跨肺压监测在急性呼吸窘迫综合征患者机械通气中的应用进展与问题

Application progress and problems of transpulmonary pressure monitoring in mechanical ventilation in the patients with acute respiratory distress syndrome

跨肺压(transpulmonary pressure,P_(L))是实际作用于肺的应力,是引起急性呼吸窘迫综合征(acute respiratory distress syndrome,ARDS)患者肺损伤的主要机制。而在ARDS患者机械通气中,采用何种最佳策略评价和预防呼吸机相关性肺损伤(ventilator associated lung injury,VILI)仍是很有争议的问题。虽然最近的研究主要聚焦在跨肺压监测指导呼吸机参数设置,实现呼吸系统的个体化治疗,结果显示能改善患者氧合,并减少VILI。但是这些研究中跨肺压的监测方法各有不同,所以各自存在一些需要解决的假设条件和潜在问题。本文分析了通过监测跨肺压指导ARDS患者机械通气中呼吸机参数设置的优缺点,以期为个体化、精准化治疗的临床应用提供帮助。

Transpulmonary pressure(P_(L))is the actual stress acting on the lung and the main mechanism of lung injury in the patients with acute respiratory distress syndrome(ARDS).What is the best strategy to evaluate and prevent ventilator-associated lung injury(VILI)in ARDS patients with mechanical ventilation is still a controversial issue.Although recent studies mainly focus on the transpulmonary pressur monitoring for guiding ventilator parameter setting and realizing individualized treatment of respiratory system,the results show that it can improve the oxygenation and reduce VILI.However,the monitoring methods of transpulmonary pressure in these studies are different,so there are some assumptions and potential problems to be solved.This paper analyzes the advantages and disadvantages of the setting of ventilator parameters by monitoring transpulmonary pressure in mechanical ventilation of ARDS patients,in order to provide help for the clinical application of individualized and accurate treatment.