目的：总结并阐述ARDS患者机械通气管理的十大核心策略，为优化肺保护性通气、改善患者预后提供基于循证医学和个体化原则的临床实践指导。方法：系统回顾近年来ARDS领域的重要研究进展、国际权威指南及高质量循证证据，结合临床实践经验，凝练出ARDS机械通气管理的十大关键环节。结果：ARDS机械通气管理的核心策略包括：精准识别与评估病情严重程度（应用柏林定义及全球新定义）；严格实施小潮气量（VT）、限制平台压（Pplat）与驱动压（ΔP）为核心的肺保护通气；个体化滴定呼气末正压（PEEP）；审慎评估与应用肺复张手法（RM）；合理选择神经肌肉阻滞剂（NMBA）；优化辅助通气模式与参数，管理自主呼吸；规范实施俯卧位通气（PPV）；适时启用体外二氧化碳清除（ECCO2R）与吸入一氧化氮（iNO）；严格把握体外膜肺氧合（ECMO）指征；早期启动撤机后肺康复。每项策略均需基于患者病理生理特点、实时监测指标及治疗反应进行动态调整。结论：系统化、个体化地应用这十大核心策略，是降低机械通气相关性肺损伤（VILI）风险、改善ARDS患者氧合与预后的关键。护理人员在参数监测、操作执行、并发症预防及患者管理中扮演着不可或缺的角色。本文为临床医护人员，特别是重症护理团队，提供了全面、实用、更新的ARDS机械通气管理框架。

关键词：急性呼吸窘迫综合征；肺保护性通气；俯卧位通气；体外膜肺氧合；体外二氧化碳清除；神经肌肉阻滞剂

Abstract:

To summarize and elucidate ten core strategies for the mechanical ventilation management of ARDS patients, providing evidence-based and individualized clinical practice guidance for optimizing lung-protective ventilation and improving patient outcomes.Methods: We systematically reviewed recent major research advances, international authoritative guidelines, and high-quality evidence in the ARDS field. Combining clinical practical experience, we distilled ten key aspects of ARDS mechanical ventilation management.Results: The core strategies for ARDS mechanical ventilation management include:（1）Accurate identification and assessment of disease severity (applying the Berlin Definition and the global new definition).（2）Strict implementation of lung-protective ventilation centered on low tidal volume (VT), limiting plateau pressure (Pplat), and driving pressure (ΔP).（3）Individualized titration of positive end-expiratory pressure (PEEP).（4）Prudent evaluation and application of recruitment maneuvers (RM).（5）Rational selection of neuromuscular blocking agents (NMBA).（6）Optimization of assisted ventilation modes and parameters, managing spontaneous breathing.（7）Standardized implementation of prone positioning ventilation (PPV).（8）Timely initiation of extracorporeal carbon dioxide removal (ECCO2R) and inhaled nitric oxide (iNO).（9）Strict adherence to indications for extracorporeal membrane oxygenation (ECMO).（10）Early initiation of post-weaning pulmonary rehabilitation.Each strategy requires dynamic adjustment based on the patient's pathophysiological characteristics, real-time monitoring indicators, and therapeutic response.Conclusion: The systematic and individualized application of these ten core strategies is key to reducing the risk of ventilator-induced lung injury (VILI) and improving oxygenation and outcomes in ARDS patients. Nurses play an indispensable role in parameter monitoring, procedure execution, complication prevention, and patient management. This article provides a comprehensive, practical, and up-to-date framework for ARDS mechanical ventilation management for clinical healthcare professionals, particularly the critical care nursing team.

Keywords: Acute respiratory distress syndrome; Lung-protective ventilation; Prone positioning ventilation; Extracorporeal membrane oxygenation; Extracorporeal carbon dioxide removal; Neuromuscular blocking agents

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