在机械通风中监测和保护隔膜功能
Margot Combet1, Briar Coman2,3,4, Irene Telias2,3,4
1Médecine Intensive-Réanimation (Département "R3S"), Hôpital Pitié-Salpêtrière, Assistance Publique - Hôpitaux de Paris, Sorbonne Université, Paris.
Current opinion in critical care
|April 10, 2025
概括
呼吸器患者的隔膜功能障碍与糟糕的结果有关. 监测鼓舞力和探索策略,如神经刺激可以改善患者的康复.
科学领域:
- 关键护理医学 关键护理医学
- 呼吸系统生理学 呼吸系统生理学
- 神经肌肉疾病 神经肌肉疾病
背景情况:
- 危急疾病可能导致隔膜功能障碍,特别是在需要长时间机械通风的患者中.
- 隔膜软弱在重症监护室 (ICU) 幸存者中很常见,并且与机械通风的断奶困难有关.
- 与呼吸机相关的肌痛创伤通过各种机制导致隔膜软弱.
研究的目的:
- 在机械通风患者中审查与隔膜功能障碍相关的临床结果.
- 为提供对膜功能当前监测工具的概述.
- 总结预防和治疗隔膜功能障碍的策略.
主要方法:
- 对隔膜功能障碍,临床结果和管理策略研究的文献综述.
- 关于呼吸机诱导的隔膜功能障碍 (VIDD) 和其影响的综合证据.
- 分析新兴的预防和治疗方法.
主要成果:
- 隔膜功能障碍在机械通风患者中普遍存在,并与不良的功能结果有关.
- 严重疾病诱导的隔膜软弱的机制是复杂的,涉及呼吸机相关的肌肉创伤.
- 神经刺激和专业康复对隔膜保护和恢复有很大的希望.
结论:
- 隔膜功能障碍会对通风患者的临床结果产生负面影响,因此需要监测呼吸力度.
- 建议以适度的吸入力为目标,如果在不损害肺部保护的情况下可行,建议这样做.
- 神经刺激和康复策略是有前途的,但需要进一步的研究才能得到广泛的临床采用.
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