准确评估机械通气与自主呼吸活动  

Accurate evaluation of mechanical ventilation and spontaneous respiratory activity

作　　者：秦英智[1] Qin Yingzhi(Department of Critical Care Medicine,Tianjin Third Central Hospital,Tianjin 300170,China)

机构地区：[1]天津市第三中心医院重症医学科,天津300170

出　　处：《中华危重病急救医学》2022年第4期343-345,共3页Chinese Critical Care Medicine

摘　　要：在机械通气过程中保持自主呼吸一直被认为可以改善氧合,因为氧合是一个关键管理目标,因此这种自主呼吸努力是有益的。然而,越来越多的证据表明,机械通气过程中自主呼吸努力可能导致或加重急性肺损伤,这种呼吸努力依赖性肺损伤称为患者自身造成的肺损伤(P-SILI)。本文通过阐述机械通气和自主呼吸引起呼吸机相关性肺损伤(VILI)的病理生理变化,以及自主呼吸在急性呼吸窘迫综合征(ARDS)机械通气中的作用,认为自主呼吸是一把"双刃剑",加重肺损伤或使患者获益取决于自主呼吸活动的强度和肺损伤的严重程度。未来的研究需要确定呼吸机通气策略,以减轻肺损伤。Maintenance of spontaneous effort during mechanical ventilation has long been recognized to improve oxygenation.Such effort has been considered beneficial because oxygenation is a key management aim.However,accumulating evidence indicates that spontaneous effort during mechanical ventilation may cause or worsen acute lung injury.Recently,effort-dependent lung injury has been termed as patient-self inflicted lung injury(P-SILI).This paper describes pathophysiological changes of ventilation-induced lung injury(VILI)induced by mechanical ventilation and spontaneous breathing,and the role of spontaneous breathing during mechanical ventilation in acute respiratory distress syndrome(ARDS).Studies have shown that spontaneous breathing is a double-edged sword,depending on the intensity of spontaneous breathing activity and the severity of lung injury.Future studies are needed to determine ventilator strategies minimizing injury.

关 键 词：自主呼吸 呼吸机相关性肺损伤 摆动现象 呼吸努力依赖性肺损伤 跨肺压 

分 类 号：R459.7[医药卫生—急诊医学]