重症心脏超声在评估机械通气撤机失败中的研究现状

Critical care echocardiography in the evaluation of weaning failure from mechanical ventilation

机械通气是重症患者重要的呼吸支持手段,机械通气时间延长或缩短均会对患者造成不利影响。因此,准确地评估及判定撤机时间是重症患者治疗过程中的重点及难点。撤机过程可引起心血管及呼吸系统的一系列病理生理变化:如胸内压显著下降、呼吸功增加、肾上腺素能激活、低氧血症、高碳酸血症等,它们被认为是撤机所致心原性肺水肿的主要机制。最新的一系列研究提示,患者的心功能可能是影响撤机成败的关键因素之一。重症心脏超声近年来在许多疾病中均得到了广泛的研究与应用。最新研究提示,重症心脏超声能够帮助预测撤机失败,并且诊断是否为心原性原因引起。因此,重症心脏超声可能能够为指导成功撤机提供新思路。

Mechanical ventilation is one of the important life support therapies. Mechanical ventilation may be harmful to critically ill patients when it is prolonged or shortened from the appropriate period. Thus,it is important and difficult to assess and judge the time of weaning in the clinical course of treatment. Weaning progress can cause a series of pathophysiological changes in cardiovascular and respiratory systems,such as decreased intrathoracic pressure,increased respiratory function,adrenergic activation,hypoxemia,hypercapnia,etc.,all of which are considered as the main mechanisms for cardiogenic pulmonary edema. Recent studies indicate that cardiac function may be one of the key factors that affecting the weaning outcomes. Critical care echocardiography have been widely studied and applied in many diseases. Latest studies found that critical care echocardiography could be used in predicting weaning failure and diagnosing whether it is cardiogenic. Therefore,Critical care echocardiography may be able to provide new ideas for guiding successful weaning.