允许性高碳酸血症在预防呼吸机相关性肺损伤中的作用_West China Medical Journal

Authors：

岳建明 ,  刘斌

四川大学华西医院麻醉手术中心（成都 610041）;

Corresponding author：

刘斌, Email: liubinhx@foxmail.com

Keywords：

机械通气; 呼吸机相关性肺损伤; 保护性肺通气策略; 允许性高碳酸血症

DOI：

10.7507/1002-0179.201511168

Video：

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Abstract Full text Figures/Tables Video References Cited by

机械通气（mechanical ventilation，MV）作为全身麻醉和生命支持的必要手段，在手术和危重患者的呼吸治疗中占有重要地位；然而，使用不当可能给患者带来潜在的损害，可诱发或加重肺部病变，如呼吸机相关性肺损伤（ventilator-induced lung injury，VILI），保护性肺通气是一种新的MV模式，能在一定程度上减轻肺损伤的程度。既往已有研究发现高碳酸血症的治疗性生理效应，且近年提出在保护性通气模式下允许一定程度的高碳酸血症，即允许性高碳酸血症（permissive hypercapnia，PHC），有望改善患者的转归。目前，PHC 在围术期及重症患者的 MV 治疗中逐渐增加，其有效性已被证实，但保护机制、适应证及禁忌证仍不完全明确，二氧化碳的允许范围、安全界限等方面仍缺乏共识。该文将近年来关于机械通气导致 VILI 的相关机制和 PHC 的研究结果作一综述。

Citation： 岳建明, 刘斌. 允许性高碳酸血症在预防呼吸机相关性肺损伤中的作用. West China Medical Journal, 2017, 32(6): 940-944. doi: 10.7507/1002-0179.201511168 Copy

