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| 題 名 | 使用呼吸器的COVID-19病人發生氣胸與縱膈氣腫:案例系列與文獻綜述=Pneumothorax and Pneumomediastinum in COVID-19 Patients on Mechanical Ventilation: A Case Series and Literature Review |
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| 作 者 | 陳道岸; 柏斯琪; 林昌生; 林介惠; 劉雅閔; 莊雅婷; 鄭進福; 洪文仲; | 書刊名 | 秀傳醫學雜誌 |
| 卷 期 | 23:2 2024.08[民113.08] |
| 頁 次 | 頁280-287 |
| 分類號 | 415.4 |
| 關鍵詞 | 嚴重特殊傳染性肺炎; 氣胸; 縱膈氣腫; 氣壓傷; 機械通氣; 馬克林效應; COVID-19; Pneumothorax; Pneumomediastinum; Barotrauma; Mechanical ventilation; Macklin effect; |
| 語 文 | 中文(Chinese) |
| DOI | 10.30185/SCMJ.202408_23(2).0017 |
| 中文摘要 | 嚴重特殊傳染性肺炎(coronavirus disease 2019, COVID-19)現今已成為影響全球的主要流行病。COVID-19病人具有高住院與住加護病房比率,這些病人可能會使用侵襲性呼吸器或非侵襲性呼吸器支持。COVID-19住院病人中約0.3-4.2%會出現氣壓傷,如再接受侵入性機械通氣其氣壓傷的發生的比率約為14.7%且死亡率將近六成。在胸部電腦斷層掃描中發現的Macklin效應可以預測高氣壓傷風險的病人。目前在COVID-19使用呼吸器病人上主要設定仍為肺保護性通氣策略,儘管如此氣壓傷比率仍高,因此這些病人發生氣壓傷的原因可能是多因素的,可能與肺部病理因素有關,較高的PEEP可能進一步增強細胞激素反應,而加劇肺泡損傷,在PEEP為10 cmH₂O左右或Pplat在小於30 cmH₂O即能發生氣壓傷。因此,呼吸器的COVID-19病人在肺保護策略下PEEP的使用需要更加留意。 |
| 英文摘要 | The Coronavirus Disease 2019 (COVID-19) has evolved into a major global pandemic, leading to high rates of hospitalization and admission to intensive care units for affected individuals. Patients with COVID-19 may undergo either invasive or non-invasive ventilator support. Approximately 0.3% to 4.2% of hospitalized COVID-19 patients develop barotrauma. If subjected to invasive mechanical ventilation, the incidence of barotrauma rises to around 14.7%, with an associated mortality rate of nearly 60%.The Macklin effect, observed in chest computed tomography scans, can be used to predict patients at a high risk of developing barotrauma. Despite the widespread implementation of lung-protective ventilation strategies, the incidence of barotrauma remains high in COVID-19 patients. The causes of barotrauma in these patients are likely multifactorial and may be related to pulmonary pathological factors. Higher positive end-expiratory pressure (PEEP) may exacerbate cytokine responses, leading to increased alveolar damage. Barotrauma can occur at a PEEP of 10 cmH₂O or a plateau pressure (Pplat) less than 30 cmH₂O. Therefore, the use of PEEP in COVID-19 patients on ventilators, under the lung-protective ventilation strategy, requires careful consideration. |
本系統中英文摘要資訊取自各篇刊載內容。