异步伤害肺和腹膜在急性呼吸困扰综合征
Haruka Hashimoto1, Takeshi Yoshida, Andi Muhammad Fadlillah Firstiogusran
1All authors: Department of Anesthesiology and Intensive Care Medicine, Graduate School of Medicine, Osaka University, Suita, Japan.
Critical care medicine
|July 17, 2023
概括
机械通风期间患者-呼吸器异步可能会损害肺部和隔膜. 呼吸堆叠导致肺和隔膜损伤,而反向触发则损伤隔膜,突出显示需要谨慎管理.
科学领域:
- 临界护理医学 临界护理医学
- 呼吸系统生理学 呼吸系统生理学
- 机械通风机械通风机械通风
背景情况:
- 在机械呼吸过程中,患者-呼吸器异步是常见的,并且与死亡率的增加有关.
- 了解异步影响肺和隔膜的特定机制对于改善患者的治疗结果至关重要.
研究的目的:
- 在动物模型中研究不同类型的患者-呼吸器异步对肺和隔膜损伤和功能的影响.
- 为了比较呼吸堆叠和反向触发对呼吸机制和器官损伤的影响.
主要方法:
- 一项前性随机动物研究使用子急性呼吸困扰综合征 (ARDS) 模型进行.
- 通过神经刺激模拟了三个通风模式 (辅助控制,呼吸叠加,逆触发),以评估肺功能,损伤标志物,隔膜力和组织学变化.
- 进行了隔膜RNA测序,以分析分子对异步反应的反应.
主要成果:
- 呼吸堆叠导致潮体积最高,肺间压力增加,氧化和服从性恶化,并诱导肺损伤.
- 呼吸堆叠和反向触发都减少了隔膜力产生和增加了异常的肌肉纤维面积.
- RNA测序显示抑制了肌肉分化/收缩基因,并激活了呼吸堆叠中的炎症途径.
结论:
- 在机械通风的背景下,呼吸堆叠显著导致肺和隔膜损伤.
- 反向触发主要导致隔膜损伤,但不是肺损伤.
- 有效管理患者-呼吸器异步是减轻二次肺和隔膜损伤在自发呼吸ARDS患者至关重要的.
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