1.	Do-Umehara HC, Chen C, Urich D, et al. Suppression of inflammation and acute lung injury by Miz1 via repression of C/EBP-δ. Nat Immunol, 2013, 14(5): 461-469.
2.	Needham DM, Colantuoni E, Mendez-Tellez PA, et al. Lung protective mechanical ventilation and two year survival in patients with acute lung injury: prospective cohort study. BMJ, 2012, 344: e2124.
3.	Protti A, Cressoni M, Santini A, et al. Lung stress and strain during mechanical ventilation: any safe threshold? Am J Respir Crit Care Med, 2011, 183(10): 1354-1362.
4.	Gattinoni L, Protti A, Caironi P, et al. Ventilator-induced lung injury: the anatomical and physiological framework. Crit Care Med, 2010, 38(10 Suppl): S539-S548.
5.	Slutsky AS, Ranieri VM. Ventilator-induced lung injury. N Engl J Med, 2013, 369(22): 2126-2136.
6.	Wu H, Kobayashi T, Wan Q, et al. Effects of surfactant replacement on alveolar overdistension and plasma cytokines in ventilator-induced lung injury. Acta Anaesthesiol Scand, 2010, 54(3): 354-361.
7.	Carrasco Loza R, Villamizar Rodríguez G, Medel Fernández N. Ventilator-Induced lung injury (VILI) in acute respiratory distress syndrome (ARDS): volutrauma and molecular effects. Open Respir Med J, 2015, 9: 112-119.
8.	Kneyber MC, Zhang H, Slutsky AS. Ventilator-induced lung injury. Similarity and differences between children and adults. Am J Respir Crit Care Med, 2014, 190(3): 258-265.
9.	Liu YY, Chiang CH, Chuang CH, et al. Spillover of cytokines and reactive Oxygen species in ventilator-induced lung injury associated with inflammation and apoptosis in distal organs. Respir Care, 2014, 59(9): 1422-1432.
10.	Chiumello D, Carlesso E, Cadringher P, et al. Lung stress and strain during mechanical ventilation for acute respiratory distress syndrome. Am J Respir Crit Care Med, 2008, 178(4): 346-355.
11.	Han B, Lodyga M, Liu M. Ventilator-induced lung injury: role of protein-protein interaction in mechanosensation. Proc Am Thorac Soc, 2005, 2(3): 181-187.
12.	De Prost N, Dreyfuss D, Saumon G. Evaluation of two-way protein fluxes across the alveolo-capillary membrane by scintigraphy in rats: effect of lung inflation. J Appl Physiol (1985), 2007, 102(2): 794-802.
13.	Albert RK. The role of ventilation-induced surfactant dysfunction and atelectasis in causing acute respiratory distress syndrome. Am J Respir Crit Care Med, 2012, 185(7): 702-708.
14.	Mead J, Takishima T, Leith D. Stress distribution in lungs: a model of pulmonary elasticity. J Appl Physiol, 1970, 28(5): 596-608.
15.	dos Santos CC, Slutsky AS. The contribution of biophysical lung injury to the development of biotrauma. Annu Rev Physiol, 2006, 68: 585-618.
16.	Liu D, Yan Z, Minshall RD, et al. Activation of calpains mediates early lung neutrophilic inflammation in ventilator-induced lung injury. Am J Physiol Lung Cell Mol Physiol, 2012, 302(4): L370-L379.
17.	戴惠军, 潘灵辉, 林飞, 等. 肺泡巨噬细胞 Toll 样受体 9-髓样分化因子 88 信号通路在呼吸机相关性肺损伤中的作用机制研究. 中华危重病急救医学, 2014, 26(5): 289-293.
18.	BENDIXEN HH, HEDLEY-WHYTE J, LAVER MB. Impaired oxygenation in surgical patients during general anesthesia controlled ventilation. A concept of atelectasis. N Engl J Med, 1963, 269: 991-996.
19.	Gajic O, Dara SI, Mendez JL, et al. Ventilator-associated lung injury in patients without acute lung injury at the onset of mechanical ventilation. Crit Care Med, 2004, 32(9): 1817-1824.
20.	Gajic O, Frutos-Vivar F, Esteban A, et al. Ventilator settings as a risk factor for acute respiratory distress syndrome in mechanically ventilated patients. Intensive Care Med, 2005, 31(7): 922-926.
21.	Hickling KG, Henderson SJ, Jackson R. Low mortality associated with low volume pressure limited ventilation with permissive hypercapnia in severe adult respiratory distress syndrome. Intensive Care Med, 1990, 16(6): 372-377.
22.	Peng G, Ivanovska J, Kantores C, et al. Sustained therapeutic hypercapnia attenuates pulmonary arterial Rho-kinase activity and ameliorates chronic hypoxic pulmonary hypertension in juvenile rats. Am J Physiol Heart Circ Physiol, 2012, 302(12): H2599-H2611.
23.	Dunlop K, Gosal K, Kantores C, et al. Therapeutic hypercapnia prevents inhaled nitric oxide-induced right-ventricular systolic dysfunction in juvenile rats. Free Radic Biol Med, 2014, 69: 35-49.
