膈肌保护性通气的概念及进展

Concept and progresses of diaphragm protective ventilation

急性呼吸窘迫综合征发展至今五十余年,从最初的机械通气治疗到呼吸机相关肺损伤的识别,肺保护通气策略已成临床诊疗共识,但这一策略限制了呼吸机或患者自身呼吸努力对肺部施加的机械压力,脱机困难发生率日趋增加,膈肌功能障碍作用日趋明显,膈肌保护性通气策略应运而出,优化机械通气参数和膈肌负荷,减少人机不同步,可减轻或避免膈肌损伤。但肺保护仍然是机械通气首要考虑的因素,通过最佳方式来降低机械通气的并发症,优化患者呼吸努力,从而达到同时保护肺和膈肌的作用。本文就膈肌保护性通气的概念和进展进行综述。

It has been over 50 years since the proposal of acute respiratory distress syndrome.From the initial mechanical ventilation treatment to the recognition of ventilator-related lung injury,lung protective ventilation strategy has become a consensus clinically.As the strategy limits the mechanical pressure exerted on the lungs by the ventilator or the patient’s own breathing efforts,the incidence of weaning difficulties is increasing,and the role of diaphragm dysfunction is becoming more and more obvious.Diaphragm protective ventilation strategy should be applied.Optimizing mechanical ventilation parameters and diaphragmatic load and reducing ventilator asynchronization,can reduce or avoid diaphragmatic injury.However,lung protection should still be the primary consideration of mechanical ventilation.Through the best way to reduce the complications of mechanical ventilation and optimize the patient’s respiratory efforts,the protection of lung and diaphragm should be achieved simultaneously.This article reviews the concept and progress of diaphragmatic protective ventilation.