膈肌功能测定与膈肌超声评估进展  

Progress in diaphragmatic function measurement and diaphragmatic ultrasound assessment

作　　者：黄嘉炜 王明军 韩佳欣 梁柱 王志刚 HUANG Jiawei;WANG Mingjun;HAN Jiaxin;LIANG Zhu;WANG Zhigang(Guangdong Medical University,Zhanjiang 524000;Affiliated Hospital of Guangdong Medical University,Zhanjiang 524000,China)

机构地区：[1]广东医科大学,广东湛江524000 [2]广东医科大学附属医院,广东湛江524000

出　　处：《临床医学研究与实践》2022年第3期186-190,共5页Clinical Research and Practice

基　　金：2016年广东医科大学附属医院博士科研启动基金(No.BJ201602)。

摘　　要：膈肌是人体中最主要的呼吸肌,除协助呼吸外,还与腹肌共同参与人体排便、排尿、分娩、呕吐等动作的完成。手术、麻醉、呼吸机的使用等带来的医源性伤害,以及膈肌本身的一些原发性和继发性疾病诱发的损伤会影响膈肌的功能,导致患者术后肺部并发症发生、术后呼吸困难、脱机困难等。在膈肌功能测定中,经膈神经磁刺激所诱发出的颤搐性跨膈压被认为是客观评估膈肌强度的金标准。但跨膈压的测定需留置胃-食道囊管,从而影响了其临床应用。超声由于具有无创、床旁实时动态观察、安全方便等优势,在临床应用中优于跨膈压测定、膈肌肌电图、放射学检查等方法。膈肌超声指标包括膈肌移动度、膈肌厚度、膈肌增厚率(DTF)、膈肌收缩速度、膈肌偏移-时间指数、膈肌浅快呼吸指数(D-RSBI)、膈肌增厚浅快呼吸指数(DT-RSBI)、膈肌对合角度、剪切波弹性成像(SWE)等。目前膈肌超声主要应用于指导机械通气撤机拔管时机、诊断慢性阻塞性肺疾病(COPD)、预测术后恢复及指导康复治疗等。基于此,本文对膈肌功能测定及近年来膈肌超声评估的进展进行综述。Diaphragm is the most important respiratory muscle in the human body.In addition to assisting breathing,it also participates in the completion of defecation,urination,delivery,vomiting and other actions with abdominal muscles.Iatrogenic injuries caused by surgery,anesthesia and the use of respirators,as well as injuries caused by some primary and secondary diseases of the diaphragm itself,will affect the function of the diaphragm,resulting in postoperative pulmonary complications,postoperative dyspnea,offline difficulties,etc.In the measurement of diaphragmatic function,the twitching diaphragmatic pressure induced by magnetic stimulation of diaphragm nerve is considered to be the gold standard for objective evaluation of diaphragm strength.However,the measurement of diaphragmatic pressure requires the indwelling of gastric esophageal cystic tube,which affects its clinical application.Ultrasound is superior to diaphragmatic pressure measurement,diaphragmatic electromyography,radiology and other methods in clinical application because of its advantages of noninvasion,bedside real-time dynamic observation,safety and convenience.Diaphragmatic ultrasound indexes include diaphragmatic excursion,diaphragmatic thickness,diaphragmatic thickening fraction(DTF),diaphragm contraction velocity,diaphragmatic excursion-time index,diaphragmatic rapid shallow breathing index(D-RSBI),diaphragmatic thickening rapid shallow breathing index(DT-RSBI),diaphragmatic involution angle,shear wave elastography(SWE),etc.At present,diaphragmatic ultrasound is mainly used to guide the timing of mechanical ventilation weaning and extubation,diagnose chronic obstructive pulmonary disease(COPD),predict postoperative recovery and guide rehabilitation treatment.Based on these,this paper reviews the progress of diaphragmatic function measurement and diaphragmatic ultrasound assessment in recent years.

关 键 词：膈肌 超声 跨膈压 剪切波弹性成像 

分 类 号：R619[医药卫生—外科学]