重症监护病房膈肌功能监测研究进展

Progress of monitoring diaphragm function in intensive care unit

膈肌无力是膈肌功能障碍和萎缩的结果,并伴有严重临床后果,在重症监护病房很常见。通过磁刺激膈神经监测跨膈压,评估膈肌功能,无需受试者配合便能够提供标准化的测量,尤其适于重症监护病房配合不佳的患者;超声评估膈肌结构(厚度、增厚)和位移似乎是可行、可重复的,但尚无大规模研究证据支持;膈肌电活动与膈肌功能虽然相关,但这些测量的重复性在受试者内部表现出很高的异质性。脱机过程、人-机不协调和膈肌功能的评估可能是这些技术在临床上最相关的适应证。本综述介绍危重患者膈肌功能的临床问题,以及床旁膈肌功能监测的最新进展。

Diaphragm weakness is the result of diaphragm dysfunction and atrophy with severe clinical consequences,which is common in intensive care unit.Magnetic stimulation of phrenic nerve can monitor transdiaphragmatic pressure and evaluate diaphragm function,which can provide standardized measurement without the cooperation of subjects,especially for patients with poor cooperation in intensive care unit.The use of ultrasound to assess diaphragm structure(thickness,thickening)and displacement seems to be feasible and repeatable,but there is no large-scale research evidence to support it.Although the electrical activity of the diaphragm is correlated with diaphragm function,the repeatability of these measurements exhibits high heterogeneity within the subjects.The weaning process,human-machine discordance and assessment of diaphragm function may be the most relevant indications of these techniques in clinic.This paper introduces the clinical problems of diaphragm function in critically ill patients and the latest progress of bedside monitoring of diaphragm function.