呼吸机相关性肺损伤与机械能

doi:10.3969/j.issn.1674-490X.2020.06.003

摘要/Abstract

摘要： 急性呼吸窘迫综合征是ICU最常见的疾病之一,病死率高达46%。机械通气作为其关键的支持治疗手段,有助于提高患肺的氧合状态。若呼吸机参数设置不当或自主呼吸努力过强均可能增加呼吸机相关性肺损伤风险,加速病情恶化,增加病死率。近年来,对呼吸机相关性肺损伤的研究,目前公认的经典机制包括气压伤、容积伤、剪切伤以及生物伤。研究者试图定性甚至定量导致肺损伤的因素。直到2016年Gattinoni等结合呼吸运动方程首次提出计算机械能概念及计算公式,为量化肺损伤带来新的研究方向。如何结合机械能的理念制定最佳的肺保护通气策略再次成为目前的研究热点。关于机械能的研究尚在起步阶段,现将从机械能方程的推导过程,各负荷因素对机械能的影响,分析最优化的通气模式和肺保护策略。

关键词: 急性呼吸窘迫综合征, 机械通气, 呼吸机相关性肺损伤, 机械能, 肺保护通气策略

Abstract: Acute respiratory distress syndrome is one of the most common diseases in ICU with a mortality rate of 46%. Mechanical ventilation as a key supporting treatment is helpful to improve the oxygenation of the affected lung. Improper setting of ventilator parameters or overexertion of spontaneous breathing may increase the risk of ventilator-induced lung injury, accelerate the deterioration of the disease, and increase the fatality rate. In recent years, research on ventilator-induced lung injury has been conducted, and the currently recognized classical mechanisms include barotrauma, volume injury, shear injury, and biological injury. Researchers have tried to quantify or even quantify the factors that contribute to lung injury. Until 2016, Gattinoni et al. proposed the concept of calculating mechanical power and calculation formula for the first time in combination with the respiratory motion equation, bringing new research direction for quantifying lung injury. How to combine the concept of mechanical power to develop the best lung protection ventilation strategy has once again become a research hotspot. The research on mechanical power is still in the initial stage. Now, the optimal ventilation mode and lung protection strategy will be analyzed from the derivation process of mechanical power equation and the influence of various load factors on mechanical power.

Key words: acute respiratory distress syndrome, mechanical ventilation, ventilator-induced lung injury, mechanical power, lung protection ventilation strategy

中图分类号:

R332.1

杨倩,梁璐. 呼吸机相关性肺损伤与机械能[J]. 医学研究与教育, 2020, 37(6): 14-22.

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