部分神经肌肉阻滞在急性呼吸窘迫综合征肺与膈肌保护性通气中的应用  

Application of partial neuromuscular blockade in lung and diaphragm protective ventilation in acute respiratory distress syndrome

作　　者：侯丹 李一青[2] 周建新 李宏亮 HOU dan;LI Yi-qing;ZHOU Jian-xin;LI Hong-liang(Department of Critical Care Medicine,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China;Department of Critical Care Medicine,Xi′an Electric Power Central Hospital,Xi′an 710032,China;Department of Critical Care Medicine,Beijing Shijitan Hospital,Capital Medical University,Beijing 100038,China)

机构地区：[1]首都医科大学附属北京天坛医院重症医学科,北京100070 [2]西安电力中心医院重症医学科,陕西西安710032 [3]首都医科大学附属北京世纪坛医院重症医学科,北京100038

出　　处：《实用医院临床杂志》2024年第4期9-13,共5页Practical Journal of Clinical Medicine

基　　金：首都临床诊疗技术研究及转化应用项目(编号:Z201100005520079)。

摘　　要：肺与膈肌保护性通气,是对急性呼吸窘迫综合征患者实施正压机械通气过程中需要遵守的基本原则。为了避免强烈的自主呼吸驱动导致的跨肺压增加和膈肌过载性损伤,神经肌肉阻滞被推荐用于中重度急性呼吸窘迫综合征的早期治疗阶段,但会引起以膈肌废用性萎缩为特征的膈肌功能障碍。部分神经肌肉阻滞通过滴定式调节神经肌肉阻滞剂的药物剂量,可以在保留膈肌活性的同时将呼吸驱动的强度控制在安全范围内,是一种可行的肺与膈肌保护性通气策略。本综述旨在对相关领域的研究现状进行总结,以期对目前的临床实践提供指导,并为未来的相关研究方向提供思路。Implementing lung and diaphragm protective ventilation is the basic principle in positive pressure mechanical ventilation in patients with acute respiratory distress syndrome.Guidelines suggest using neuromuscular blockade agents to treat moderate to severe acute respiratory distress syndrome during the early stage to avoid vigorous spontaneous breathing,which could lead to increased driving pressure and diaphragm overload damage;however,diaphragmatic muscle disuse atrophy will be inevitable.Partial neuromuscular blockade by titration of the dose of neuromuscular blockers may keep the diaphragm active while maintaining the respiratory drive within the safe range,providing a feasible protective ventilation strategy in the lungs and diaphragm.This review aims to summarize the research status in related fields to provide guidance for current clinical practice and ideas for future research directions.

关 键 词：急性呼吸窘迫综合征 呼吸驱动 机械通气 肺与膈肌保护性通气 神经肌肉阻滞 

分 类 号：R563.8[医药卫生—呼吸系统]