24.	Emery MJ, Eveland RL, Min JH, et al. CO₂ relaxation of the rat lung parenchymal strip. Respir Physiol Neurobiol, 2013, 186(1): 33-39.
25.	Taghavi S, Jayarajan SN, Ferrer LM, et al. "Permissive hypoventilation" in a swine model of hemorrhagic shock. J Trauma Acute Care Surg, 2014, 77(1): 14-19.
26.	Nnorom CC, Davis C, Fedinec AL, et al. Contributions of KATP and KCa channels to cerebral arteriolar dilation to hypercapnia in neonatal brain. Physiol Rep, 2014, 2(8). pii: e12127.
27.	Peltekova V, Engelberts D, Otulakowski G, et al. Hypercapnic acidosis in ventilator-induced lung injury. Intensive Care Med, 2010, 36(5): 869-878.
28.	Contreras M, Ansari B, Curley G, et al. Hypercapnic acidosis attenuates ventilation-induced lung injury by a nuclear factor-κB-dependent mechanism. Crit Care Med, 2012, 40(9): 2622-2630.
29.	Yang WC, Song CY, Wang N, et al. Hypercapnic acidosis confers antioxidant and anti-apoptosis effects against ventilator-induced lung injury. Lab Invest, 2013, 93(12): 1339-1349.
30.	Otulakowski G, Engelberts D, Gusarova GA, et al. Hypercapnia attenuates ventilator-induced lung injury via a disintegrin and metalloprotease-17. J Physiol, 2014, 592(20): 4507-4521.
31.	Schellekens WJ, Van Hees HW, Kox M, et al. Hypercapnia attenuates ventilator-induced diaphragm atrophy and modulates dysfunction. Crit Care, 2014, 18(1): R28.
32.	Gao W, Liu DD, Li D, et al. Effects of hypercapnia on T cells in lung ischemia/reperfusion injury after lung transplantation. Exp Biol Med, 2014, 239(12): 1597-1605.
33.	Cheng DS, Han W, Chen SM, et al. Airway epithelium controls lung inflammation and injury through the NF-kappa B pathway. J Immunol, 2007, 178(10): 6504-6513.
34.	Ijland MM, Heunks LM, Van Der Hoeven JG. Bench-to-bedside review: hypercapnic acidosis in lung injury--from 'permissive' to 'therapeutic'. Crit Care, 2010, 14(6): 237.
35.	Hickling KG, Walsh J, Henderson S, et al. Low mortality rate in adult respiratory distress syndrome using low-volume, pressure-limited ventilation with permissive hypercapnia: a prospective study. Crit Care Med, 1994, 22(10): 1568-1578.
36.	Davidson AC, Banham S, Elliott M, et al. BTS/ICS guideline for the ventilatory management of acute hypercapnic respiratory failure in adults. Thorax, 2016, 71(Suppl 2): ii1-i35.
37.	Nayak S, Jindal A. Permissive hypercapnia: Is there any upper limit? Indian J Crit Care Med, 2015, 19(1): 56-57.
38.	Urwin L, Murphy R, Robertson C, et al. A case of extreme hypercapnia: implications for the prehospital and accident and emergency department management of acutely dyspnoeic patients. Emerg Med J, 2004, 21(1): 119-120.
39.	Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. The acute respiratory distress syndrome network. N Engl J Med, 2000, 342(18): 1301-1308.
40.	Curley GF, Laffey JG, Kavanagh BP. CrossTalk proposal: there is added benefit to providing permissive hypercapnia in the treatment of ARDS. J Physiol, 2013, 591(11): 2763-2765.
41.	Guidry CA, Hranjec T, Rodgers BM, et al. Permissive hypercapnia in the management of congenital diaphragmatic hernia: our institutional experience. J Am Coll Surg, 2012, 214(4): 640-645, 647.e1; discussion 646-7.
42.	Curley G, Contreras MM, Nichol AD, et al. Hypercapnia and acidosis in sepsis: a double-edged sword? Anesthesiology, 2010, 112(2): 462-472.
43.	Maclntyre N, Huang YC. Acute exacerbations and respiratory failure in chronic obstructive pulmonary disease. Proc Am Thorac Soc, 2008, 5(4): 530-535.
44.	Peters JI, Stupka JE, Singh H, et al. Status asthmaticus in the medical intensive care unit: a 30-year experience. Respir Med, 2012, 106(3): 344-348.
45.	Thome UH, Genzel-Boroviczeny O, Bohnhorst B, et al. Permissive hypercapnia in extremely low birthweight infants (PHELBI): a randomised controlled multicentre trial. Lancet Respir Med, 2015, 3(7): 534-543.
46.	O'toole D, Hassett P, Contreras M, et al. Hypercapnic acidosis attenuates pulmonary epithelial wound repair by an NF-kappaB dependent mechanism. Thorax, 2009, 64(11): 976-982.
47.	Helenius IT, Krupinski T, Turnbull DW, et al. Elevated CO₂ suppresses specific Drosophila innate immune responses and resistance to bacterial infection. Proc Natl Acad Sci U S A, 2009, 106(44): 18710-18715.
48.	Kilpatrick B, Slinger P. Lung protective strategies in anaesthesia. Br J Anaesth, 2010, 105(Suppl 1): i108-i116.

