呼吸机引起的膈肌功能障碍与脱机肺水肿的研究进展

Progress in research of ventilator-induced diaphragm dysfunction and weaning-induced pulmonary oedema

膈肌功能障碍和脱机引起的肺水肿是导致脱机失败的两个重要原因。膈肌功能障碍会降低膈肌收缩力量,使肺通气减少,引起脱机失败;脱机时胸内负压增大,通过增加静脉回流和左心室后负荷,导致脱机肺水肿和呼吸窘迫。本文对膈肌功能障碍和脱机引起的肺水肿的发生机制、诊断方法以及治疗策略进行综述。

Diaphragm dysfunction and weaning-induced pulmonary oedema are two important causes of weaning failure.Diaphragm dysfunction can reduce contraction force of the diaphragm,compromising pulmonary ventilation loss and causing a subsequent weaning failure.Large negative swings in intrathoracic pressure during weaning tend to increase the venous return and the left ventricular afterload,contributing to weaning-induced pulmonary oedema and respiratory distress.This article reviews the mechanisms,diagnosis and strategies of treatment of diaphragm dysfunction and weaning-induced pulmonary oedema.