机械功率在呼吸机相关性肺损伤中的研究进展  

Research progress of mechanical power in ventilator-induced lung injury

作　　者：李咏臻 张奕 盛晓峰 陈正龙 宋元林 Li Yongzhen;Zhang Yi;Sheng Xiaofeng;Chen Zhenglong;Song Yuanlin(School of Health Science and Engineering,University of Shanghai for Science and Technology,Shanghai 200093,China;School of Medical Instrumentation,Shanghai University of Medicine&Health Sciences,Shanghai 201318,China;Department of Respiration and Intensive Care Medicine,Zhongshan Hospital,Fudan University,Shanghai 200032,China)

机构地区：[1]上海理工大学健康科学与工程学院,上海200093 [2]上海健康医学院医疗器械学院,上海201318 [3]复旦大学附属中山医院呼吸科与危重医学科,上海200032

出　　处：《国际生物医学工程杂志》2023年第4期360-364,共5页International Journal of Biomedical Engineering

基　　金：上海市自然科学基金项目(21ZR1428300);上海市"科技创新行动计划"生物医药科技支撑专项(20S31905100)。

摘　　要：重症加强护理病房(ICU)急性呼吸窘迫综合征具有较高的发病率和死亡率,该类患者治疗过程中通常需要机械通气来维持其呼吸功能。然而,机械通气参数设置不当可能会导致呼吸机相关性肺损伤(VILI)。为了有效防止VILI的发生,急性呼吸窘迫综合征研究联盟推荐使用小潮气量和限制气道平台压的保护性通气策略,但是从呼吸机能量传递的角度来看,VILI实际上是潮气量、气道压力和呼吸频率等呼吸参数综合作用的结果。机械功率能很好地体现了上述参数的共同作用,正日益成为临床研究的热点。主要介绍了机械能与机械功率的定义,并对不同呼吸模式下机械功率的计算方法进行系统地综述,同时总结回顾了机械功率与VILI有关的基础研究和临床研究,进一步探究机械功率的安全阈值可望为未来临床制定个性化机械通气策略,有效预防VILI的发生提供新的思路。ICU acute respiratory distress syndrome has a high morbidity and mortality rate,and these patients usually need mechanical ventilation to maintain their respiratory function during treatment.However,improper setting of mechanical ventilation parameters may lead to ventilator-induced lung injury(VILI).In order to effectively prevent the occurrence of VILI,ARDSnet recommends the use of a protective ventilation strategy with low tidal volume and limited airway plateau pressure.However,from the perspective of ventilator energy transfer,VILI is actually the result of a combination of respiratory parameters such as tidal volume,airway pressure,and respiratory rate.The mechanical power well reflects the combined effect of the above parameters and is increasingly becoming a hot topic in clinical research.In this review paper,the definitions of mechanical energy and mechanical power were introduced,and the calculation methods of mechanical power under different respiratory modes are summarized.Moreover,the clinical studies related to mechanical power and VILI and further exploration of the safety threshold of mechanical power are reviewed.It is expected to provide new ideas for the future clinical development of personalized mechanical ventilation strategies and the effective prevention of VILI.

关 键 词：机械功率 呼吸机相关性肺损伤 机械能 急性呼吸窘迫综合征 个性化机械通气 

分 类 号：R563.8[医药卫生—呼吸系统]