Liu Y Q
Department of Respiratory and Critical Care Medicine, Respiratory Medical Center of Fujian Province, the Second Affiliated Hospital, Fujian Medical University, Quanzhou, Fujian 362000, China.
Zhonghua Wei Chang Wai Ke Za Zhi. 2020 Nov 25;23(11):1032-1035. doi: 10.3760/cma.j.cn.441530-20200810-00469.
Lung protection is important in the treatment of patients with intra-abdominal infection (IAI). This article focuses on the management strategy of lung protection in IAI patients. In the implementation of IAI individual respiratory protection, good humidification and chest physical therapy, nutritional support, strict balloon management, keeping a semi-supine position, and reducing the duration and depth of analgesia and sedation are helpful to maintain effective coughing capacity and prevent silent aspiration. It is also necessary to prevent ventilator-associated lung injury in mechanical ventilation, and implement strategies of small tidal volume, limited platform pressure, diaphragmatic protection and right heart protection ventilation in acute respiratory distress syndrome (ARDS). Respiratory mechanical indicators, including airway resistance, respiratory compliance, maximum inspiratory pressure (MIP), and airway closure pressure (P0.1) can be used in IAI patients receiving mechanical ventilation for individualized assessment and monitoring of respiratory functional status. Patients with IAI who have not been treated with mechanical ventilation can use simplified bedside lung function indicators, including forced vital capacity of inhalation and exhalation, maximum inspiratory pressure and exhalation pressure, as well as volume and rate of 1s. In pulmonary rehabilitation, the protection technique of the seven-word principle of humidification, turning, patting, coughing, expansion, blowing and mobilization are implemented.
肺部保护在腹腔内感染(IAI)患者的治疗中至关重要。本文重点关注IAI患者肺部保护的管理策略。在实施IAI个体呼吸保护时,良好的湿化和胸部物理治疗、营养支持、严格的气囊管理、保持半卧位以及减少镇痛和镇静的持续时间和深度,有助于维持有效的咳嗽能力并预防隐性误吸。在机械通气中预防呼吸机相关性肺损伤也很有必要,在急性呼吸窘迫综合征(ARDS)中实施小潮气量、限制平台压、膈肌保护和右心保护通气策略。呼吸力学指标,包括气道阻力、呼吸顺应性、最大吸气压力(MIP)和气道闭合压(P0.1),可用于接受机械通气的IAI患者,以个体化评估和监测呼吸功能状态。未接受机械通气的IAI患者可使用简化的床边肺功能指标,包括吸气和呼气用力肺活量、最大吸气压力和呼气压力,以及1秒量和速率。在肺康复中,实施湿化、翻身、拍背、咳嗽、扩胸、吹气球和活动这七字原则的保护技术。