1. Do-Umehara HC, Chen C, Urich D, et al. Suppression of inflammation and acute lung injury by Miz1 via repression of C/EBP-δ. Nat Immunol, 2013, 14(5): 461-469.
2. Needham DM, Colantuoni E, Mendez-Tellez PA, et al. Lung protective mechanical ventilation and two year survival in patients with acute lung injury: prospective cohort study. BMJ, 2012, 344: e2124.
3. Protti A, Cressoni M, Santini A, et al. Lung stress and strain during mechanical ventilation: any safe threshold? Am J Respir Crit Care Med, 2011, 183(10): 1354-1362.
4. Gattinoni L, Protti A, Caironi P, et al. Ventilator-induced lung injury: the anatomical and physiological framework. Crit Care Med, 2010, 38(10 Suppl): S539-S548.
5. Slutsky AS, Ranieri VM. Ventilator-induced lung injury. N Engl J Med, 2013, 369(22): 2126-2136.
6. Wu H, Kobayashi T, Wan Q, et al. Effects of surfactant replacement on alveolar overdistension and plasma cytokines in ventilator-induced lung injury. Acta Anaesthesiol Scand, 2010, 54(3): 354-361.
7. Carrasco Loza R, Villamizar Rodríguez G, Medel Fernández N. Ventilator-Induced lung injury (VILI) in acute respiratory distress syndrome (ARDS): volutrauma and molecular effects. Open Respir Med J, 2015, 9: 112-119.
8. Kneyber MC, Zhang H, Slutsky AS. Ventilator-induced lung injury. Similarity and differences between children and adults. Am J Respir Crit Care Med, 2014, 190(3): 258-265.
9. Liu YY, Chiang CH, Chuang CH, et al. Spillover of cytokines and reactive Oxygen species in ventilator-induced lung injury associated with inflammation and apoptosis in distal organs. Respir Care, 2014, 59(9): 1422-1432.
10. Chiumello D, Carlesso E, Cadringher P, et al. Lung stress and strain during mechanical ventilation for acute respiratory distress syndrome. Am J Respir Crit Care Med, 2008, 178(4): 346-355.
11. Han B, Lodyga M, Liu M. Ventilator-induced lung injury: role of protein-protein interaction in mechanosensation. Proc Am Thorac Soc, 2005, 2(3): 181-187.
12. De Prost N, Dreyfuss D, Saumon G. Evaluation of two-way protein fluxes across the alveolo-capillary membrane by scintigraphy in rats: effect of lung inflation. J Appl Physiol (1985), 2007, 102(2): 794-802.
13. Albert RK. The role of ventilation-induced surfactant dysfunction and atelectasis in causing acute respiratory distress syndrome. Am J Respir Crit Care Med, 2012, 185(7): 702-708.
14. Mead J, Takishima T, Leith D. Stress distribution in lungs: a model of pulmonary elasticity. J Appl Physiol, 1970, 28(5): 596-608.
15. dos Santos CC, Slutsky AS. The contribution of biophysical lung injury to the development of biotrauma. Annu Rev Physiol, 2006, 68: 585-618.
16. Liu D, Yan Z, Minshall RD, et al. Activation of calpains mediates early lung neutrophilic inflammation in ventilator-induced lung injury. Am J Physiol Lung Cell Mol Physiol, 2012, 302(4): L370-L379.
17. 戴惠军, 潘灵辉, 林飞, 等. 肺泡巨噬细胞 Toll 样受体 9-髓样分化因子 88 信号通路在呼吸机相关性肺损伤中的作用机制研究. 中华危重病急救医学, 2014, 26(5): 289-293.
