气道闭合的监测在机械通气中的研究进展  

Progress in the monitoring of airway closure in mechanical ventilation

作　　者：刘婷 杨少康 陈亿霏 刘悦 潘纯 Liu Ting;Yang Shaokang;Chen Yifei;Liu Yue;Pan Chun(Jiangsu Provincial Key Laboratory of Critical Care Medicine,Department of Critical Care Medicine,Zhongda Hospital,School of Medicine,Southeast University,Nanjing 210009,China;Sichuan Academy of Medical Sciences,Critical Care Medicine Center,Sichuan People’s Hospital,Chengdu 610072,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 [2]四川省医学科学院,四川省人民医院重症医学中心,成都610072

出　　处：《中华重症医学电子杂志》2024年第4期394-398,共5页Chinese Journal Of Critical Care & Intensive Care Medicine(Electronic Edition)

摘　　要：气道闭合是由于气道塌陷导致气道和肺泡之间连接中断,其发生率约为30%,在肥胖合并急性呼吸窘迫综合征(ARDS)患者中的发生率更可高达65%。“液体桥形成”“小气道顺应性塌陷”“表面活性物质耗竭”等均可导致气道闭合,但确切机制尚不清楚。气道闭合不仅影响肺通气功能,在机械通气过程中,忽略此现象还会造成肺可复张性评估及呼吸力学测定错误,从而影响呼吸机参数的恰当设置,甚至可导致或加重肺损伤,对基于心肺交互作用的容量反应性评估指标也可产生一定影响。临床上可通过“低流速法”或“传导压力法”对气道闭合现象进行监测。本文围绕气道闭合现象及其对呼吸和循环的影响进行综述,强调监测气道闭合的重要性,以加深临床医师对气道闭合的认识,从而改善存在气道闭合的机械通气患者的预后。Airway closure refers to a lack of communication between proximal airways and alveoli due to airway collapse.It occurs in about 30%of patients,rising to up to 65%of patients with obesity and ARDS.“Liquid bridge formation,”“small airway compliant collapse,”or“surfactant depletion”can lead to airway closure,however,the exact mechanism is unknown.Airway closure not only affects the function of lung ventilation,but also in the process of mechanical ventilation,ignoring this phenomenon can lead to errors in lung recruitment assessment and respiratory mechanics measurement.This can affect the appropriate setting of ventilator parameters,even leading to or aggravating lung injury,and impacting on the fluid responsiveness assessment index based on heart-lung interaction.Airway closure can be monitored clinically by“low flow method”or“conductive pressure method”.This article reviews the phenomenon of airway closure and its impacts on respiration and circulation,emphasizing the importance of monitoring airway closure to deepen clinicians’understanding and thereby improve the prognosis of mechanically ventilated patients with airway closure.

关 键 词：气道闭合 气道开放压 肺损伤 呼吸力学 

分 类 号：R563.8[医药卫生—呼吸系统]