·标准与指南·

    机械通气临床应用指南(2006)

    中华医学会重症医学分会

    Pract ical guidel ines for mechan ical ven t ilat ion (2006) S ociety of C rit ical CareM ed icine, Ch inese M ed ical

    A ssociat ion

    Corresp ond ing au thors: Q IN Y ing 2 z h i (D ep artm ent of Intensive Care U nit, the T h ird Central H osp ital,T ianj in 210009, Ch ina . Em ail: y z hqin@y ahoo . com. cn ) and L IU D a2 w ei (D ep artm ent of C rit ical Care

    M ed icine, P ek ing U nion M ed ical Col leg e H osp ital, Ch inese M ed ical S cience A cad emy , B eij ing 100730,Ch ina . Em ail: dw l iu@m edm ail . com. cn or dw l iu@p um ch. cn)

    【Abstract】 W ith the expanding understanding of basic know ledge concerning resp irato ry funct ion and

    techno logy of resp irato r, mechanical vent ilat ion has become an impo r tant intervent ional armamentar ium to

    imp rove gas exchange and decrease resp irato ry wo rk . It is one of the impo r tant means to enhance oxygen

    delivery, p ro tect the lung, and resto re homeo stasis in the t reatment ofmult ip le o rgan dysfunct ion syndrome .

    The p rogression in medical sciences and increasing data per taining to evidence - based medicine have also

    render the use of mechanical vent ilat ion standardized w ith mo re app rop r iate indicat ion . U nder the

    afo rement ioned condit ions, it seem s to be essent ial that the indicat ions and the operat ion and manipulat ion of

    the soph ist icated vent ilato r should be standardized in the care of cr it ically ill pat ients . A t the same t ime,accumulat ion of clinical exper iences in recent years w ith abundant relevant data as a result of mult i- center

    studies have furnished h igh ly valuable info rmat ion to accomp lish th is effo r t . Based on evidenced- base data,the Ch inese Society of Cr it ical CareM edicine (Ch ineseM edicalA ssociat ion) held a consensus conference to

    draf t a guideline fo r the recommendat ion of mechanical vent ilat ion to catego r ize all the info rmat ion gathered

    f rom the literature into f ive grades f rom A to E, w ith A being the h ighest, acco rding to a modif ied Delph i

    cr iter ia, w h ich w ere adop ted by the Internat ional Sep sis Fo rum held in 2001. A f ter fur ther nat ionw ide

    inquir ies and conscient ious discussions, th is guideline has been draf ted pending fur ther addit ion and

    co r rect ion . Th is guideline ch ief ly covers the fo llow ing aspects: the cho ice of mechanical vent ilat ion fo r

    cr it ically ill pat ients, the aim and indicat ion of mechanical vent ilat ion, non - invasive po sit ive p ressure

    vent ilat ion, regulat ion of modes and set t ings of the vent ilato r, etc . W ith imp lementat ion of the guideline, it

    is hoped that the clinical use of mechanical vent ilat ion in the cr it ically ill pat ients w ill be mo re o r less

    standardized . The guideline w ill be updated w hen new know ledge is available .

    器官功能支持是重症医学临床实践的重要内容之一。机

    械通气开始仅作为肺脏通气功能支持治疗手段, 目前已发展

    到涉及气体交换、呼吸做功、肺损伤、胸腔内器官压力及容积

    环境、循环功能等多方面的重要干预措施, 并主要通过提高

    氧输送(DO2)、保护肺脏、改善内环境等途径, 成为治疗多器

    官功能障碍综合征(MODS)的重要手段。不同疾病对机械通

    气具有特异性的要求, 医学理论的发展及循证医学数据的增

    加对呼吸机临床应用提出了更加明确的针对性和规范性。中

    华医学会重症医学分会以循证医学证据为基础, 采用国际通

    用方法, 广泛征求意见和建议, 反复认真讨论, 达成关于机械

    通气临床应用方面的共识, 以期对危重患者的机械通气临床

    应用进行规范。中华医学会重症医学分会今后还将根据循证

    医学证据的发展及新的共识对《机械通气临床应用指南》进

    行更新。指南中的推荐意见依据2001 年ISF 提出的Delph i分

    级标准, 所涉及的文献按照研究方法和结果分成5 个层次, 推

    荐意见的推荐级别按照Delph i分级分为A～E 级, 其中A 级

    为最高 ......