保留自主呼吸对于重度急性呼吸窘迫综合征患者的影响:弊大于利

The influence of spontaneous breathing on severe ARDS patients: more harm than good

急性呼吸窘迫综合征(ARDS)是临床上常见的以顽固性低氧为表现的呼吸功能不全或衰竭的综合征,肺不均一性是其主要病理生理特点.传统观点认为,保留ARDS患者自主呼吸有助于改善全身氧合.但是近年来发现,对于重度ARDS患者,保留患者自主呼吸会加重肺损伤,过强的自主呼吸会导致重度ARDS患者跨肺压升高、肺内气体摆动、肺水肿加重以及人机不同步,引起患者肺内炎症加重,氧合功能恶化,最终影响患者预后,增加病死率.本文就自主呼吸对重度ARDS患者呼吸功能的影响机制展开综述.

Acute respiratory distress syndrome (ARDS) is a clinical syndrome that is characterized by acute respiratory dysfunction or failure with refractory hypoxemia. Inhomogeneity of injury is the main pathophysiologic characteristic of ARDS. Conventionally, it is believed that spontaneous breathing can improve oxygenation. However, it has recently been proved that spontaneous breathing may worsen lung injury in severe ARDS patients. The mechanisms of injury from spontaneous breathing include elevated transpulmonary pressure, pendelluft, worse lung edema and patient-ventilator asynchronies, all of which aggravate pulmonary inflammation, worsen oxygenation and increase mortality. The purpose of this review is to discuss the influence of spontaneous breathing on severe ARDS patients.