Morales-Quinteros Luis, Camprubí-Rimblas Marta, Bringué Josep, Bos Lieuwe D, Schultz Marcus J, Artigas Antonio
Intensive Care Unit, Hospital Universitario Sagrado Corazón, Carrer de Viladomat, 288, 08029, Barcelona, Spain.
Department of Medicine, Universitat Autònoma de Barcelona, Bellatera, Spain.
Intensive Care Med Exp. 2019 Jul 25;7(Suppl 1):39. doi: 10.1186/s40635-019-0239-0.
The biological effects and physiological consequences of hypercapnia are increasingly understood. The literature on hypercapnia is confusing, and at times contradictory. On the one hand, it may have protective effects through attenuation of pulmonary inflammation and oxidative stress. On the other hand, it may also have deleterious effects through inhibition of alveolar wound repair, reabsorption of alveolar fluid, and alveolar cell proliferation. Besides, hypercapnia has meaningful effects on lung physiology such as airway resistance, lung oxygenation, diaphragm function, and pulmonary vascular tree.In acute respiratory distress syndrome, lung-protective ventilation strategies using low tidal volume and low airway pressure are strongly advocated as these have strong potential to improve outcome. These strategies may come at a price of hypercapnia and hypercapnic acidosis. One approach is to accept it (permissive hypercapnia); another approach is to treat it through extracorporeal means. At present, it remains uncertain what the best approach is.
高碳酸血症的生物学效应和生理后果正日益为人所了解。关于高碳酸血症的文献令人困惑，且有时相互矛盾。一方面，它可能通过减轻肺部炎症和氧化应激而具有保护作用。另一方面，它也可能通过抑制肺泡伤口修复、肺泡液重吸收和肺泡细胞增殖而产生有害影响。此外，高碳酸血症对肺生理功能，如气道阻力、肺氧合、膈肌功能和肺血管树，具有重要影响。在急性呼吸窘迫综合征中，强烈提倡采用低潮气量和低气道压力的肺保护性通气策略，因为这些策略具有显著改善预后的潜力。这些策略可能会以高碳酸血症和高碳酸性酸中毒为代价。一种方法是接受它（允许性高碳酸血症）；另一种方法是通过体外手段进行治疗。目前，最佳方法仍不确定。
