Department of Intensive Care Medicine, Bern University Hospital and University of Bern (Inselspital), Bern, Switzerland.
Curr Opin Crit Care. 2010 Apr;16(2):165-8. doi: 10.1097/MCC.0b013e3283374b1c.
Mechanical ventilation is a cornerstone of ICU treatment. Because of its interaction with blood flow and intra-abdominal pressure, mechanical ventilation has the potential to alter hepato-splanchnic perfusion, abdominal organ function and thereby outcome of the most critically ill patients.
Mechanical ventilation can alter hepato-splanchnic perfusion, but the effects are minimal (with moderate inspiratory pressures, tidal volumes, and positive end-expiratory pressure levels) or variable (with high ones). Routine nursing procedures may cause repeated episodes of inadequate hepato-splanchnic perfusion in critically ill patients, but an association between perfusion and multiple organ dysfunction cannot yet be determined. Clinical research continues to be challenging as a result of difficulties in measuring hepato-splanchnic blood flow at the bedside.
Mechanical ventilation and attempts to improve oxygenation such as intratracheal suctioning and recruitment maneuvers, may have harmful consequences in patients with already limited cardiovascular reserves or deteriorated intestinal perfusion. Due to difficulties in assessing hepato-splanchnic perfusion, such effects are often not detected.
机械通气是 ICU 治疗的基石。由于其与血流和腹腔内压的相互作用，机械通气有可能改变肝-肠灌注，从而影响到最危重患者的器官功能和预后。
机械通气可以改变肝-肠灌注，但影响很小（中等吸气压力、潮气量和呼气末正压水平）或多变（高压力时）。常规护理程序可能导致危重患者反复出现肝-肠灌注不足，但目前尚不能确定灌注与多器官功能障碍之间的关系。由于难以在床边测量肝-肠血流，临床研究仍然具有挑战性。
机械通气和试图改善氧合的措施，如气管内吸引和复张手法，可能对已经存在心血管储备有限或肠道灌注恶化的患者产生有害影响。由于难以评估肝-肠灌注，这些影响通常无法被发现。
