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中华重症医学电子杂志 ›› 2019, Vol. 05 ›› Issue (03) : 209 -212. doi: 10.3877/cma.j.issn.2096-1537.2019.03.001

所属专题: 重症医学 文献

观点

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
刘旭1, 潘纯1,()   
  1. 1. 210009 南京,东南大学附属中大医院重症医学科
  • 收稿日期:2017-10-09 出版日期:2019-08-28
  • 通信作者: 潘纯
  • 基金资助:
    国家自然科学基金面上项目(81571847); 江苏省医学重点学科(实验室)(ZDXKA2016025)

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

Xu Liu1, Chun Pan1,()   

  1. 1. Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, China
  • Received:2017-10-09 Published:2019-08-28
  • Corresponding author: Chun Pan
  • About author:
    Corresponding author: Pan Chun, Email:
引用本文:

刘旭, 潘纯. 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[J/OL]. 中华重症医学电子杂志, 2019, 05(03): 209-212.

Xu Liu, Chun Pan. The influence of spontaneous breathing on severe ARDS patients: more harm than good[J/OL]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2019, 05(03): 209-212.

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.

图1 不同研究对象肺内气体摆动。图a为正常人,图b为ARDS患者,1 cmH2O=0.098 kPa
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