\u9ad8\u8d28\u91cf\u6807\u51c6\u5e76\u8fdb\u5165\u4e3b\u8981\u5206\u6790\u7684\u7814\u7a76\u3002ART\u7814\u7a76\u4e2d\uff0c\u5bf9\u4e0d\u540c\u65f6\u95f4\u70b9\u6b7b\u4ea1\u7387\u7684\u5206\u6790\u53d1\u73b0\u4e86\u4e0d\u4e00\u81f4\u7684\u7ed3\u679c\uff0c\u4f466\u4e2a\u6708\u6b7b\u4ea1\u7387\u53ef\u80fd\u589e\u52a0\u3002\u7ed3\u5408Meta\u5206\u6790\u7ed3\u679c\uff08\u6307\u5357\u5236\u5b9a\u8fc7\u7a0b\u4e2d\u7684\u4e8c\u6b21\u5206\u6790\uff09\u663e\u793a\u5e72\u9884\u5bf9\u6b7b\u4ea1\u7387\u65e2\u65e0\u6709\u5bb3\u5f71\u54cd\uff0c\u4e5f\u65e0\u6709\u76ca\u5f71\u54cd\u3002\u5f02\u8d28\u6027\u5206\u6790\u5c1a\u65e0\u5b9a\u8bba\u3002<\/p>\n<p>\u76f8\u53cd\uff0c\u5bf9\u6c14\u538b\u4f24\u8fdb\u884c\u5206\u6790\uff0cART\u8bd5\u9a8c\u7684\u7ed3\u679c\u663e\u793aRM\u5177\u6709\u660e\u663e\u7684\u6709\u5bb3\u5f71\u54cd\uff08RR 3.56\uff1b95% CI 1.64 ~ 7.73\uff09\uff0c\u4e0e\u5176\u4ed6\u7814\u7a76\u7684Meta\u5206\u6790\u7ed3\u679c\u6709\u5f88\u5927\u4e0d\u540c\uff08RR 0.60\uff1b95% CI 0.25 ~ 1.41\uff09\u3002\u8fd9\u4e00\u7ed3\u679c\u6709\u529b\u5730\u652f\u6301\u4e86\u53cd\u5bf9\u4f7f\u7528\u9ad8\u538bRM\u7b56\u7565\u7684\u5efa\u8bae\u3002<\/p>\n<p>\u4e09\u4e2a\u7814\u7a76\u62a5\u9053\u4e86VFD<sup>[112, 129,130]<\/sup>\u3002\u672c\u6587\u7684\u4e3b\u8981\u5206\u6790\u57fa\u4e8eART\u8bd5\u9a8c<sup>[112]<\/sup>\uff0c\u8be5\u8bd5\u9a8c\u663e\u793a\u5e72\u9884\u7ec4\u4e2dVFD\u663e\u8457\u4e0b\u964d\uff08\u5747\u503c\uff09\uff0c\u56e0\u4e3a\u5176\u4ed6\u4e24\u9879\u7814\u7a76\u62a5\u544a\u7684\u662f\u4e2d\u4f4d\u6570\u548c\u56db\u5206\u4f4d\u6570\u95f4\u8ddd\uff0c\u56e0\u6b64\u65e0\u6cd5\u4e0eART\u8bd5\u9a8c\u8fdb\u884cMeta\u5206\u6790\u3002<\/p>\n<p>8.3.4 \u63a8\u8350\u610f\u89c1 6.3<\/p>\n<p>\u4e0d\u5efa\u8bae\u4f7f\u7528\u957f\u7a0b\u9ad8\u538bRM\u7b56\u7565\uff08\u5b9a\u4e49\u4e3a\u6c14\u9053\u538b \u2265 35 cmH2O \u81f3\u5c11\u7ef4\u63011\u5206\u949f\uff09\u6765\u964d\u4f4eARDS\u60a3\u8005\u7684\u6b7b\u4ea1\u7387\u3002\uff08\u5f3a\u63a8\u8350\uff1b\u4e2d\u7b49\u8d28\u91cf\u8bc1\u636e\u3002\uff09<\/p>\n<p>\u6b64\u63a8\u8350\u610f\u89c1\u4e5f\u9002\u7528\u4e8eCOVID-19\u5bfc\u81f4\u7684ARDS\u3002\uff08\u5f3a\u63a8\u8350\uff1b\u4f4e\u8d28\u91cf\u8bc1\u636e\u3002\uff09<\/p>\n<p>8.4 \u95ee\u98986.4\uff1a\u5728\u63a5\u53d7\u6709\u521b\u673a\u68b0\u901a\u6c14\u7684ARDS\u60a3\u8005\u4e2d\uff0c\u5e38\u89c4\u4f7f\u7528\u77ed\u7a0b\u9ad8\u538bRM\u4e0e\u4e0d\u4f7f\u7528RM\u76f8\u6bd4\uff0c\u80fd\u5426\u964d\u4f4e\u6b7b\u4ea1\u7387?<\/p>\n<p>8.4.1 \u8bc1\u636e\u6982\u8ff0<\/p>\n<p>\u77ed\u7a0b\u9ad8\u538bRM\u5b9a\u4e49\u4e3a\u6c14\u9053\u538b\u529b \u2265 35 cmH2O\u6301\u7eed\u65f6\u95f4\u5c0f\u4e8e1\u5206\u949f\u7684RM\u65b9\u6cd5\u3002\u4e09\u9879\u7814\u7a76\u7eb3\u5165\u5206\u6790\u3002Kacmarek\u7b49\u4eba\uff08n = 200\uff09\u6bd4\u8f83\u4e86\u4e24\u79cd\u77ed\u7a0b\u9ad8\u538bRM\u65b9\u6cd5\uff08PEEP\u77ed\u6682\u5347\u9ad8\u81f335-45 cmH2O\uff0c\u7a7f\u63d2\u8fdb\u884c\u964d\u9636\u68afPEEP\u6ef4\u5b9a\uff09\u4e0eRM\u91c7\u7528\u4f4ePEEP\/FiO2\u8868\u6cd5\u7684\u5dee\u522b<sup>[133]<\/sup>\u3002LOVS\uff08n = 983\uff09\u4f7f\u7528\u4e86\u4e00\u6b21\u77ed\u7a0bRM\uff0840 cmH2O\u5438\u6c14\u538b\u529b\u4e0b\u963b\u65ad40\u79d2\uff1b\u9ad8PEEP\/FiO2\u8868\u7684\u540e\u7eedRM\u5141\u8bb8\u547c\u5438\u673a\u7535\u8def\u65ad\u5f00\uff09\uff0c\u5bf9\u7167\u7ec4\u91c7\u7528\u4f4ePEEP\/FiO2\u8868\u4e14\u4e0d\u5e94\u7528RM<sup>[107]<\/sup>\u3002Xi\u7b49\u4eba\u5c06\u6bcf8\u5c0f\u65f6\u91cd\u590d\u4e00\u6b21\u7684\u77ed\u7a0bRM\uff0840 cmH2O\u5438\u6c14\u538b\u529b\u4e0b\u963b\u65ad40\u79d2\uff09\uff0c\u6301\u7eed5\u5929\u4e0e\u4e0d\u4f7f\u7528RM\u8fdb\u884c\u4e86\u6bd4\u8f83<sup>[134]<\/sup>\u3002Xi\u7b49\u4eba\u7684\u7814\u7a76\u6ca1\u6709\u5c06\u4e24\u7ec4\u7684PEEP\u6807\u51c6\u5316\uff0c\u56e0\u6b64\u5355\u72ec\u5206\u6790\u3002<\/p>\n<p>\u5728\u4e09\u9879\u7814\u7a76\u7684\u4efb\u4f55\u4e00\u9879\u8bd5\u9a8c\u4e2d\uff0c\u7ec4\u95f4\u7684\u6b7b\u4ea1\u7387\u6ca1\u6709\u663e\u8457\u5dee\u5f02\uff0c\u5bf9\u4e24\u9879\u6807\u5316\u4e86PEEP\u8bbe\u5b9a\u7684\u7814\u7a76\u8fdb\u884cMeta\u5206\u6790\uff0c\u4ea6\u672a\u53d1\u73b0\u663e\u8457\u5dee\u5f02\uff08\u5408\u5e76RR 0.89\uff1b95% CI 0.77 ~ 1.04\uff09\u3002Kacmarek\u7b49\u4eba\u6216Xi\u7b49\u4eba\u7814\u7a76\u4e2d\u7684VFD\u5728\u6cbb\u7597\u7ec4\u4e4b\u95f4\u6ca1\u6709\u663e\u8457\u5dee\u5f02\u3002LOVS\u7814\u7a76\u4e2d\u672a\u62a5\u544aVFD<sup>[107]<\/sup>\u3002<\/p>\n<p>\u5728\u4e09\u9879\u7814\u7a76\u7684\u4efb\u4f55\u4e00\u9879\u8bd5\u9a8c\u4e2d\uff0c\u6c14\u538b\u4f24\u5728\u7ec4\u95f4\u65e0\u663e\u8457\u5dee\u5f02\uff0c\u5bf9\u4e24\u9879\u6807\u5316\u4e86PEEP\u8bbe\u5b9a\u7684\u7814\u7a76\u8fdb\u884cMeta\u5206\u6790\uff0c\u4ea6\u672a\u53d1\u73b0\u663e\u8457\u5dee\u5f02\uff08\u5408\u5e76RR 1.14\uff1b95% CI 0.81~ 1.62\uff09\u3002<\/p>\n<p>\u5728\u8840\u6db2\u52a8\u529b\u5b66\u65b9\u9762\uff0c\u5728Kacmarek\u7b49\u4eba\u7684\u7814\u7a76\u4e2d\uff0c\u4f4e\u8840\u538b\u3001\u5fc3\u5f8b\u5931\u5e38\u6216\u5fc3\u810f\u9aa4\u505c\u7684\u53d1\u751f\u7387\u5728\u4e24\u7ec4\u95f4\u6ca1\u6709\u663e\u8457\u5dee\u5f02\u3002LOVS\u7814\u7a76\u4e2d\uff0c\u8840\u6db2\u52a8\u529b\u5b66\u4e0d\u7a33\u5b9a\u62a5\u544a\u5f62\u5f0f\u4e3a\u4f7f\u7528\u8840\u7ba1\u6d3b\u6027\u836f\u7684\u5929\u6570\u548c\u5355\u65e5\u8840\u7ba1\u6d3b\u6027\u836f\u4f7f\u7528\u5242\u91cf\uff0c\u5404\u7ec4\u4e4b\u95f4\u5177\u6709\u53ef\u6bd4\u6027\u3002Xi\u7b49\u4eba\u7684\u7814\u7a76\u672a\u5145\u5206\u63cf\u8ff0\u8840\u6db2\u52a8\u529b\u5b66\u6548\u5e94\u3002<\/p>\n<p>\u7531\u4e8e\u7f3a\u4e4f\u652f\u6301\u6216\u53cd\u5bf9\u4f7f\u7528RM\u64cd\u4f5c\u7684\u8bc1\u636e\uff0c\u8003\u8651\u5230\u6f5c\u5728\u7684\u5b89\u5168\u95ee\u9898\uff0c\u56e0\u6b64\u4e0d\u63a8\u8350\u5e38\u89c4\u4f7f\u7528\u3002<\/p>\n<p>8.4.2 \u63a8\u8350\u610f\u89c1 6.4<\/p>\n<p>\u63a8\u8350\u4e0d\u5e38\u89c4\u4f7f\u7528\u77ed\u7a0b\u9ad8\u538bRM\u64cd\u4f5c\uff08\u5b9a\u4e49\u4e3a\u6c14\u9053\u538b \u2265 35 cmH2O\u6301\u7eed\u4e0d\u8d85\u8fc71\u5206\u949f\uff09\u6765\u964d\u4f4eARDS\u60a3\u8005\u7684\u6b7b\u4ea1\u7387\u3002\uff08\u5f31\u63a8\u8350\uff1b\u9ad8\u8d28\u91cf\u8bc1\u636e\u3002\uff09<\/p>\n<p>\u6b64\u63a8\u8350\u610f\u89c1\u4e5f\u9002\u7528\u4e8eCOVID-19\u5bfc\u81f4\u7684ARDS\u3002\uff08\u5f31\u63a8\u8350\uff1b\u4e2d\u7b49\u8d28\u91cf\u8bc1\u636e\u3002\uff09<\/p>\n<p>8.4.3 \u4e34\u5e8a\u5e94\u7528\u4e13\u5bb6\u610f\u89c1<\/p>\n<p>\u4f4e\u8840\u538b\u548c\u4f4e\u6c27\u5408\u662fRM\u671f\u95f4\u6216\u4e4b\u540e\u6700\u5e38\u89c1\u7684\u4e0d\u826f\u4e8b\u4ef6\uff0c\u53d1\u751f\u7387\u5206\u522b\u5747\u4e3a10%<sup>[119]<\/sup>\u3002\u5fc3\u52a8\u8fc7\u7f13\uff08\u53ef\u80fd\u662f\u8ff7\u8d70\u795e\u7ecf\u4ecb\u5bfc\u7684\uff09\u4e5f\u53ef\u80fd\u53d1\u751f<sup>[135]<\/sup>\u3002\u4e34\u5e8a\u8bd5\u9a8c\u6570\u636e\u8868\u660e\uff0c\u957f\u7a0b\u9ad8\u538bRM\u4e0d\u4ec5\u4f1a\u5bfc\u81f4\u8840\u6db2\u52a8\u529b\u5b66\u4e0d\u7a33\u5b9a\uff0c\u8fd8\u4f1a\u589e\u52a0\u6c14\u538b\u4f24\u548c\u5fc3\u810f\u9aa4\u505c\u7684\u98ce\u9669<sup>[112]<\/sup>\u3002\u8fd9\u4e9b\u98ce\u9669\u5927\u4e8e\u5176\u6f5c\u5728\u76ca\u5904\uff0c\u56e0\u6b64\u4e0d\u5efa\u8bae\u4f7f\u7528\u3002<\/p>\n<p>\u77ed\u7a0b\u9ad8\u538bRM\u4e5f\u53ef\u80fd\u4ea7\u751f\u77ed\u6682\u7684\u3001\u6f5c\u5728\u53ef\u9006\u7684\u4f4e\u8840\u538b\u548c\u5fc3\u52a8\u8fc7\u7f13<sup>[115, 135]<\/sup>\uff0c\u8fd9\u53ef\u80fd\u7531\u6025\u6027\u53f3\u5fc3\u8870\u7aed\u6240\u81f4\u3002\u73b0\u6709\u6570\u636e\u4e0d\u652f\u6301\u5e38\u89c4\u4f7f\u7528\u77ed\u7a0bRM\uff0c\u53ef\u80fd\u662f\u56e0\u4e3a\u77ed\u6682\u5347\u9ad8\u7684\u6c14\u9053\u538b\u529b\u5bf9\u80ba\u529b\u5b66\u7684\u5f71\u54cd\u662f\u77ed\u6682\u7684\uff0c\u9664\u975e\u8054\u5408\u5176\u4ed6\u9632\u6b62\u80ba\u6ce1\u6301\u7eed\u584c\u9677\u7684\u64cd\u4f5c<sup>[136]<\/sup>\u3002\u7136\u800c\uff0c\u5728\u53ef\u80fd\u662f\u7531\u53bb\u590d\u5f20\u5bfc\u81f4\u4f4e\u6c27\u7684\u60c5\u51b5\u4e0b\uff0c\u5982\u547c\u5438\u673a\u65ad\u5f00\u3001\u5438\u75f0\u3001\u652f\u6c14\u7ba1\u955c\u68c0\u67e5\u6216\u4f53\u4f4d\u6539\u53d8\u540e\uff0c\u77ed\u6682RM\u5728\u9006\u8f6c\u4f4e\u6c27\u8840\u75c7\u65b9\u9762\u6709\u4e00\u5b9a\u7684\u4f5c\u7528\u3002\u5982\u679c\u8981\u8fdb\u884c\u77ed\u7a0b\u9ad8\u538bRM\uff0c\u9700\u8981\u6709\u5b8c\u6574\u7684\u9884\u6848\uff0c\u4e00\u65e6\u51fa\u73b0\u8840\u6d41\u52a8\u529b\u5b66\u4e0d\u7a33\u5b9a\u7684\u60c5\u51b5\uff0c\u5e94\u7acb\u5373\u4e2d\u6b62RM\u64cd\u4f5c\u3002<\/p>\n<p>8.4.4 \u672a\u89e3\u51b3\u7684\u95ee\u9898\u548c\u7814\u7a76\u7a7a\u767d<\/p>\n<p>\u4ee5\u201c\u53f9\u6c14\u201d\u547c\u5438\u7684\u5f62\u5f0f\u8fdb\u884c\u7684\u77ed\u7a0bRM\u64cd\u4f5c\uff0c\u5e76\u6bcf\u9694\u51e0\u5206\u949f\u8fdb\u884c\u4e00\u6b21\u6216\u591a\u6b21\u201c\u53f9\u6c14\u201d\uff0c\u53ef\u4ee5\u9632\u6b62\u4f4e\u6c14\u9053\u538b\u529b\u3001\u4f4eVT\u901a\u6c14\u53ef\u80fd\u53d1\u751f\u7684\u6e10\u8fdb\u6027\u53bb\u590d\u5f20<sup>[127, 137]<\/sup>\u3002\u8fd9\u79cd\u5468\u671f\u6027\u64cd\u4f5c\u662f\u5426\u80fd\u51cfVILI\u6216\u5e26\u6765\u5b89\u5168\u98ce\u9669\uff0c\u591a\u4e45\u8fdb\u884c\u4e00\u6b21\u201c\u53f9\u6c14\u201d\u4ee5\u63d0\u4f9b\u80ba\u4fdd\u62a4\uff08\u5982\u679c\u6709\u7684\u8bdd\uff09\uff0c\u4ee5\u53ca\u5728\u54ea\u4e9b\u60a3\u8005\u7fa4\u4f53\u53ef\u4ece\u4e2d\u83b7\u76ca\uff0c\u90fd\u9700\u8981\u8fdb\u4e00\u6b65\u7814\u7a76\u3002<\/p>\n<p>9 \u9886\u57df7\uff1a\u4fef\u5367\u4f4d<\/p>\n<p>9.1 \u95ee\u9898 7.1\uff1a\u5bf9\u4e8e\u6c14\u7ba1\u63d2\u7ba1\u7684ARDS\u60a3\u8005\uff0c\u4fef\u5367\u4f4d\u4e0e\u4ef0\u5367\u4f4d\u76f8\u6bd4\u662f\u5426\u80fd\u964d\u4f4e\u6b7b\u4ea1\u7387\uff1f<\/p>\n<p>9.1.1 \u80cc\u666f<\/p>\n<p>20\u4e16\u7eaa70\u5e74\u4ee3\uff0c\u4fef\u5367\u4f4d\u88ab\u63d0\u51fa\u6765\u7528\u4e8eAHRF\u548cARDS\u60a3\u8005\u3002\u4fef\u5367\u4f4d\u80fd\u8d77\u5230\u6539\u5584\u6c27\u5408\u3001\u66f4\u597d\u5730\u5747\u5316\u80ba\u5e94\u529b\u4ee5\u53ca\u964d\u4f4e\u53f3\u5fc3\u5ba4\u5e94\u53d8\u7684\u751f\u7406\u5b66\u4f5c\u7528\u3002\u591a\u5e74\u6765\uff0c\u8fdb\u884c\u4e86\u82e5\u5e72\u6bd4\u8f83\u4fef\u5367\u4f4d\u4e0e\u4ef0\u5367\u4f4d\u7684\u4e34\u5e8a\u8bd5\u9a8c\uff0c\u4e14\u540e\u671f\u7684\u8bd5\u9a8c\u8bbe\u8ba1\u5728\u5bf9\u4e4b\u524d\u8bd5\u9a8c\u8fdb\u884c\u6279\u5224\u6027\u5206\u6790\u7684\u57fa\u7840\u4e0a\u4e0d\u65ad\u6539\u8fdb<sup>[138-144]<\/sup>\u3002\u56e0\u6b64\uff0c\u8d8a\u6765\u8d8a\u591a\u7684\u4f4e\u6c27\u8840\u75c7\u60a3\u8005\u5e94\u7528\u4fef\u5367\u4f4d\uff0c\u4fef\u5367\u4f4d\u901a\u6c14\u5468\u671f\u7684\u6301\u7eed\u65f6\u95f4\u9010\u6e10\u589e\u52a0\uff0c\u4fdd\u62a4\u6027\u901a\u6c14\u4e0e\u4fef\u5367\u4f4d\u7684\u5e94\u7528\u9010\u6e10\u8054\u5408\u30022013\u5e74\uff0cPROSEVA\u8bd5\u9a8c\u8868\u660e\u4fef\u5367\u4f4d\u901a\u6c14\u5bf9\u4e2d\u91cd\u5ea6ARDS\u60a3\u8005\u5177\u6709\u660e\u663e\u7684\u4fdd\u62a4\u4f5c\u7528<sup>[9]<\/sup>\u30022017\u5e74\uff0cESICM\u548c\u7f8e\u56fd\u80f8\u79d1\u5b66\u4f1a\uff08American Thoracic Society\uff0cATS\uff09\u5bf9\u5305\u542b\u56db\u9879\u6700\u5927\u7684\u8bd5\u9a8c\u5728\u5185\u7684\u6c47\u603b\u6570\u636e\u548c\u5355\u4e2a\u60a3\u8005\u6570\u636e\u7684Meta\u5206\u6790\u7ed3\u679c<sup>[10, 138, 139, 143, 144]<\/sup>\uff0c\u63a8\u8350\u5728ARDS\u60a3\u8005\u4e2d\u4f7f\u7528\u4fef\u5367\u4f4d\u901a\u6c14<sup>[13]<\/sup>\u3002\u5728\u6c47\u603b\u6570\u636e\u7684Meta\u5206\u6790\u4e2d\uff0c\u603b\u4f53\u7ed3\u679c\u5e76\u65e0\u663e\u8457\u5dee\u5f02\uff1b\u7136\u800c\uff0c\u5728\u4fef\u5367\u4f4d\u6301\u7eed\u65f6\u95f4\u8d85\u8fc712\u5c0f\u65f6\u6216\u7eb3\u5165PaO2\/FiO2 \u2264 200 mmHg\u60a3\u8005\u7684\u7814\u7a76\u4e2d\uff0c\u4fef\u5367\u4f4d\u901a\u6c14\u7ec4\u6b7b\u4ea1\u7387\u663e\u8457\u964d\u4f4e\u3002\u5355\u4e2a\u60a3\u8005Meta\u5206\u6790\u53d1\u73b0<sup>[10]<\/sup>\uff0c\u4fef\u5367\u4f4d\u901a\u6c14\u53ef\u4f7fPaO2\/FiO2 \u2264100 mmHg\u60a3\u8005\u7684\u751f\u5b58\u83b7\u76ca\u3002\u7136\u800c\uff0c\u8fd9\u4e2a\u4e9a\u7ec4\u5206\u6790\u6ca1\u6709\u7ed9\u51fa\u4efb\u4f55\u660e\u786e\u7684\u7ed3\u8bba\uff0c\u56e0\u4e3a\u968f\u673a\u5206\u7ec4\u7684\u76ca\u5904\u5728\u4e9a\u7ec4\u4e2d\u5e76\u975e\u4e00\u76f4\u80fd\u591f\u7ef4\u6301\u7684\uff08\u53ea\u6709\u4e00\u9879\u7814\u7a76\u6839\u636e\u4f4e\u6c27\u8840\u75c7\u7684\u7a0b\u5ea6\u5bf9\u60a3\u8005\u8fdb\u884c\u4e86\u5206\u5c42<sup>[144]<\/sup>\uff09\u3002\u603b\u7684\u6765\u8bf4\uff0cMeta\u5206\u6790\u4e2d\u7684\u4e9a\u7ec4\u5206\u6790\u5177\u6709\u63a2\u7d22\u6027\uff0c\u5176\u7ed3\u679c\u5e94\u8c28\u614e\u89e3\u8bfb\u3002\u8fc4\u4eca\u6ca1\u6709\u4e13\u95e8\u9488\u5bf9COVID-19\u673a\u68b0\u901a\u6c14\u60a3\u8005\u8fdb\u884c\u4fef\u5367\u4f4d\u7684RCT\u3002<\/p>\n<p>9.1.2 \u8bc1\u636e\u6982\u8ff0<\/p>\n<p>\u57fa\u4e8e2017\u5e74\u6307\u5357\u4e2d\u9009\u5b9a\u7684\u516b\u9879\u8bd5\u9a8c\u8fdb\u884c\u4e86\u5206\u6790\uff0c\u56e0\u4e3a\u6b64\u540e\u6ca1\u6709\u672a\u68c0\u7d22\u5230\u5173\u4e8e\u8fd9\u4e00\u4e3b\u9898\u7684\u8bd5\u9a8c\u3002\u7136\u800c\uff0c\u6392\u9664\u4e862004\u5e74\u4e0d\u9650\u4e8eARDS\u7684\u8bd5\u9a8c<sup>[139]<\/sup>\u3002\u5bf9\u77ed\u671f\u6b7b\u4ea1\u7387\u7ed3\u5c40\u8fdb\u884c\u4e86Meta\u5206\u6790\uff0c\u77ed\u671f\u6b7b\u4ea1\u7387\u5b9a\u4e49\u4e3a28\u5929\u6216ICU\u6b7b\u4ea1\uff0c\u5e76\u5bf990\u5929\u6b7b\u4ea1\u7387\u5355\u72ec\u8fdb\u884c\u5206\u6790\u3002<\/p>\n<p>\u4e0d\u540c\u7814\u7a76\u5728\u901a\u6c14\u65b9\u5f0f\u3001\u6bcf\u65e5\u4fef\u5367\u4f4d\u901a\u6c14\u65f6\u95f4\u3001\u60a3\u8005\u9009\u62e9\u548c\u4fef\u5367\u4f4d\u5e94\u7528\u65f6\u673a\u7b49\u65b9\u9762\u5b58\u5728\u76f8\u5173\u7684\u4e34\u5e8a\u5f02\u8d28\u6027\u3002<\/p>\n<p>\u77ed\u671f\u6b7b\u4ea1\u7387\u5728\u4fef\u5367\u4f4d\u548c\u4ef0\u5367\u4f4d\u4e4b\u95f4\u6ca1\u6709\u5dee\u5f02\uff08RR 0.79 95% CI [0.61 ~ 1.03]\uff09\u3002\u5728\u524d\u4e94\u9879\u8bd5\u9a8c\u7684\u4e9a\u7ec4\u4e2d\uff0c\u77ed\u671f\u6b7b\u4ea1\u7387\u5728\u4fef\u5367\u4f4d\u548c\u4ef0\u5367\u4f4d\u4e4b\u95f4\u6ca1\u6709\u5dee\u5f02\uff080.91 [0.77 ~ 1.08]\uff09\u3002\u7136\u800c\uff0c\u5728PROSEVA\u8bd5\u9a8c\u4e2d\u4fef\u5367\u4f4d\u7ec4\u7684\u77ed\u671f\u6b7b\u4ea1\u7387\u660e\u663e\u8f83\u4f4e\uff080.49 [0.35 ~ 0.69]\uff09\uff0c\u4ea4\u4e92\u4f5c\u7528\u68c0\u9a8c\u5177\u6709\u7edf\u8ba1\u5b66\u610f\u4e49\u3002<\/p>\n<p>\u8fdc\u671f\u6b7b\u4ea1\u7387\u5728\u4fef\u5367\u4f4d\u548c\u4ef0\u5367\u4f4d\u4e4b\u95f4\u6ca1\u6709\u5dee\u5f02\uff080.81 [0.64 ~ 1.02]\uff09\u3002\u5728\u524d\u4e94\u9879\u8bd5\u9a8c\u7684\u4e9a\u7ec4\u4e2d\uff0c\u8fdc\u671f\u6b7b\u4ea1\u7387\u6ca1\u6709\u5dee\u5f02\uff080.93 [0.79 ~ 1.09]\uff09\u3002\u5728PROSEVA\u8bd5\u9a8c\u4e2d\uff0c\u4fef\u5367\u4f4d\u7ec4\u768490\u5929\u6b7b\u4ea1\u7387\u660e\u663e\u63d0\u9ad8\uff080.58 [0.44 ~ 0.76]\uff09\uff08P &lt; 0.01\uff09\u3002\u5728\u8fd9\u79cd\u60c5\u51b5\u4e0b\uff0c\u4ea4\u4e92\u4f5c\u7528\u68c0\u9a8c\u7ed3\u679c\u4e5f\u5177\u6709\u7edf\u8ba1\u5b66\u610f\u4e49\u3002PROSEVA\u8bd5\u9a8c\u7684\u72ec\u7279\u53d1\u73b0\u5728\u4e00\u9879\u7d2f\u79efMeta\u5206\u6790\u4e2d\u5f97\u5230\u4e86\u8fdb\u4e00\u6b65\u8bc1\u5b9e\uff0c\u8be5\u5206\u6790\u8c03\u67e5\u4e86\u5386\u6b21Meta\u5206\u6790\u7684\u7ed3\u679c\u3002\u6b64\u5916\uff0c\u901a\u8fc7\u201cdouble p plot\u201d\u65b9\u6cd5\uff08\u662f\u4e00\u79cd\u6539\u826f\u7684Baujat\u56fe\u89e3\u6cd5\uff0c\u8be6\u89c1\u5f15\u6587145\uff09\u8fdb\u884c\u5f02\u8d28\u6027\u5206\u6790<sup>[145]<\/sup>\uff0c\u7ed3\u679c\u663e\u793aPROSEVA\u8bd5\u9a8c\u4e3a\u660e\u663e\u7684\u79bb\u7fa4\u503c\u3002<\/p>\n<p>\u56e0\u6b64\uff0c\u672c\u6587\u7684\u4e3b\u8981\u5206\u6790\u662f\u57fa\u4e8e\u5bf9PROSEVA\u8bd5\u9a8c\u7ed3\u679c\u7684\u5355\u72ec\u8bc4\u4f30\u3002\u76f8\u53cd\uff0c\u4e8c\u6b21\u5206\u6790\u5305\u62ec\u4e86\u6240\u6709\u8bd5\u9a8c\u3002<\/p>\n<p>9.1.3 \u63a8\u8350\u610f\u89c17.1<\/p>\n<p>\u4e0e\u4ef0\u5367\u4f4d\u76f8\u6bd4\uff0c\u5efa\u8bae\u5bf9\u4e2d\u91cd\u5ea6ARDS\u60a3\u8005\uff08\u5b9a\u4e49\u4e3a\u8fdb\u884c\u4f18\u5316\u901a\u6c14\u8bbe\u7f6e\u540e\uff0c\u4ecdPaO2\/FiO2 &lt; 150 mmHg\u548cPEEP \u2265 5 cmH2O\uff09\u5b9e\u65bd\u4fef\u5367\u4f4d\u4ee5\u964d\u4f4e\u6b7b\u4ea1\u7387\u3002\uff08\u5f3a\u63a8\u8350\uff0c\u9ad8\u8d28\u91cf\u652f\u6301\u8bc1\u636e\u3002\uff09<\/p>\n<p>\u6b64\u63a8\u8350\u610f\u89c1\u4e5f\u9002\u7528\u4e8eCOVID-19\u5bfc\u81f4\u7684ARDS\u3002\uff08\u5f3a\u63a8\u8350\uff1b\u4e2d\u7b49\u8d28\u91cf\u95f4\u63a5\u652f\u6301\u8bc1\u636e\u3002\uff09<\/p>\n<p>9.1.4 \u4e34\u5e8a\u5e94\u7528\u4e13\u5bb6\u610f\u89c1<\/p>\n<p>\u6839\u636ePROSEVA\u8bd5\u9a8c\u6807\u51c6\uff0c\u603b\u7684\u98ce\u9669-\u83b7\u76ca\u6bd4\u652f\u6301\u91c7\u53d6\u4fef\u5367\u4f4d\uff0c\u7279\u522b\u662f\u8003\u8651\u5230\u5927\u591a\u6570ICU\u914d\u5907\u4e86\u8db3\u591f\u719f\u7ec3\u7684\u62a4\u7406\u4eba\u5458\uff0c\u4e14\u80fd\u591f\u5173\u6ce8\u538b\u529b\u76f8\u5173\u76ae\u80a4\u5e76\u53d1\u75c7\u7684\u98ce\u9669\uff0c\u91c7\u7528\u4fef\u5367\u4f4d\u662f\u53ef\u884c\u7684\u3002<\/p>\n<p>9.1.5 \u672a\u89e3\u51b3\u7684\u95ee\u9898\u548c\u7814\u7a76\u7a7a\u767d<\/p>\n<p>\u9274\u4e8e\u76ee\u524d\u8be5\u9886\u57df\u4fef\u5367\u4f4d\u4e0e\u4ef0\u5367\u4f4d\u7f3a\u4e4f\u5e73\u8861\uff0c\u4e0d\u592a\u53ef\u80fd\u5728\u4e2d\u91cd\u5ea6COVID\u76f8\u5173ARDS\u4e2d\u5f00\u5f00\u5c55\u4fef\u5367\u4f4d\u4e0e\u4ef0\u5367\u4f4d\u7684\u5bf9\u6bd4\u8bd5\u9a8c\u3002\u6cd5\u56fd\u6b63\u5728\u8fdb\u884c\u4e00\u9879\u9488\u5bf9\u8f7b\u4e2d\u5ea6ARDS\u6210\u4eba\u63d2\u7ba1\u60a3\u8005\u7684\u76f8\u5173\u8bd5\u9a8c\uff08NCT05056090\uff09\u3002<\/p>\n<p>9.2 \u95ee\u9898 7.2\uff1a\u5bf9\u4e8e\u4e2d\u91cd\u5ea6ARDS\u60a3\u8005\uff0c\u5e94\u4f55\u65f6\u5f00\u59cb\u4fef\u5367\u4f4d\u4ee5\u964d\u4f4e\u6b7b\u4ea1\u7387\uff1f<\/p>\n<p>9.2.1 \u80cc\u666f<\/p>\n<p>\u6ca1\u6709\u8bbe\u8ba1\u4e13\u95e8\u7684\u8bd5\u9a8c\u6765\u63a2\u8ba8\u4f55\u65f6\u5f00\u59cb\u8fdb\u884c\u4fef\u5367\u4f4d\u7684\u6807\u51c6\u3002\u56e0\u6b64\uff0c\u672c\u95ee\u9898\u6240\u4f7f\u7528\u7684\u8bc1\u636e\u4e0e\u4e0a\u4e00\u95ee\u9898\u76f8\u540c\u3002<\/p>\n<p>9.2.2 \u63a8\u8350\u610f\u89c17.2<\/p>\n<p>\u5efa\u8bae\u63d2\u7ba1\u540e\u65e9\u671f\u63a5\u53d7\u6709\u521b\u673a\u68b0\u901a\u6c14\u7684ARDS\u60a3\u8005\u671f\u5e94\u7528LTV\u5e76\u8c03\u6574PEEP\u7a33\u5b9a\u4e00\u6bb5\u65f6\u95f4\u540e\uff0cPaO2\/FiO2\u4ecd\u5c0f\u4e8e150 mmHg\u65f6\u5f00\u59cb\u91c7\u7528\u4fef\u5367\u4f4d\uff1b\u4fef\u5367\u4f4d\u5e94\u957f\u65f6\u95f4\u5e94\u7528\uff08\u8fde\u7eed16\u5c0f\u65f6\u6216\u4ee5\u4e0a\uff09\u4ee5\u964d\u4f4e\u6b7b\u4ea1\u7387\u3002\uff08\u5f3a\u63a8\u8350\uff1b\u9ad8\u8d28\u91cf\u652f\u6301\u8bc1\u636e\u3002\uff09<\/p>\n<p>\u6b64\u63a8\u8350\u610f\u89c1\u4e5f\u9002\u7528\u4e8eCOVID-19\u4e2d\u7684ARDS\u3002\uff08\u5f3a\u63a8\u8350\uff1b\u4e2d\u7b49\u8d28\u91cf\u95f4\u63a5\u652f\u6301\u8bc1\u636e\u3002\uff09<\/p>\n<p>9.2.3 \u4e34\u5e8a\u5e94\u7528\u4e13\u5bb6\u610f\u89c1<\/p>\n<p>\u76ee\u524d\u7684\u5efa\u8bae\u662f\u57fa\u4e8ePROSEVA\u8bd5\u9a8c\u8fd9\u4e00\u9879\u8bd5\u9a8c\u83b7\u5f97\u7684\u8bc1\u636e\u3002\u4fef\u5367\u4f4d\u524d\u7684\u7a33\u5b9a\u671f\u5e94\u8003\u8651\u5230\u4f18\u5316\u547c\u5438\u673a\u8bbe\u7f6e\u548c\u8840\u6db2\u52a8\u529b\u5b66\u7684\u65f6\u95f4\u3002\u5373\u4f7f\u6700\u521d\u6c27\u5408\u72b6\u51b5\u6ca1\u6709\u660e\u663e\u6539\u5584\uff0c\u4e5f\u5e94\u7ee7\u7eed\u91c7\u53d6\u4fef\u5367\u4f4d\uff0c\u8fd9\u662f\u56e0\u4e3a\u4fef\u5367\u4f4d\u6709\u53ef\u80fd\u901a\u8fc7\u5747\u5316\u80ba\u5e94\u529b\u6765\u4fdd\u62a4\u80ba\u90e8\uff0c\u5e76\u6709\u53ef\u80fd\u52a0\u901f\u5eb7\u590d\u8fc7\u7a0b\u3002<\/p>\n<p>9.2.4 \u672a\u89e3\u51b3\u7684\u95ee\u9898\u548c\u7814\u7a76\u7a7a\u767d<\/p>\n<p>\u76ee\u524d\u8fd8\u6ca1\u6709\u8bd5\u9a8c\u6bd4\u8f83\u4ef0\u5367\u4f4d\u4e0d\u540c\u7684\u6301\u7eed\u65f6\u95f4\uff0c\u4e5f\u6ca1\u6709\u8bd5\u9a8c\u63a2\u8ba8\u9664\u4e86\u6c27\u5408\u4ee5\u5916\u7684\u5176\u4ed6\u6307\u6807\u6765\u786e\u5b9a\u4f55\u65f6\u505c\u6b62\u4fef\u5367\u4f4d\u3002\u4fef\u5367\u4f4d\u548c\u968f\u540e\u7684\u4ef0\u5367\u4f4d\u4e4b\u95f4\u7684PaO2\/FiO2\u6bd4\u503c\u7684\u5dee\u5f02\u53ef\u7528\u4e8e\u6307\u5bfc\u4f55\u65f6\u505c\u6b62\u4fef\u5367\u4f4d\u3002\u6b64\u5916\uff0c\u5728\u51b3\u5b9a\u4f55\u65f6\u505c\u6b62\u4fef\u5367\u4f4d\u65f6\uff0c\u9664\u4e86\u6c27\u5408\u548c\/\u6216\u6b7b\u8154\u901a\u6c14\u6307\u6807\u5916\uff0c\u8fd8\u53ef\u8003\u8651\u4f7f\u7528\u547c\u5438\u529b\u5b66\uff0c\u4f8b\u5982\u5c06\u9a71\u52a8\u538b\u4fdd\u6301\u5728\u5b89\u5168\u8303\u56f4\u5185\u3002\u5bf9\u4e8e\u6c14\u4f53\u4ea4\u6362\u6539\u5584\u751a\u5fae\u7684\u60a3\u8005\uff0c\u5e94\u8fdb\u4e00\u6b65\u8bc4\u4f30\u5ef6\u957f\u4fef\u5367\u4f4d\u65f6\u95f4\u7684\u6548\u679c\u3002<\/p>\n<p>9.3 \u95ee\u9898 7.3\uff1a\u5bf9\u4e8e\u672a\u63d2\u7ba1\u7684AHRF\u60a3\u8005\uff0c\u4e0e\u4ef0\u5367\u4f4d\u76f8\u6bd4\uff0c\u6e05\u9192\u4fef\u5367\u4f4d\u662f\u5426\u80fd\u51cf\u5c11\u63d2\u7ba1\u6216\u964d\u4f4e\u6b7b\u4ea1\u7387\uff1f<\/p>\n<p>9.3.1 \u80cc\u666f<\/p>\n<p>\u5728\u6700\u8fd1\u7684COVID-19\u5927\u6d41\u884c\u671f\u95f4\uff0c\u968f\u7740\u65e0\u521b\u547c\u5438\u652f\u6301\u7b56\u7565\u5728\u75c5\u623f\u548cICU\u7684\u63a8\u5e7f\uff0c\u5bf9\u975e\u673a\u68b0\u901a\u6c14\u60a3\u8005\u7ecf\u5e38\u5b9e\u65bd\u6240\u8c13\u7684\u201c\u6e05\u9192\u4fef\u5367\u4f4d\u201d\uff08awake prone positioning\uff0cAPP\uff09\uff0c\u5e76\u6210\u4e3a\u591a\u9879\u4e34\u5e8a\u8bd5\u9a8c\u7684\u7126\u70b9<sup>[146]<\/sup>\u3002\u4e8b\u5b9e\u4e0a\uff0c\u6240\u6709\u6765\u81eaRCT\u7684\u9ad8\u8d28\u91cf\u8bc1\u636e\u90fd\u6765\u81eaCOVID-19\u60a3\u8005\u7684\u7814\u7a76\u3002<\/p>\n<p>9.3.2 \u8bc1\u636e\u6982\u8ff0<\/p>\n<p>\u672c\u6307\u5357\u5173\u4e8e\u6e05\u9192\u4fef\u5367\u4f4d\u4e0e\u4ef0\u5367\u4f4d\u7684Meta\u5206\u6790\u5171\u7eb3\u5165\u4e86\u4e09\u9879\u6bd4\u8f83APP\u4e0e\u4ef0\u5367\u4f4d\u7684\u8bd5\u9a8c\uff0c\u8fd9\u4e9b\u8bd5\u9a8c\u5747\u9488\u5bf9COVID-19\u60a3\u8005<sup>[147-149]<\/sup>\u3002\u5176\u4e2d\u4e00\u9879\u662fMeta\u8bd5\u9a8c<sup>[147]<\/sup>\uff0c\u5305\u62ec\u5728\u516d\u4e2a\u4e0d\u540c\u56fd\u5bb6\uff08\u52a0\u62ff\u5927\u3001\u6cd5\u56fd\u3001\u7231\u5c14\u5170\u3001\u58a8\u897f\u54e5\u3001\u897f\u73ed\u7259\u3001\u7f8e\u56fd\uff09\u8fdb\u884c\u7684\u516d\u9879RCT\u7814\u7a76\uff0c\u5bf9\u8bd5\u9a8c\u65b9\u6848\u8fdb\u884c\u4e86\u4f18\u5316\u5e76\u5bf9\u6570\u636e\u8fdb\u884c\u4e86\u6574\u5408<sup>[147]<\/sup>\u3002\u4e09\u9879\u8bd5\u9a8c\u4e2d\u7684\u5927\u591a\u6570\u60a3\u8005\u90fd\u63a5\u53d7\u4e86HFNO\u6cbb\u7597\u3002\u5177\u4f53\u6765\u8bf4\uff0c\u5728Meta\u8bd5\u9a8c\u4e2d\uff0c\u5165\u7ec4\u65f6\u63a5\u53d7HFNO\u6cbb\u7597\u7684\u60a3\u8005\u6bd4\u4f8b\u5728APP\u7ec4\u53ca\u5bf9\u7167\u7ec4\u5747\u4e3a100%<sup>[147]<\/sup>\uff1b\u5728\u745e\u5178\u7684\u7814\u7a76\u4e2d\uff0c\u5165\u7ec4\u65f6APP\u7ec4\u63a5\u53d7HFNO\u6cbb\u7597\u7684\u60a3\u8005\u6bd4\u4f8b\u4e3a86.1%\uff0c\u5bf9\u7167\u7ec4\u4e3a74.1%<sup>[148]<\/sup>\uff1b\u5728\u7b2c\u4e09\u9879\u7814\u7a76\u4e2d\uff0c\u5165\u7ec4\u65f6\uff0cAPP\u7ec4\u63a5\u53d7HFNO\u6cbb\u7597\u7684\u60a3\u8005\u6bd4\u4f8b\u4e3a72.2%\uff0c\u5bf9\u7167\u7ec4\u4e3a67.7%<sup>[149]<\/sup>\u3002\u76f8\u5e94\u7684NIV\u7387\u5206\u522b\u4e3a0% vs 0%\u300158.3% vs 69.2%\u548c5.9% vs 10.3%<sup>[147-149]<\/sup>\u3002<\/p>\n<p>\u5728\u4e3b\u8981\u5206\u6790\u4e2d\uff0cMeta\u8bd5\u9a8c\u88ab\u5206\u6210\u4e866\u4e2a\u5355\u72ec\u7684\u90e8\u5206\uff08\u53736\u4e2aRCT\u7814\u7a76\uff09\uff0c\u56e0\u6b64\u5bf9\u516b\u9879\u8bd5\u9a8c\u8fdb\u884c\u4e86Meta\u5206\u6790\u3002\u6b64\u5916\uff0c\u5728\u58a8\u897f\u54e5\u8fdb\u884c\u7684\u8bd5\u9a8c\u4eceMeta\u8bd5\u9a8c\u4e2d\u88ab\u5254\u9664\uff0c\u56e0\u4e3a\u4e0e\u5176\u4ed6\u4e94\u9879\u8bd5\u9a8c\u76f8\u6bd4\uff0c\u8be5\u8bd5\u9a8c\u63d2\u7ba1\u7387\u660e\u663e\u504f\u4f4e\uff1b\u6b64\u5916\uff0c\u8be5\u8bd5\u9a8c\u4e2d\uff0c\u60a3\u8005APP\u6301\u7eed\u65f6\u95f4\u6bd4\u5176\u4ed6\u8bd5\u9a8c\u9ad8\u51fa\u4e24\u500d\uff0c\u800c\u4e14\u8be5\u8bd5\u9a8c\u5728\u56fe\u4e2d\u663e\u793a\u4e3a\u79bb\u7fa4\u503c\uff0c\u63d0\u793a\u8be5\u7814\u7a76\u4e0eMeta\u5206\u6790\u4e2d\u7684\u5176\u5b83\u7814\u7a76\u4e0d\u4e00\u81f4\u3002\u56e0\u6b64\uff0c\u4e3b\u8981\u5206\u6790\u662f\u5728\u4e24\u4e2a\u4e9a\u7ec4\u4e2d\u8fdb\u884c\uff1a\u4e00\u4e2a\u4e9a\u7ec4\u7eb3\u5165\u4e03\u9879\u8bd5\u9a8c\uff0c\u53e6\u4e00\u4e2a\u4e9a\u7ec4\u53ea\u6709\u58a8\u897f\u54e5\u7684\u8bd5\u9a8c\u3002<\/p>\n<p>\u8be5Meta\u8bd5\u9a8c\u7684\u4e3b\u8981\u7ed3\u5c40\u662f\u4e3a\u590d\u5408\u7ec8\u70b9\uff0c\u5305\u62ec28\u5929\u6b7b\u4ea1\u7387\u548c\u63d2\u7ba1\u7387\u3002\u590d\u5408\u7ed3\u5c40\u7684\u8981\u7d20\u5fc5\u987b\u6ee1\u8db3\u4e09\u4e2a\u6761\u4ef6\u624d\u5177\u6709\u53ef\u9760\u6027\uff1a\u5177\u6709\u76f8\u4f3c\u7684\u4e34\u5e8a\u76f8\u5173\u6027\u3001\u53d1\u751f\u9891\u7387\u76f8\u540c\u3001\u5e76\u4e14\u5e94\u5f53\u53d7\u5230\u76f8\u4f3c\u7684\u8ddf\u8e2a\u5e72\u9884\u5f71\u54cd\u3002\u672c\u6587\u7684\u7814\u7a76\u4e2d\u9009\u62e9\u7684\u590d\u5408\u7ec8\u70b9\u4e0d\u7b26\u5408\u8fd9\u4e9b\u6807\u51c6\uff0c\u56e0\u6b64\uff0c\u5bf928\u5929\u621630\u5929\u63d2\u7ba1\u7387\u548c\u6b7b\u4ea1\u7387\u5206\u522b\u8fdb\u884c\u4e86\u63a2\u8ba8\u3002<\/p>\n<p>\u5728\u5305\u62ec\u4e94\u9879\u8f83\u504f\u501a\u6c34\u5e73\u8f83\u4f4e\u8bd5\u9a8c\u7684\u4e3b\u8981\u5206\u6790\u4ee5\u53ca\u5728\u5305\u62ec\u6240\u6709\u516b\u9879\u7814\u7a76\u7684\u6b21\u8981\u5206\u6790\u4e2d\uff0cAPP\u5747\u80fd\u660e\u663e\u964d\u4f4e\u63d2\u7ba1\u98ce\u9669\uff08RR\u5206\u522b\u4e3a0.84 [0.94 ~ 0.87]\u548c0.84 [0.73 ~ 0.96]\uff09\u3002\u5728\u4e03\u9879\u8bd5\u9a8c\u7684\u4e9a\u7ec4\u5206\u6790\u4e2d\uff0cAPP\u7ec4\u548c\u5bf9\u7167\u7ec4\u7684\u63d2\u7ba1\u7387\u6ca1\u6709\u5dee\u5f02\uff080.89 [0.77 ~ 1.04]\uff09\uff1b\u76f8\u53cd\uff0c\u58a8\u897f\u54e5\u7684\u8bd5\u9a8c\u62a5\u544aAPP\u7ec4\u7684\u63d2\u7ba1\u98ce\u9669\u663e\u8457\u964d\u4f4e\uff080.7 [0.54 ~ 0.9]\uff09\u3002\u867d\u7136\u4ea4\u4e92\u4f5c\u7528\u68c0\u9a8c\u5728\u7edf\u8ba1\u5b66\u4e0a\u5e76\u4e0d\u663e\u8457\uff0c\u4f46\u4ed4\u7ec6\u5206\u6790\u5f02\u8d28\u6027\u540e\u53d1\u73b0\uff0c\u58a8\u897f\u54e5\u7684\u8bd5\u9a8c\u662f\u4e00\u4e2a\u5f02\u5e38\u503c\uff0cAPP\u5bf9\u6b7b\u4ea1\u7387\u65e0\u5f71\u54cd\u3002<\/p>\n<p>9.3.3 \u63a8\u8350\u610f\u89c17.3<\/p>\n<p>\u4e0e\u4ef0\u5367\u4f4d\u76f8\u6bd4\uff0c\u5efa\u8bae\u5bf9\u672a\u63d2\u7ba1\u7684COVID-19\u76f8\u5173AHRF\u60a3\u8005\u91c7\u53d6APP\uff0c\u4ee5\u51cf\u5c11\u63d2\u7ba1\u7387\u3002\uff08\u5f31\u63a8\u8350\uff1b\u4f4e\u8d28\u91cf\u652f\u6301\u8bc1\u636e\u3002\uff09<\/p>\n<p>\u5bf9\u4e8e\u672a\u63d2\u7ba1\u7684COVID-19\u76f8\u5173AHRF\u60a3\u8005\uff0c\u65e0\u6cd5\u63a8\u8350\u6216\u53cd\u5bf9\u91c7\u53d6APP\u6765\u964d\u4f4e\u6b7b\u4ea1\u7387\u3002\uff08\u65e0\u63a8\u8350\uff1b\u4e2d\u7b49\u8d28\u91cf\u652f\u6301\u8bc1\u636e\u8868\u660e\u65e0\u5f71\u54cd\u3002\uff09<\/p>\n<p>\u5bf9\u4e8e\u975eCOVID-19\u5f15\u8d77\u7684AHRF\u60a3\u8005\uff0c\u65e0\u6cd5\u63a8\u8350\u6216\u53cd\u5bf9\u91c7\u53d6APP\u3002\uff08\u65e0\u63a8\u8350\uff1b\u65e0\u8bc1\u636e\u3002\uff09<\/p>\n<p>9.3.4 \u4e34\u5e8a\u5e94\u7528\u4e13\u5bb6\u610f\u89c1<\/p>\n<p>\u5bf9\u4e8eCOVID-19\u6240\u81f4AHRF\u7684\u60a3\u8005\u53ef\u8003\u8651\u91c7\u7528APP\u3002\u9700\u8981\u5bc6\u5207\u76d1\u6d4b\uff0c\u4ee5\u907f\u514d\u5ef6\u8fdf\u63d2\u7ba1\uff0c\u5e76\u5b9a\u671f\u8bc4\u4f30\u548c\u7ba1\u7406\u60a3\u8005\u8212\u9002\u5ea6\u548c\u8010\u53d7\u6027\u3002<\/p>\n<p>9.3.5 \u672a\u89e3\u51b3\u7684\u95ee\u9898\u548c\u7814\u7a76\u7a7a\u767d<\/p>\n<p>APP\u5bf9\u4e8e\u975eCOVID-19\u5f15\u8d77\u7684AHRF\u60a3\u8005\u7684\u5f71\u54cd\u9700\u8981\u66f4\u591a\u7684\u6570\u636e\u3002\u9009\u62e9\u5408\u9002\u7684\u9884\u540e\u662f\u4e00\u4e2a\u95ee\u9898\uff0c\u56e0\u4e3a\u7efc\u5408\u8bc4\u5206\u5b58\u5728\u4e00\u5b9a\u7684\u5c40\u9650\u6027\uff1b\u6b7b\u4ea1\u7387\u53ef\u80fd\u662f\u6700\u76f8\u5173\u7684\u7ed3\u679c\u3002APP\u9700\u8981\u9610\u660e\u7684\u5176\u4ed6\u95ee\u9898\u5305\u62ec\uff1a\u5730\u70b9\uff08ICU\u4e0e\u975eICU\uff09\u3001\u6700\u9002\u5408\u7684\u547c\u5438\u652f\u6301\uff08HFNO\u3001CPAP\u3001NIV\uff09\u4ee5\u53caAPP\u5bf9\u5438\u6c14\u52aa\u529b\u3001\u547c\u5438\u529f\u548c\u6f5c\u5728\u80ba\u635f\u4f24\u7684\u5f71\u54cd\u3002<\/p>\n<p>10 \u9886\u57df8\uff1a\u795e\u7ecf\u808c\u8089\u963b\u6ede\u5242<\/p>\n<p>10.1 \u95ee\u9898 8.1\uff1a\u5728\u975eCOVID-19\u6216COVID-19\u5bfc\u81f4\u7684\u4e2d\u91cd\u5ea6ARDS\u60a3\u8005\u4e2d\uff0c\u5e38\u89c4\u6301\u7eed\u8f93\u6ce8\u795e\u7ecf\u808c\u8089\u963b\u6ede\u5242\u662f\u5426\u4f1a\u964d\u4f4e\u6b7b\u4ea1\u7387\uff1f<\/p>\n<p>10.1.1 \u80cc\u666f<\/p>\n<p>\u5bf9\u63a5\u53d7\u673a\u68b0\u901a\u6c14\u7684ARDS\u60a3\u8005\u4f7f\u7528\u795e\u7ecf\u808c\u8089\u963b\u6ede\u5242\uff08neuromuscular blocking agents\uff0cNMBA\uff09\u53ef\u964d\u4f4e\u547c\u5438\u529f\u3001\u6539\u5584\u4eba\u673a\u5931\u8c03\uff0c\u5e76\u53ef\u80fd\u5f71\u54cd\u9884\u540e<sup>[150]<\/sup>\u3002\u7136\u800c\uff0c\u957f\u671f\u4f7f\u7528NMBA\u4e5f\u4f1a\u5bfc\u81f4\u795e\u7ecf\u808c\u8089\u65e0\u529b\uff0c\u5e76\u9700\u8981\u6df1\u5ea6\u9547\u9759\uff0c\u8fd9\u672c\u8eab\u5c31\u4f1a\u5bfc\u81f4\u4e0d\u826f\u540e\u679c<sup>[151-152]<\/sup>\u3002\u5341\u591a\u5e74\u524d\uff0cACURASYS\u8bd5\u9a8c\u62a5\u544a\u79f0\uff0c\u7ecf\u8c03\u67e5\u5206\u6790\uff0c\u4e0e\u4e0d\u5e38\u89c4\u4f7f\u7528NMBA\u3001\u4ec5\u6df1\u5ea6\u9547\u9759\u7684\u60a3\u8005\u76f8\u6bd4\uff0c\u65e9\u671f\u8f93\u6ce8NMBA\uff08\u7ef4\u630148\u5c0f\u65f6\uff09\u7684\u4e2d\u91cd\u5ea6ARDS\u60a3\u8005\uff08PaO2\/FiO2 &lt;150 mmHg\uff0cPEEP \u2265 5\uff09\u6b7b\u4ea1\u7387\u66f4\u4f4e<sup>[153]<\/sup>\u3002\u53e6\u5916\u4e09\u9879\u7eb3\u5165\u6807\u51c6\u548c\u6cbb\u7597\u65b9\u6848\u7c7b\u4f3c\u7684\u5c0f\u578b\u8bd5\u9a8c\u4e5f\u663e\u793a\u5e38\u89c4\u4f7f\u7528NMBA\u6709\u76ca<sup>[154-156]<\/sup>\u3002\u7136\u800c\uff0c\u81ea\u8fd9\u4e9b\u8bd5\u9a8c\u4ee5\u6765\uff0cICU\u7684\u6cbb\u7597\u5df2\u7ecf\u53d1\u751f\u4e86\u53d8\u5316\uff0c\u5f3a\u8c03\u6d45\u9547\u9759\u548c\u66f4\u65e9\u6062\u590d\u81ea\u4e3b\u547c\u5438\u3002<\/p>\n<p>\u5728\u6700\u8fd1\u7684ROSE\u8bd5\u9a8c\u4e2d\uff0c\u4e2d\u5ea6\u81f3\u91cd\u5ea6ARDS\u60a3\u8005\u88ab\u968f\u673a\u5206\u914d\u5230\u8fde\u7eed\u8f93\u6ce8NMBA\uff08\u7ef4\u6301 48\u5c0f\u65f6\uff09\u540c\u65f6\u8fdb\u884c\u6df1\u9547\u9759\uff08\u5e72\u9884\u7ec4\uff09\u7ec4\u6216\u5e38\u89c4\u6cbb\u7597\uff08\u5bf9\u7167\u7ec4\uff09\uff0c\u5bf9\u7167\u7ec4\u4e0d\u5e38\u89c4\u5e94\u7528\u795e\u7ecf\u808c\u8089\u963b\u6ede\u5242\uff0c\u5e76\u91c7\u7528\u8f83\u6d45\u7684\u9547\u9759\u76ee\u6807\uff0c\u7ed3\u679c\u53d1\u73b0\uff0c\u4e24\u7ec490\u5929\u6b7b\u4ea1\u7387\u65e0\u663e\u8457\u5dee\u5f02<sup>[157]<\/sup>\u3002\u5bf9\u4e8e\u63a5\u53d7\u673a\u68b0\u901a\u6c14\u7684COVID-19 ARDS\uff0cNMBA\u7684\u5e94\u7528\u5448\u4e0a\u5347\u8d8b\u52bf\uff0c\u6700\u5e38\u89c1\u7684\u7528\u836f\u76ee\u7684\u662f\u907f\u514d\u81ea\u4e3b\u547c\u5438\u8fc7\u5f3a\uff0c\u51cf\u5c11\u56e0PL\u8fc7\u9ad8\u800c\u5bfc\u81f4\u7684P-SILI\u6216\u4eba\u673a\u5931\u8c03<sup>[158]<\/sup>\u3002\u7136\u800c\uff0c\u76ee\u524d\u5c1a\u7f3a\u4e4f\u5728COVID-19\u60a3\u8005\u4f7f\u7528NMBA\u7684\u968f\u673a\u8bd5\u9a8c\u3002\u9274\u4e8eROSE\u8bd5\u9a8c\u6392\u9664\u4e86\u5927\u91cf\u5df2\u7ecf\u63a5\u53d7NMBA\u6cbb\u7597\u7684\u60a3\u8005\uff0c\u65e9\u671f\u6301\u7eed\u5e94\u7528NMBA\u7684\u76ca\u5904\u4ecd\u4e0d\u660e\u786e\u3002<\/p>\n<p>10.1.2 \u8bc1\u636e\u6982\u8ff0<\/p>\n<p>\u4e24\u9879\u7814\u7a76\u63d0\u4f9b\u4e86\u4e0d\u540c\u7684\u7ed3\u679c\uff0c\u5bf9\u4e8e90\u5929\u7684\u9884\u540e\uff0cACURASYS\u8bd5\u9a8c\u62a5\u544a\u4e86\u5176\u4fdd\u62a4\u4f5c\u7528<sup>[153]<\/sup>\uff0c\u800c\u6700\u65b0\u7684ROSE\u8bd5\u9a8c\u5219\u663e\u793aNMBA\u5bf9\u9884\u540e\u65e0\u663e\u8457\u5f71\u54cd<sup>[157]<\/sup>\u3002ACURASYS\u8bd5\u9a8c\u7684\u6837\u672c\u91cf\u8ba1\u7b97\u662f\u57fa\u4e8e\u9884\u671f\u6b7b\u4ea1\u7387\u7684\u5927\u5e45\u964d\u4f4e\uff0815%\uff09\u30029%\u7684\u51cf\u5c11\u5e76\u65e0\u7edf\u8ba1\u5b66\u610f\u4e49\uff08P = 0.08\uff09\u3002\u8be5\u7814\u7a76\u7684\u6837\u672c\u91cf\u7684\u68c0\u9a8c\u6548\u80fd\u4e3a42%\uff0c\u5982\u679c\u8981\u662f\u68c0\u9a8c\u6548\u80fd\u8fbe\u523080%\uff0c\u5219\u9700\u8981\u7eb3\u5165842\u540d\u60a3\u8005\u3002ROSE\u8bd5\u9a8c\u5047\u5b9a\u6b7b\u4ea1\u7387\u964d\u4f4e8%\uff0c\u5047\u8bbe\u68c0\u9a8c\u6548\u80fd\u4e3a90%\uff0c\u8ba1\u5212\u7eb3\u5165\u7ea61400\u540d\u60a3\u8005\uff0c\u5e76\u8fdb\u884c\u968f\u673a\u5206\u7ec4\u3002\u5c3d\u7ba1\u6570\u636e\u4e0d\u7cbe\u786e\u3001\u65e0\u6cd5\u6392\u9664\u4f4e\u5f02\u8d28\u6027\u6216\u9ad8\u5f02\u8d28\u6027\uff0c\u5bf9\u8fd9\u4e24\u9879\u7814\u7a76\u8fdb\u884c\u7684Meta\u5206\u6790\u53d1\u73b0\uff0c\u603b\u4f53\u7ec4\u95f4\u65e0\u663e\u8457\u5dee\u5f02\uff0c\u5f02\u8d28\u6027\u4f30\u8ba1\u503c\u8f83\u9ad8\uff08I2 56%\uff09\u3002\u5bf9\u603b\u4f53\u8bc1\u636e\u7684\u8bc4\u4f30\u7ed3\u679c\u4e3a\u4e2d\u5ea6\u53cd\u5bf9\uff08\u6839\u636e\u5bf9\u4e0d\u7cbe\u786e\u6570\u636e\u8fdb\u884c\u964d\u7ea7\u540e\u7684GRADE\u5206\u7ea7\uff09\u3002\u6839\u636e\u8bc4\u4f30\u5de5\u5177\u504f\u501a\u98ce\u9669\uff08the risk of biases, RoB\uff092\u6765\u8bc4\u4f30\u7ed3\u679c\uff0c\u63d0\u793a\u603b\u4f53\u504f\u501a\u98ce\u9669\u8f83\u4f4e\u3002<\/p>\n<p>\u5728\u5206\u679028\u5929\u6216ICU\u6b7b\u4ea1\u7387\u65f6\uff0c\u5171\u7eb3\u5165\u4e86\u4e94\u9879\u8bd5\u9a8c<sup>[153-157]<\/sup>\u3002\u5176\u4e2d\u4e09\u9879\u62a5\u544a\u4e8628\u5929\u6b7b\u4ea1\u7387\uff0c\u4e24\u9879\u62a5\u544a\u4e86ICU\u6b7b\u4ea1\u7387<sup>[153,157]<\/sup>\u3002Meta\u5206\u6790\u7ed3\u679c\u8868\u660e\uff0c\u4e0e\u4e0d\u5e94\u7528NMBA\u76f8\u6bd4\uff0c\u5e94\u7528NMBA\u7ec4\u7684\u6b7b\u4ea1\u7387\u6ca1\u6709\u663e\u8457\u964d\u4f4e\uff0c\u76f8\u5bf9\u98ce\u9669\u4e3a0.80\uff0895% CI 0.57 ~ 1.04\uff09\uff0cP\u503c\u4e3a0.086\u3002<\/p>\n<p>\u4e24\u9879\u5927\u578b\u7814\u7a76\u4e4b\u95f4\u5b58\u5728\u4e00\u4e9b\u5dee\u5f02<sup>[153,157]<\/sup>\u3002\u4e0eACURASYS\u8bd5\u9a8c\u76f8\u6bd4\uff0cROSE\u8bd5\u9a8c\u4e2d\u4fef\u5367\u4f4d\u901a\u6c14\u8f83\u5c11\uff0815.8% vs 44.8%\uff09\u3002\u5728ROSE\u8bd5\u9a8c\u4e2d\uff0c\u5bf9\u7167\u7ec4\u7684\u9547\u9759\u76ee\u6807\u8f83\u6d45\uff0c\u8fd9\u53ef\u80fd\u4e0e\u5bf9\u7167\u7ec4\u4e25\u91cd\u5fc3\u8840\u7ba1\u4e8b\u4ef6\u53d1\u751f\u4f8b\u6570\u5c11\uff0814\u4f8bvs 4\u4f8b\uff0c\u5e72\u9884\u7ec4vs\u5bf9\u7167\u7ec4\uff09\u548c\u6b7b\u4ea1\u7387\u8f83\u4f4e\u6709\u5173\u3002ROSE\u8bd5\u9a8c\u4e2d\u4f7f\u7528\u4e86\u8f83\u9ad8\u7684PEEP\u7b56\u7565\uff0cNMBA\u5bf9\u6b7b\u4ea1\u7387\u7684\u5f71\u54cd\u5c1a\u4e0d\u660e\u786e\u3002\u540c\u6837\u6709\u8da3\u7684\u662f\uff0cROSE\u7814\u7a76\u4e2d\u5e72\u9884\u7ec4\u7684\u6b7b\u4ea1\u7387\u4e0eROSE\u4ee5\u53caACURASYS\u8bd5\u9a8c\u4e2d\u5bf9\u7167\u7ec4\u7684\u6b7b\u4ea1\u7387\u5747\u65e0\u5dee\u5f02\u3002\u8fd9\u4e00\u7ed3\u679c\u6709\u4e24\u79cd\u53ef\u80fd\u7684\u89e3\u91ca\u3002\u9996\u5148\uff0c\u4e24\u9879\u8bd5\u9a8c\u4e2d\u60a3\u8005\u7684\u4e25\u91cd\u7a0b\u5ea6\u53ef\u80fd\u76f8\u540c\uff0c\u4f46\u7531\u4e8e\u5e72\u9884\u63aa\u65bd\u5b58\u5728\u8f83\u5927\u533a\u522b\uff0c\u4f8b\u5982\uff0c\u836f\u7269\u6cbb\u7597\u65b9\u6cd5\u76f8\u540c\uff0c\u4f46PEEP\u65b9\u6848\u6216\u4fef\u5367\u4f4d\u901a\u6c14\u7b49\u901a\u6c14\u7b56\u7565\u4e0d\u540c\uff0c\u4f7f\u5f97ROSE\u8bd5\u9a8c\u4e2d\u7684\u5e72\u9884\u63aa\u65bd\u603b\u4f53\u4e0a\u65e0\u6548\u3002\u53e6\u4e00\u79cd\u53ef\u80fd\u662fACURASYS\u8bd5\u9a8c\u4e2d\u7684\u60a3\u8005\u75c5\u60c5\u8f83\u8f7b\uff0c\u4f46\u5bf9\u7167\u7ec4\uff08\u4e0eROSE\u8bd5\u9a8c\u76f8\u6bd4\uff09\u7684\u9547\u9759\u7a0b\u5ea6\u8f83\u6df1\uff0c\u5bfc\u81f4\u8be5\u7ec4\u6b7b\u4ea1\u7387\u589e\u9ad8\u3002<\/p>\n<p>\u76ee\u524d\u8fd8\u6ca1\u6709\u9488\u5bf9COVID-19\u5f15\u8d77\u7684ARDS\u60a3\u8005\u7684RCT\u8bd5\u9a8c\u3002\u53ea\u6709\u6765\u81ea\u975eCOVID\u7814\u7a76\u7684\u95f4\u63a5\u8bc1\u636e\u3002<\/p>\n<p>10.1.3 \u63a8\u8350\u610f\u89c18.1<\/p>\n<p>\u5efa\u8bae\u4e0d\u8981\u5e38\u89c4\u6301\u7eed\u8f93\u6ce8NMBA\u6765\u964d\u4f4e\u975eCOVID-19\u5f15\u8d77\u7684\u4e2d\u91cd\u5ea6ARDS\u60a3\u8005\u7684\u6b7b\u4ea1\u7387\u3002\uff08\u5f3a\u63a8\u8350\uff0c\u4e2d\u7b49\u8d28\u91cf\u8bc1\u636e\u3002\uff09<\/p>\n<p>\u65e0\u6cd5\u63a8\u8350\u6216\u53cd\u5bf9\u5e38\u89c4\u6301\u7eed\u8f93\u6ce8NMBA\u6765\u964d\u4f4eCOVID-19\u5f15\u8d77\u7684\u4e2d\u91cd\u5ea6ARDS\u60a3\u8005\u7684\u6b7b\u4ea1\u7387\u3002\uff08\u65e0\u63a8\u8350\uff1b\u65e0\u8bc1\u636e\u3002\uff09<\/p>\n<p>10.1.4 \u4e34\u5e8a\u5e94\u7528\u4e13\u5bb6\u610f\u89c1<\/p>\n<p>\u5728ACURASYS\u8bd5\u9a8c\u4e2d\uff0c\u672a\u5e94\u7528\u795e\u7ecf\u808c\u8089\u963b\u6ede\u5242\u7684\u4fef\u5367\u4f4d\u901a\u6c14\u4e0e\u66f4\u6df1\u7684\u9547\u9759\u76ee\u6807\u6709\u5173\uff0c\u8fd9\u53ef\u80fd\u662f\u5bf9\u7167\u7ec4\u6b7b\u4ea1\u7387\u589e\u52a0\u7684\u539f\u56e0\u4e4b\u4e00<sup>[153]<\/sup>\u3002\u7eb3\u5165\u7684\u56db\u9879\u7814\u7a76\uff0c\u4e0e\u5bf9\u7167\u7ec4\u76f8\u6bd4\uff0cNMBA\u5e94\u7528\u5bf9\u6c14\u80f8\u6709\u660e\u663e\u7684\u4fdd\u62a4\u4f5c\u7528<sup>[153-155, 157]<\/sup>\u3002\u8fd9\u4e00\u53d1\u73b0\u53ef\u80fd\u652f\u6301\u5bf9\u6709\u6c14\u80f8\u98ce\u9669\u7684\u60a3\u8005\u4f7f\u7528NMBA\u3002<\/p>\n<p>10.1.5 \u672a\u89e3\u51b3\u7684\u95ee\u9898\u548c\u7814\u7a76\u7a7a\u767d<\/p>\n<p>\u672a\u6765\u7684\u7814\u7a76\u5e94\u4f18\u5148\u8003\u8651\u5176\u4ed6\u7ed3\u5c40\uff0c\u5305\u62ec\u6210\u529f\u62d4\u7ba1\u3001\u518d\u63d2\u7ba1\u3001ICU\u83b7\u5f97\u6027\u808c\u65e0\u529b\u3001\u5065\u5eb7\u76f8\u5173\u751f\u6d3b\u8d28\u91cf\uff08Health related quality of life\uff0cHRQoL\uff09\uff0cNMBA\u7684\u51cf\u505c\u548cNMBA\u5728\u4fef\u5367\u4f4d\u4e2d\u7684\u5e94\u7528\u3002\u53e6\u4e00\u4e2a\u91cd\u8981\u7684\u7814\u7a76\u9886\u57df\u662f\u8bc6\u522b\u6709\u521b\u901a\u6c14ARDS\u60a3\u8005\u4e0e\u547c\u5438\u673a\u4e4b\u95f4\u7684\u4e0d\u826f\u76f8\u4e92\u4f5c\u7528\uff0c\u56e0\u4e3a\u8fd9\u4f1a\u5bf9\u4e34\u5e8a\u7ed3\u5c40\u4ea7\u751f\u6f5c\u5728\u5f71\u54cd\uff0c\u5e76\u53ef\u80fd\u6210\u4e3a\u4f7f\u7528NMBA\u7684\u9002\u5e94\u75c7\u3002\u60a3\u8005\u548c\u62a4\u7406\u4eba\u5458\u7684\u89c2\u70b9\u5e94\u6210\u4e3a\u786e\u5b9a\u672a\u6765\u7814\u7a76\u95ee\u9898\u548c\u7ed3\u679c\u7684\u6838\u5fc3\u3002<\/p>\n<p>11 \u9886\u57df 9\uff1a\u4f53\u5916\u751f\u547d\u652f\u6301<\/p>\n<p>11.1 \u95ee\u98989.1\uff1a\u5728\u4e25\u91cdARDS\u6216COVID-19\u7684\u6210\u5e74\u60a3\u8005\u4e2d\uff0c\u4e0e\u4f20\u7edf\u673a\u68b0\u901a\u6c14\u6cbb\u7597\u76f8\u6bd4\uff0c\u9759\u8109\uff0d\u9759\u8109\u4f53\u5916\u819c\u6c27\u5408\u662f\u5426\u80fd\u6539\u5584\u9884\u540e\uff1f<\/p>\n<p>11.1.1 \u80cc\u666f<\/p>\n<p>\u9759\u8109\uff0d\u9759\u8109\u4f53\u5916\u819c\u6c27\u5408\uff08veno\u2011venous extracorporeal membrane oxygenation\uff0cVV-ECMO\uff09\u7528\u4e8e\u652f\u6301\u6216\u66ff\u4ee3\u6c14\u4f53\u4ea4\u6362\u3002\u5728ECMO\u671f\u95f4\uff0c\u8840\u6db2\u6d41\u7ecf\u201c\u819c\u80ba\u201d\u4ee5\u5f25\u6563\u5f62\u5f0f\u8fdb\u884c\u6c27\u6c14\u548c\u4e8c\u6c27\u5316\u78b3\u7684\u4ea4\u6362\u3002\u6280\u672f\u65b9\u9762\u7684\u6539\u8fdb\u4f7f\u6c14\u4f53\u4ea4\u6362\u5f97\u5230\u6539\u5584\uff0c\u51cf\u5c11\u4e86\u5e76\u53d1\u75c7\u7684\u53d1\u751f<sup>[159]<\/sup>\u3002ECMO\u5df2\u7528\u4e8e\u4e25\u91cdARDS\u60a3\u8005\uff0c\u5305\u62ec\u8fd1\u4e9b\u5e74\u51fa\u73b0\u7684COVID-19\u60a3\u8005\u3002\u7ecf\u9a8c\u4e30\u5bcc\u7684\u4e2d\u5fc3\u62a5\u9053\u63a5\u53d7ECMO\u6cbb\u7597\u7684\u60a3\u8005\u9884\u540e\u66f4\u4f73<sup>[160]<\/sup>\u3002\u5728\u5e94\u7528ECMO\u671f\u95f4\u9700\u8981\u5168\u65b9\u4f4d\u7684\u7ec4\u5408\u6cbb\u7597\u63aa\u65bd\uff0c\u800c\u975e\u5355\u72ec\u5e94\u7528ECMO\u6cbb\u7597\uff0c\u624d\u80fd\u591f\u6539\u5584\u5e94\u7528ECMO\u60a3\u8005\u7684\u9884\u540e\uff0c\u8fd9\u4e9b\u63aa\u65bd\u5305\u62ec\u80ba\u4fdd\u62a4\u6027\u901a\u6c14\u548c\u4fef\u5367\u4f4d\u3002<\/p>\n<p>11.1.2 \u8bc1\u636e\u6982\u8ff0<\/p>\n<p>\u4e8c\u9879RCT\u4e3a\u8fd9\u4e9b\u63a8\u8350\u610f\u89c1\u63d0\u4f9b\u4e86\u4f9d\u636e\u3002CESAR\u8bd5\u9a8c\u7eb3\u5165180\u4f8bARDS\u60a3\u8005\uff0cEOLIA\u8bd5\u9a8c\u7eb3\u5165249\u4f8bARDS\u60a3\u8005\u3002EOLIA\u7eb3\u5165\u6807\u51c6\u5982\u4e0b\uff1a\u547c\u5438\u9891\u7387\u589e\u52a0\u81f335\u6b21\/\u5206\u548c\u4f18\u5316\u673a\u68b0\u901a\u6c14\u8bbe\u7f6e\u7ef4\u6301Pplat\u226432 cmH2O\u7684\u524d\u63d0\u4e0b\uff0c\u4ecd\u51fa\u73b0PaO2\/FiO2\uff1c50 mmHg\u6301\u7eed\u65f6\u95f4\uff1e3\u5c0f\u65f6\uff0c\u6216PaO2\/FiO2\uff1c80 mmHg\u6301\u7eed\u65f6\u95f4\uff1e6\u5c0f\u65f6\uff0c\u6216pH\uff1c7.25\u4e14PaCO2 \u2265 60 mmHg\u6301\u7eed\u65f6\u95f4\uff1e6\u5c0f\u65f6<sup>[162]<\/sup>\u3002<\/p>\n<p>\u8fd9\u4e9b\u7814\u7a76\u7eb3\u5165\u4e86\u5404\u79cd\u539f\u56e0\u5bfc\u81f4\u7684\u91cd\u5ea6ARDS\u60a3\u8005\uff08\u5e73\u5747PaO2\/FiO2\u503c\u7ea6\u4e3a75 mmHg\uff09\uff0c\u4e14\u8fd9\u4e8c\u9879\u7814\u7a76\u90fd\u662f\u5728COVID-19\u5927\u6d41\u884c\u4e4b\u524d\u5f00\u5c55\u7684\u3002EOLIA\u548cCESAR\u8bd5\u9a8c\u88ab\u8ba4\u4e3a\u5728\u4e34\u5e8a\u4e0a\u5177\u6709\u8db3\u591f\u7684\u540c\u8d28\u6027\uff0c\u53ef\u4ee5\u8fdb\u884cMeta\u5206\u6790\u3002\u6309\u7167RoB2\u5de5\u5177\uff0cCESAR\u8bd5\u9a8c\u5b58\u5728\u8f83\u9ad8\u7684\u504f\u501a\u98ce\u9669\uff0c\u56e0\u4e3a\u5e72\u9884\u7ec4\u4e2d\u7ea6\u6709\u56db\u5206\u4e4b\u4e00\u7684\u60a3\u8005\u672a\u63a5\u53d7ECMO\u6cbb\u7597\u3002<\/p>\n<p>Meta\u5206\u6790\u53d1\u73b0\uff0c\u4e0e\u4f20\u7edf\u673a\u68b0\u901a\u6c14\u76f8\u6bd4\uff0c\u63a5\u53d7VV-ECMO\u7684\u60a3\u800560\u5929\u6b7b\u4ea1\u7387\u663e\u8457\u964d\u4f4e\uff08RR 0.72\uff1b95% CI 0.57 ~ 0.91\uff1b\u4e2d\u7b49\u4fe1\u5ea6\uff09\u3002\u8fd9\u79cd\u4fdd\u62a4\u4f5c\u7528\u572890\u5929\u6b7b\u4ea1\u7387\u4ee5\u53ca60\u5929\u6b7b\u4ea1\u7387\u548c\u6cbb\u7597\u5931\u8d25\u7684\u7efc\u5408\u7ed3\u5c40\u4e2d\u662f\u4e00\u81f4\u7684\u3002\u5305\u62ecEOLIA\u7814\u7a76\u7684\u8d1d\u53f6\u65af\u4e8b\u540e\u5206\u6790\u5728\u5185\u7684\u89c2\u5bdf\u6027\u7814\u7a76<sup>[163]<\/sup>\uff0c\u5927\u591a\u8bc1\u5b9e\u4e86ECMO\u7684\u4fdd\u62a4\u4f5c\u7528<sup>[163-171]<\/sup>\u3002\u7136\u800c\uff0c\u4ed6\u4eec\u63d0\u4f9b\u7684\u6781\u4f4e\u8d28\u91cf\u8bc1\u636e\u5e76\u6ca1\u6709\u5bf9\u4e24\u9879\u968f\u673a\u8bd5\u9a8c\u7684Meta\u5206\u6790\u5f97\u51fa\u7684\u4e2d\u7b49\u8d28\u91cf\u8bc1\u636e\u5e26\u6765\u5b9e\u8d28\u6027\u7684\u5f71\u54cd\u3002\u7531\u4e8e\u65b9\u6cd5\u5b66\u7684\u9650\u5236\uff0c\u89c2\u5bdf\u6027\u7814\u7a76\u6ca1\u6709\u7eb3\u5165\u5230Meta\u5206\u6790\u4e2d\u3002<\/p>\n<p>\u5728COVID-19\u60a3\u8005\u4e2d\u672a\u68c0\u7d22\u5230\u76f8\u5173RCT\u3002\u7531\u4e8e\u7f3a\u4e4f\u76f4\u63a5\u8bc1\u636e\uff0c\u5173\u4e8eECMO\u5728COVID-19\u60a3\u8005\u4e2d\u7684\u8bc1\u636e\u7b49\u7ea7\u88ab\u964d\u7ea7\u4e3a\u5f31\u63a8\u8350\u3002COVID-19\u7684\u89c2\u5bdf\u6027\u7814\u7a76\u5927\u591a\u663e\u793aECMO\u5bf9\u77ed\u671f\u751f\u5b58\u7684\u4fdd\u62a4\u4f5c\u7528<sup>[167, 169-171]<\/sup>\u3002\u7531\u4e8e\u65b9\u6cd5\u5b66\u7684\u9650\u5236\uff0c\u672c\u6587\u5e76\u6ca1\u6709\u5c06\u89c2\u5bdf\u6027\u7814\u7a76\u7eb3\u5165\u5230Meta\u5206\u6790\u4e2d\u3002<\/p>\n<p>ECMO\u7684\u4f7f\u7528\u4e0e\u4e25\u91cd\u51fa\u8840\u98ce\u9669\u76f8\u5173\u3002\u636e\u62a5\u9053\u5728EOLIA\u8bd5\u9a8c\u7684\u5e72\u9884\u7ec4\u4e2d\uff0c\u5bfc\u81f4\u8f93\u8840\u7684\u51fa\u8840\u4e8b\u4ef6\u53d1\u751f\u7387\u66f4\u9ad8\uff0846%\uff1a28%\uff09\uff0c\u4e25\u91cd\u8840\u5c0f\u677f\u51cf\u5c11\u75c7\u53d1\u751f\u7387\u4e5f\u66f4\u9ad8\uff0827%\uff1a16%\uff09\u3002\u7136\u800c\uff0c\u5e72\u9884\u7ec4\u4e2d\u7f3a\u8840\u6027\u5352\u4e2d\u53d1\u751f\u7387\u8f83\u4f4e\uff08\u7edd\u5bf9\u98ce\u9669\u964d\u4f4e\u73875%\uff1b95% CI\uff0c2% ~ 10%\uff09\uff0c\u51fa\u8840\u6027\u5352\u4e2d\u65e0\u5dee\u5f02<sup>[162]<\/sup>\u3002<\/p>\n<p>11.1.3 \u63a8\u8350\u610f\u89c19.1<\/p>\n<p>\u63a8\u8350\u6839\u636eEOLIA\u8bd5\u9a8c\u6807\u51c6\uff0c\u5bf9\u975eCOVID-19\u5f15\u8d77\u7684\u91cd\u5ea6ARDS\u60a3\u8005\u5e94\u5728\u7b26\u5408\u89c4\u5b9a\u6807\u51c6\u7684ECMO\u4e2d\u5fc3\u63a5\u53d7ECMO\u6cbb\u7597\uff0c\u5e76\u9075\u5faa\u4e0eEOLIA\u8bd5\u9a8c\u4e2d\u7c7b\u4f3c\u7684\u7ba1\u7406\u7b56\u7565\u3002\uff08\u5f3a\u63a8\u8350\uff0c\u4e2d\u7b49\u8d28\u91cf\u8bc1\u636e\u3002\uff09<\/p>\n<p>\u6b64\u63a8\u8350\u610f\u89c1\u4e5f\u9002\u7528\u4e8eCOVID-19\u5f15\u8d77\u7684\u91cd\u5ea6ARDS\u60a3\u8005\u3002\uff08\u5f3a\u63a8\u8350\uff1b\u4f4e\u8d28\u91cf\u95f4\u63a5\u8bc1\u636e\u3002\uff09<\/p>\n<p>11.1.4 \u4e34\u5e8a\u5e94\u7528\u4e13\u5bb6\u610f\u89c1<\/p>\n<p>ECMO\u7684\u5b9e\u65bd\u9700\u8981\u5177\u6709\u8be5\u6280\u672f\u4e13\u4e1a\u77e5\u8bc6\u7684\u56e2\u961f\u6765\u5b89\u5168\u6709\u6548\u8fdb\u884c\u3002\u968f\u7740\u975eECMO\u4e2d\u5fc3\u60a3\u8005\u7684\u96c6\u4e2d\u5316\uff0c\u5bf9\u6709\u80fd\u529b\u8f6c\u8fd0ECMO\u60a3\u8005\u7684ECMO\u56e2\u961f\uff08\u79fb\u52a8ECMO\uff09\u7684\u9700\u6c42\u589e\u9ad8\u3002\u800c\u63d0\u4f9b\u8fd9\u6837\u7684\u670d\u52a1\u9700\u8981\u8d44\u6e90\u548c\u6280\u80fd\u3002<\/p>\n<p>\u5173\u4e8eECMO\u7684RCT\u96be\u4ee5\u5728COVID-19\u6240\u81f4\u91cd\u5ea6ARDS\u60a3\u8005\u4e2d\u8fdb\u884c\u3002\u5373\u4f7f\u5728\u7ecf\u9a8c\u4e30\u5bcc\u7684\u4e2d\u5fc3\u8fdb\u884cECMO\u6cbb\u7597\uff0c\u7531COVID-19\u5f15\u8d77\u7684ARDS\u60a3\u800590\u5929\u5185\u7684\u65e9\u671f\u6b7b\u4ea1\u7387\u4e0e\u975eCOVID-19\u7684ARDS\u60a3\u8005\u76f8\u4f3c\u3002\u867d\u7136\u5f62\u6210\u8be5\u63a8\u8350\u610f\u89c1\u7684\u4e24\u9879RCT\u7814\u7a76\u672a\u5305\u542bCOVID-19\u60a3\u8005\uff0c\u4f46\u4ece\u751f\u7269\u5b66\u65b9\u9762\u7406\u89e3\uff0c\u975eCOVID-19\u548cCOVID-19\u5f15\u8d77\u7684ARDS\u5e94\u7528ECMO\u6cbb\u7597\u7684\u6548\u679c\u7c7b\u4f3c\u3002\u7136\u800c\uff0c\u867d\u7136ECMO\u5728\u5176\u4e2d\u7684\u8d21\u732e\u5c1a\u4e0d\u660e\u786e\uff0c\u4f46\u662f\u4e25\u91cd\u548c\u957f\u671f\u591a\u7ef4\u5ea6\u6b8b\u75be\u7387\u5728COVID-19\u60a3\u8005\u4e2d\u6bd4\u91cd\u5ea6ARDS\u60a3\u8005\u4e2d\u66f4\u9ad8\u3002<\/p>\n<p>11.1.5 \u672a\u89e3\u51b3\u7684\u95ee\u9898\u548c\u7814\u7a76\u7a7a\u767d<\/p>\n<p>\u672a\u6765\u7684\u7814\u7a76\u5e94\u4f18\u5148\u8003\u8651\u60a3\u8005\u548c\u5bb6\u5c5e\u7b49\u591a\u65b9\u9762\u7684\u957f\u671f\u7ed3\u5c40\uff0c\u5e76\u660e\u786eECMO\u76f8\u5173\u7684\u7279\u5f02\u6027\u75be\u75c5\u3002\u60a3\u8005\u548c\u533b\u62a4\u4eba\u5458\u7684\u89c2\u70b9\u5747\u5e94\u8fdb\u884c\u6c47\u603b\u4ee5\u786e\u5b9a\u672a\u6765\u7684\u7814\u7a76\u65b9\u5411\u548c\u7ed3\u5c40\u6307\u6807\u3002<\/p>\n<p>11.2 \u95ee\u98989.2\uff1a\u5728\u6210\u5e74ARDS\u60a3\u8005\u4e2d\uff0c\u4e0e\u5e38\u89c4\u673a\u68b0\u901a\u6c14\u6cbb\u7597\u76f8\u6bd4\uff0c\u4f53\u5916\u4e8c\u6c27\u5316\u78b3\u6e05\u9664\u662f\u5426\u80fd\u6539\u5584\u9884\u540e\uff1f<\/p>\n<p>11.2.1 \u80cc\u666f<\/p>\n<p>\u4f53\u5916\u4e8c\u6c27\u5316\u78b3\u53bb\u9664\uff08extracorporeal carbon dioxide removal\uff0cECCO2R\uff09\u65e8\u5728\u901a\u8fc7\u4f53\u5916\u5faa\u73af\u6e05\u9664CO2\u3002\u7531\u4e8e\u6e05\u9664CO2\u6240\u9700\u7684\u8840\u6d41\u901f\u8fdc\u4f4e\u4e8e\u5b9e\u73b0\u5145\u5206\u6c27\u5408\u6240\u9700\u7684\u8840\u6d41\u901f\uff0c\u56e0\u6b64\u4e0eECMO\u76f8\u6bd4\uff0cECCO2R\u4f7f\u7528\u66f4\u4f4e\u7684\u4f53\u5916\u8840\u6d41\u901f\uff08\u901a\u5e38\u5728200\u81f31500 mL\/min\u4e4b\u95f4\uff09\u3002\u867d\u7136ECCO2R\u901a\u5e38\u662f\u6839\u636e\u4f53\u5916\u5faa\u73af\u7684\u8840\u6d41\u6d41\u901f\u51b3\u5b9a\uff0c\u4f46\u4e5f\u6709\u4eba\u5efa\u8baeECCO2R\u5e94\u8be5\u6839\u636e\u4e34\u5e8a\u533b\u751f\u7684\u76ee\u6807\u7528\u9014\u6765\u51b3\u5b9a\u3002ECCO2R\u5728ARDS\u4e2d\u7684\u4e3b\u8981\u76ee\u7684\u662f\u51cf\u5c11\u975e\u4fdd\u62a4\u6027\u673a\u68b0\u901a\u6c14\u7684\u5b9e\u65bd\u3002<\/p>\n<p>11.2.2 \u8bc1\u636e\u6982\u8ff0<\/p>\n<p>\u5173\u4e8eECCO2R\u610f\u89c1\u7684\u57fa\u7840\u6e90\u4e8e\u4e8c\u9879RCT\u3002Xtravent\u8bd5\u9a8c\u7eb3\u5165\u4e8679\u4f8bPaO2\/FiO2\uff1c200 mmHg\u7684ARDS\u60a3\u8005\uff0c\u8fd9\u4e9b\u60a3\u8005\u91c7\u7528\u201c\u65e0\u6cf5\u201d\u52a8\u9759\u8109\uff08\u7ea61-2L\/min\uff09\u901a\u8def\u8fdb\u884cCO2\u6e05\u9664<sup>[173]<\/sup>\u3002REST\u8bd5\u9a8c\u7eb3\u5165412\u540d\u4f4e\u6c27\u8840\u75c7\u60a3\u8005\uff08PaO2\/FiO2\uff1c150 mmHg\uff09\uff0c\u8fd9\u90e8\u5206\u60a3\u8005\u91c7\u7528\u9759\u8109\uff0d\u9759\u8109\u4f4e\u6d41\u91cf\uff08\u7ea6450 ml\/min\uff09\u901a\u8def\u6e05\u9664CO2\u3002\u4e0a\u8ff0\u4e24\u9879\u7814\u7a76\u4e2d\u5927\u591a\u6570\u662fARDS\u60a3\u8005\uff08\u7ea660%\uff09<sup>[174]<\/sup>\u3002Xtravent\u548cREST\u8bd5\u9a8c\u5728\u4e34\u5e8a\u4e0a\u88ab\u8ba4\u4e3a\u5177\u6709\u8db3\u591f\u7684\u540c\u8d28\u6027\uff0c\u53ef\u4ee5\u8fdb\u884cMeta\u5206\u6790\u3002\u6839\u636eRoB2\u8bc4\u4f30\uff0cXtravent\u8bd5\u9a8c\u548cREST\u8bd5\u9a8c\u90fd\u5b58\u5728\u65b9\u6cd5\u5b66\u4e0a\u7684\u4e00\u4e9b\u95ee\u9898\u3002\u5728\u6bd4\u8f83\u8131\u673a\u65f6\u95f4\u65f6\uff0c\u7531\u4e8e\u7f3a\u4e4f\u76f2\u6cd5\uff0c\u5b58\u5728\u65b9\u6cd5\u5b66\u7f3a\u9677\u3002<\/p>\n<p>\u5728\u8fd9\u4e8c\u9879\u8bd5\u9a8c\u7684Meta\u5206\u6790\u4e2d\uff0cECCO2R\u5e76\u6ca1\u6709\u964d\u4f4e\u6b7b\u4ea1\u7387\uff08RR 1.03\uff1b95% CI 0.82-1.3\uff1b\u9ad8\u7f6e\u4fe1\u5ea6\uff09\u3002\u5728\u63a5\u53d7ECCO2R\u6cbb\u7597\u7684\u60a3\u8005\u4e2d\uff0c28\u5929\u65e0\u673a\u68b0\u901a\u6c14\u5929\u6570\u66f4\u5c11\uff08\u5e73\u5747\u5dee-1.21\uff1b95% CI 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\u82d7\u660e\u6708 &hellip; <a href=\"http:\/\/zydq.1006ss.com\/?p=37175\">\u7ee7\u7eed\u9605\u8bfb <span class=\"meta-nav\">&rarr;<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[70],"tags":[],"class_list":["post-37175","post","type-post","status-publish","format-standard","hentry","category-70"],"_links":{"self":[{"href":"http:\/\/zydq.1006ss.com\/index.php?rest_route=\/wp\/v2\/posts\/37175","targetHints":{"allow":["GET"]}}],"collection":[{"href":"http:\/\/zydq.1006ss.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/zydq.1006ss.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/zydq.1006ss.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/zydq.1006ss.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=37175"}],"version-history":[{"count":0,"href":"http:\/\/zydq.1006ss.com\/index.php?rest_route=\/wp\/v2\/posts\/37175\/revisions"}],"wp:attachment":[{"href":"http:\/\/zydq.1006ss.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=37175"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/zydq.1006ss.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=37175"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/zydq.1006ss.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=37175"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}