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血管外肺水(EVLW)增加是急性呼吸窘迫综合征(ARDS)重要的病理生理特征。实施小潮气量肺保护性通气策略可以显著改善ARDS患者的预后,但是实施小潮气量通气不利于塌陷肺泡的复张。因此,有必要在肺保护的基础上联合使用肺复张进行治疗。肺复张是指在机械通气过程中,施加高呼吸道压力进行短暂肺膨胀促使塌陷肺泡复张,起到减少分流、改善氧合、减少炎性介质产生和呼吸机相关性肺损伤的作用。目前多数研究认为肺复张可以降低EVLW,但是肺复张如何影响EVLW仍有一定争议,该文对此研究进展进行综述。
Increased extravascular lung water (EVLW) is an important pathophysiologic feature of acute respiratory distress syndrome (ARDS). The implementation of small tidal volume protective ventilation strategy can significantly improve the prognosis of patients with ARDS, but the implementation of small tidal volume ventilation is not conducive to collapse of alveolar remodeling. Therefore, it is necessary to use pulmonary reexpansion in combination with pulmonary protection. Pulmonary reclaim refers to the role of mechanical ventilation in the application of high respiratory pressure for transient pulmonary expansion to promote collapse of alveolar remodeling, play to reduce shunt, improve oxygenation, reduce the production of inflammatory mediators and ventilator-associated lung injury. At present, most studies think that pulmonary recanalization can reduce EVLW, but there is still some controversy about how pulmonary reclamation affects EVLW. This article reviews the research progress.