18. BENDIXEN HH, HEDLEY-WHYTE J, LAVER MB. Impaired oxygenation in surgical patients during general anesthesia controlled ventilation. A concept of atelectasis. N Engl J Med, 1963, 269: 991-996.
19. Gajic O, Dara SI, Mendez JL, et al. Ventilator-associated lung injury in patients without acute lung injury at the onset of mechanical ventilation. Crit Care Med, 2004, 32(9): 1817-1824.
20. Gajic O, Frutos-Vivar F, Esteban A, et al. Ventilator settings as a risk factor for acute respiratory distress syndrome in mechanically ventilated patients. Intensive Care Med, 2005, 31(7): 922-926.
21. Hickling KG, Henderson SJ, Jackson R. Low mortality associated with low volume pressure limited ventilation with permissive hypercapnia in severe adult respiratory distress syndrome. Intensive Care Med, 1990, 16(6): 372-377.
22. Peng G, Ivanovska J, Kantores C, et al. Sustained therapeutic hypercapnia attenuates pulmonary arterial Rho-kinase activity and ameliorates chronic hypoxic pulmonary hypertension in juvenile rats. Am J Physiol Heart Circ Physiol, 2012, 302(12): H2599-H2611.
23. Dunlop K, Gosal K, Kantores C, et al. Therapeutic hypercapnia prevents inhaled nitric oxide-induced right-ventricular systolic dysfunction in juvenile rats. Free Radic Biol Med, 2014, 69: 35-49.
24. Emery MJ, Eveland RL, Min JH, et al. CO₂ relaxation of the rat lung parenchymal strip. Respir Physiol Neurobiol, 2013, 186(1): 33-39.
25. Taghavi S, Jayarajan SN, Ferrer LM, et al. "Permissive hypoventilation" in a swine model of hemorrhagic shock. J Trauma Acute Care Surg, 2014, 77(1): 14-19.
26. Nnorom CC, Davis C, Fedinec AL, et al. Contributions of KATP and KCa channels to cerebral arteriolar dilation to hypercapnia in neonatal brain. Physiol Rep, 2014, 2(8). pii: e12127.
27. Peltekova V, Engelberts D, Otulakowski G, et al. Hypercapnic acidosis in ventilator-induced lung injury. Intensive Care Med, 2010, 36(5): 869-878.
28. Contreras M, Ansari B, Curley G, et al. Hypercapnic acidosis attenuates ventilation-induced lung injury by a nuclear factor-κB-dependent mechanism. Crit Care Med, 2012, 40(9): 2622-2630.
29. Yang WC, Song CY, Wang N, et al. Hypercapnic acidosis confers antioxidant and anti-apoptosis effects against ventilator-induced lung injury. Lab Invest, 2013, 93(12): 1339-1349.
30. Otulakowski G, Engelberts D, Gusarova GA, et al. Hypercapnia attenuates ventilator-induced lung injury via a disintegrin and metalloprotease-17. J Physiol, 2014, 592(20): 4507-4521.
31. Schellekens WJ, Van Hees HW, Kox M, et al. Hypercapnia attenuates ventilator-induced diaphragm atrophy and modulates dysfunction. Crit Care, 2014, 18(1): R28.
32. Gao W, Liu DD, Li D, et al. Effects of hypercapnia on T cells in lung ischemia/reperfusion injury after lung transplantation. Exp Biol Med, 2014, 239(12): 1597-1605.
33. Cheng DS, Han W, Chen SM, et al. Airway epithelium controls lung inflammation and injury through the NF-kappa B pathway. J Immunol, 2007, 178(10): 6504-6513.
34. Ijland MM, Heunks LM, Van Der Hoeven JG. Bench-to-bedside review: hypercapnic acidosis in lung injury--from 'permissive' to 'therapeutic'. Crit Care, 2010, 14(6): 237.
