患者自我造成的肺损伤是一个重要的现象
Eleonora Balzani1, Glasiele C Alcala2, Giacomo Bellani1,3
1Centre for Medical Sciences-CISMed, University of Trento, Trento, Italy.
Current opinion in critical care
|December 8, 2025
概括
机械通风过程中过度的吸入力可能会导致患者自身造成的肺损伤 (P-SILI),损害肺和隔膜. 策略旨在调节,而不是消除这种努力,以改善急性缺血性呼吸衰竭的结果.
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
- 肺部康复治疗 肺部康复治疗
背景情况:
- 机械通风对于急性低血量呼吸衰竭 (AHRF) 非常重要.
- 过度的患者吸入力可能会导致患者自我造成的肺损伤 (P-SILI),恶化结果.
- 了解P-SILI机制对于优化通风策略至关重要.
研究的目的:
- 审查对P-SILI.的机制性见解.
- 总结P-SILI的临床前和临床证据.
- 概述目前预防P-SILI的策略,同时保持隔膜功能.
主要方法:
- 对P-SILI.的机制性见解的审查.
- 对肺和隔膜损伤的临床前实验研究的分析.
- 对临床研究的评估,将鼓舞人心的努力与患者的结果联系起来.
- 评估新兴和已建立的P-SILI预防策略.
主要成果:
- 临床前研究表明,强烈的鼓舞力加剧肺损伤和隔膜损伤.
- 积极的终端呼气压力 (PEEP) 和持续的积极的气道压力 (CPAP) 可以减轻伤害.
- 临床数据将高启发力与增加的死亡率,呼吸机依赖性和并发症联系起来.
- 讨论了各种干预措施,包括镇静,神经肌肉阻塞和体外二氧化碳去除.
结论:
- P-SILI是由于过度的吸入力造成肺和隔膜压力的结果.
- 预防策略应侧重于调节,而不是消除患者的努力.
- 建议采用综合方法,包括通风设置,镇静和驱动调节.
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