Kuz'kov V V, Suborov E V, Fot E V, Rodionova L N, Sokolova M M, Lebedinskiy K M, Kirov M Yu
Anesteziol Reanimatol. 2016 Nov;61(6):461-468.
In parallel with increasing number, duration and extensiveness of surgical interventions, postoperative pulmonary complications (PPC) and acute respiratory distress syndrome (ARDS) remain the major challenges for anesthesiologists and surgical ICU physicians. PPC and ARDS have multiple risk factors that should be recognized early and modifed within the appropriate "time window ". Today we possess reliable models (ARISCAT LIPS, EALI etc.) to predict the risk of non-infectious (hypoxemia, atelectases, pleuritis) and infectious PPC (postoperative pneumonia). The bundle of primaty and secondary prevention strategies is available and can be implemented both in the perioperative settings and in the ICU in patients at risk of PPC and ARDS. The prophylactic approach is realized as a bundle of strategies presented in "Checklist for Lung Injury Prevention" (CLIP). The bundle of preventive protective ventilation comprises low tidal volume (6-8 ml/kg predicted body weight), control of respiratory plateau and driving pressures, moderate positive end- expiratory pressure (PEEPS cm H20), and minimal safe level of inspired oxygen fraction. Pharmacological prevention ofARDS has shown quite satisfactory experimental results and needs further clinicql investigations.
随着外科手术干预的数量、持续时间和范围不断增加，术后肺部并发症（PPC）和急性呼吸窘迫综合征（ARDS）仍然是麻醉医生和外科重症监护病房医生面临的主要挑战。PPC和ARDS有多种风险因素，应尽早识别并在适当的“时间窗”内加以调整。如今，我们拥有可靠的模型（ARISCAT、LIPS、EALI等）来预测非感染性（低氧血症、肺不张、胸膜炎）和感染性PPC（术后肺炎）的风险。一级和二级预防策略组合是可用的，并且可以在围手术期以及有PPC和ARDS风险的ICU患者中实施。预防性方法通过《肺损伤预防检查表》（CLIP）中列出的一系列策略来实现。预防性保护性通气策略包括低潮气量（6 - 8 ml/kg预计体重）、控制呼吸平台压和驱动压、适度的呼气末正压（PEEP 5 - 8 cm H20）以及最低安全水平的吸入氧分数。ARDS的药物预防已显示出相当令人满意的实验结果，需要进一步的临床研究。
