急性呼吸窘迫综合征患者肌松剂滴定的必要性与可行性  

Muscle relaxants titration in patients with acute respiratory distress syndrome:necessity and feasibility

作　　者：刘悦 潘纯[1] Yue Liu;Chun Pan(Jiangsu Provincial Key Laboratory of Critical Care Medicine,Department of Critical Care Medicine,Zhongda Hospital,Southeast University,Nanjing 210009,China)

机构地区：[1]江苏省重症医学重点实验室,东南大学附属中大医院重症医学科,南京210009

出　　处：《中华重症医学电子杂志》2024年第2期108-112,共5页Chinese Journal Of Critical Care & Intensive Care Medicine(Electronic Edition)

基　　金：江苏省卫健委重点项目(ZD2021057)。

摘　　要：ARDS患者常面临呼吸驱动过强的窘境,肌松治疗是规避过强呼吸驱动可能导致的膈肌功能障碍的有效手段。然而由于ARDS治疗中肌松剂的滥用,最新欧洲重症医学学会(ESICM)指南指出,ARDS治疗中不推荐常规使用肌松剂用于降低病死率。因此在ARDS临床治疗中应当针对有肌松指征的患者进行肌松剂量的滴定,谨慎选择合适的肌松深度,才能使肌松治疗有助于患者预后的改善。目前可通过无创及有创等多种手段进行肌松深度的监测,从而避免盲目肌松带来的危害,实现膈肌保护性通气。Patients diagnosed with acute respiratory distress syndrome(ARDS)often face the dilemma of excessive respiratory drive.Muscle relaxation therapy is an effective means to avoid diaphragm dysfunction that may be caused by excessive respiratory drive.However,due to the abuse of muscle relaxants in the treatment of ARDS,the latest ESICM guidelines point out that the routine use of muscle relaxants in the treatment of ARDS is not recommended to reduce mortality.Therefore,in the clinical treatment of ARDS,the dose of muscle relaxation should be titrated for patients with indications of muscle relaxation,and the appropriate depth of muscle relaxation should be carefully selected so that muscle relaxation treatment can help improve the prognosis of patients.Currently,the depth of muscle relaxation can be monitored through non-invasive and invasive means,so as to avoid the harm caused by blind muscle relaxation and realize protective ventilation of the diaphragm.

关 键 词：急性呼吸窘迫综合征 神经阻滞药物 呼吸力学 个体化治疗 

分 类 号：R563.8[医药卫生—呼吸系统]