危重症患者呼吸支持策略:肺-膈肌保护性通气  

Respiratory support strategy for critically ill patients:Lung-and diaphragm-protective ventilation

作　　者：温若譞 胡兴硕 赵瑛 杨庆云[1] 谢菲[1] 解立新[1] Wen Ruoxuan;Hu Xingshuo;Zhao Ying;Yang Qingyun;Xie Fei;Xie Lixin(College of Respiratory and Critical Care Medicine,Chinese PLA General Hospital,Beijing 100091,China)

机构地区：[1]解放军总医院呼吸与危重症医学部,北京100091

出　　处：《国际呼吸杂志》2024年第1期14-20,共7页International Journal of Respiration

基　　金：军队生物安全研究专项计划(23SWAQ11-1)。

摘　　要：机械通气过程中可能因各种原因造成医源性肺和膈肌损伤,肺保护性机械通气已被广泛认可和实施。近年来呼吸机相关性膈肌功能障碍也逐步引起临床医师关注,并提出膈肌保护性通气策略。2019年,以尽可能保护患者肺和膈肌功能为目标的肺-膈肌保护性通气策略被首次提及。本文总结了肺-膈肌保护性通气策略的实施原则、监测方法和具体的监测目标,以及一些可能有助于通气策略更好实施的干预治疗,旨在帮助临床医师从生理学角度更好地理解肺-膈肌保护性通气理念,并在临床中进行呼吸驱动监测。Mechanical ventilation may cause iatrogenic lung and diaphragm injuries for a variety of reasons.Lung protective mechanical ventilation has been widely recognized and implemented,and ventilator-induced diaphragmatic dysfunction has been gradually concerned by clinicians in recent years.The diaphragm protective ventilation strategy has been later proposed.The lung and diaphragm protective ventilation strategy contributes to the protection of lung and diaphragm functions as much as possible,which was initially described in 2019.This paper summarized the implementation principles,monitoring methods and specific monitoring objectives of the lung and diaphragm protective ventilation strategy,as well as some interventions that may contribute to a better implementation of the ventilation strategy.The findings aim to help clinicians better understand the concept of lung and diaphragm protective ventilation from the physiological prospective,thus accelerating the monitoring of respiration in the clinical practice.

关 键 词：呼吸机相关性肺损伤 呼吸 人工 膈肌功能障碍 肺膈肌保护性通气 

分 类 号：R56[医药卫生—呼吸系统]