机械通气诱导气道塌陷中气道平滑肌细胞力学行为异常的研究进展  

Mechanical Ventilator-Induced Airway Collapse Due to Abnormal Mechanical Behaviors of Airway Smooth Muscle Cells:A Review

作　　者：罗明志 张向荣 孙长雨 钟家缘 王春红 顾榕 倪凯 邓林红 LUO Mingzhi;ZHANG Xiangrong;SUN Changyu;ZHONG Jiayuan;WANG Chunhong;GU Rong;NI Kai;DENG Linhong(Changzhou Key Laboratory of Respiratory Medical Engineering,Institute of Biomedical Engineering and Health Sciences,School of Medical and Health Engineering,Changzhou University,Changzhou 213164,Jiangsu,China)

机构地区：[1]常州大学常州市呼吸医学工程重点实验室,生物医学工程与健康科学研究院,医学与健康工程学院,江苏常州213164

出　　处：《医用生物力学》2024年第5期998-1004,共7页Journal of Medical Biomechanics

基　　金：国家自然科学基金面上项目(12072048,12272063)。

摘　　要：机械通气为呼吸危重症患者提供生命支持,但也引起致命的肺损伤(ventilator induced lung injury,VILI),后者因病理机制不明一直是呼吸与危重症学科的重大难题。近年的研究发现,一方面VILI伴随同一气道多点塌陷现象,但这一现象很难用传统塌陷模型加以解释。另一方面,机械通气条件下气道平滑肌细胞(airway smooth muscle cells,ASMC)发生力学行为异常并伴随Piezo1表达变化和内质网应激等现象。这些现象显示,机械通气导致ASMC的力学行为异常与气道多点塌陷以及VILI密切相关。但要从细胞力学角度解释机械通气导致气道塌陷和VILI的机制,还需要系统深入地研究机械通气条件下ASMC力学行为变化规律与气道塌陷和肺损伤的相互关系及其力-化学信号耦合过程。本文综述了近期有关机械通气条件下气道塌陷现象、机械通气相关高拉伸对ASMC力学行为的调控及力-化学信号耦合机制等方面的研究进展,以期为进一步探索ASMC力学行为异常在VILI病理机制中的作用、有效防治VILI的新药干预靶点,以及临床优化的机械通气策略等提供重要的参考依据和启发性的研究思路。Mechanical ventilation(MV)provides life support for critically ill respiratory patients,but in the meantime can cause fatal ventilator-induced lung injury(VILI),and the latter remains a major challenge in respiratory and critical care medicine,because the pathological mechanism has not been fully elucidated.Recent studies show that on the one hand,in the lung with VILI,there exists airway collapse at multi-sites of an individual airway,which can not be explained by traditional airway collapse models.But on the other hand,under MV conditions,airway smooth muscle cells(ASMC)exhibit abnormal mechanical behaviors,accompanied by regulation of Piezo1 expression and endoplasmic reticulum stress.These phenomenons indicate that the MV-induced abnormal mechanical behavior of ASMC is closely related to multiple airway collapse and VILI.Therefore,by studying the MV-induced changes of ASMC mechanical behaviors and their relationship with airway collapse in lung injury,as well as the related mechanochemical signal coupling process,it is expected to reveal a novel mechanism of MV-associated airway collapse and lung injury from the perspective of cell mechanics.In this review,the recent research progress of airway collapse during MV,the regulation of ASMC mechanical behavior by MV-related high stretch,especially the related mechanochemical signal coupling mechanism is summarized.These advances may provide a novel insight for exploring the roles of ASMC abnormal mechanical behavior in the pathological mechanism of VILI,alternative targets of drug intervention for prevention and treatment of VILI,as well as for optimizing the ventilation mode in clinical practice.

关 键 词：机械通气 拉伸应变 气道平滑肌细胞 细胞力学响应 细胞力学感受器 

分 类 号：R318.01[医药卫生—生物医学工程]