35. Hickling KG, Walsh J, Henderson S, et al. Low mortality rate in adult respiratory distress syndrome using low-volume, pressure-limited ventilation with permissive hypercapnia: a prospective study. Crit Care Med, 1994, 22(10): 1568-1578.
36. Davidson AC, Banham S, Elliott M, et al. BTS/ICS guideline for the ventilatory management of acute hypercapnic respiratory failure in adults. Thorax, 2016, 71(Suppl 2): ii1-i35.
37. Nayak S, Jindal A. Permissive hypercapnia: Is there any upper limit? Indian J Crit Care Med, 2015, 19(1): 56-57.
38. Urwin L, Murphy R, Robertson C, et al. A case of extreme hypercapnia: implications for the prehospital and accident and emergency department management of acutely dyspnoeic patients. Emerg Med J, 2004, 21(1): 119-120.
39. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. The acute respiratory distress syndrome network. N Engl J Med, 2000, 342(18): 1301-1308.
40. Curley GF, Laffey JG, Kavanagh BP. CrossTalk proposal: there is added benefit to providing permissive hypercapnia in the treatment of ARDS. J Physiol, 2013, 591(11): 2763-2765.
41. Guidry CA, Hranjec T, Rodgers BM, et al. Permissive hypercapnia in the management of congenital diaphragmatic hernia: our institutional experience. J Am Coll Surg, 2012, 214(4): 640-645, 647.e1; discussion 646-7.
42. Curley G, Contreras MM, Nichol AD, et al. Hypercapnia and acidosis in sepsis: a double-edged sword? Anesthesiology, 2010, 112(2): 462-472.
43. Maclntyre N, Huang YC. Acute exacerbations and respiratory failure in chronic obstructive pulmonary disease. Proc Am Thorac Soc, 2008, 5(4): 530-535.
44. Peters JI, Stupka JE, Singh H, et al. Status asthmaticus in the medical intensive care unit: a 30-year experience. Respir Med, 2012, 106(3): 344-348.
45. Thome UH, Genzel-Boroviczeny O, Bohnhorst B, et al. Permissive hypercapnia in extremely low birthweight infants (PHELBI): a randomised controlled multicentre trial. Lancet Respir Med, 2015, 3(7): 534-543.
46. O'toole D, Hassett P, Contreras M, et al. Hypercapnic acidosis attenuates pulmonary epithelial wound repair by an NF-kappaB dependent mechanism. Thorax, 2009, 64(11): 976-982.
47. Helenius IT, Krupinski T, Turnbull DW, et al. Elevated CO₂ suppresses specific Drosophila innate immune responses and resistance to bacterial infection. Proc Natl Acad Sci U S A, 2009, 106(44): 18710-18715.
48. Kilpatrick B, Slinger P. Lung protective strategies in anaesthesia. Br J Anaesth, 2010, 105(Suppl 1): i108-i116.

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23.	袁菁，张佳，崔秀云，张宇婷，吴雅茹，徐春艳. 宫颈癌手术患者出院准备现状及影响因素分析. 中国医药导报. 2024(34): 88-93 . Baidu Scholar
24.	李琳，汤磊，赵亚伟，马柳疆，李前跃. 基于生物信息学分析膀胱癌的关键基因. 兵团医学. 2024(04): 1-5+73 . Baidu Scholar

Other types of references(2)

1.	李钰. 纳米材料在肝细胞癌磁共振增强与多模式协同治疗中的应用研究[D]. 兰州大学. 2024. Baidu Scholar
2.	李朕. 紫龙金片联合埃克替尼治疗晚期非小细胞肺癌的临床及作用机制研究[D]. 新疆医科大学. 2024. Baidu Scholar

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