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中华重症医学电子杂志 ›› 2023, Vol. 09 ›› Issue (01) : 19 -24. doi: 10.3877/cma.j.issn.2096-1537.2023.01.004

专题笔谈

反转触发:易被忽视的人机不同步
李宏亮1, 周建新2,()   
  1. 1. 100070 北京,首都医科大学附属北京天坛医院重症医学科
    2. 100070 北京,首都医科大学附属北京天坛医院重症医学科;100038 北京,首都医科大学附属北京世纪坛医院重症医学科
  • 收稿日期:2022-09-22 出版日期:2023-02-28
  • 通信作者: 周建新
  • 基金资助:
    首都临床诊疗技术研究及转化应用项目(Z201100005520079)

Reverse triggering: the easily overlooked patient-ventilator asynchrony

Hongliang Li1, Jianxin Zhou2,()   

  1. 1. Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
    2. Department of Critical Care Medicine, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China; Department of Critical Care Medicine, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
  • Received:2022-09-22 Published:2023-02-28
  • Corresponding author: Jianxin Zhou
引用本文:

李宏亮, 周建新. 反转触发:易被忽视的人机不同步[J]. 中华重症医学电子杂志, 2023, 09(01): 19-24.

Hongliang Li, Jianxin Zhou. Reverse triggering: the easily overlooked patient-ventilator asynchrony[J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2023, 09(01): 19-24.

在众多的人机不同步类型中,源于呼吸拖带所致的反转触发是一种较为独特的存在,除具有高度的隐匿性之外,如果成功触发呼吸机导致呼吸叠加,将会在控制性机械通气的预期之外提供更大的潮气量和更高的跨肺压,从而引起呼吸机相关肺损伤,并且对膈肌功能也产生一定的影响。本文从流行病学、病理生理学机制、临床意义及分型、识别及干预措施等角度对其研究现状进行综述,旨在提高临床医师的重视程度,并希望以此推动相关临床及基础研究的开展。

Among many types of patient-ventilator asynchrony, reverse triggering derived from respiratory entrainment is a unique existence. It's challenging to identify reverse triggering in clinical scenario. What's more, if the ventilator is triggered successfully, it is also called breath stacking. In that case, the increased tidal volume or transpulmonary pressure will lead to ventilator-induced lung injury and influence function of the diaphragm. We have reviewed the epidemiology, pathophysiology mechanisms, phenotypes, clinical significance, and management strategies of reverse triggering, aiming to improve clinical physicians' awareness and facilitate fundamental and clinical research.

图1 呼吸拖带示意图(容量控制通气模式,恒定送气流速)。图a为呼吸机流速-时间曲线;图b为食管内压-时间曲线。可见患者自主的神经吸气努力均发生在呼气相,对应的呼气峰流速较完全性控制通气时明显减小;每2次呼吸机控制性通气后出现一次神经吸气努力,拖带比为1∶2。红色虚线代表周期性呼吸机控制性通气的开始,绿色虚线代表拖带出的神经吸气努力的开始,两者之间的差值即为相位差(dP)。相位差和呼吸机通气周期的比值与360°的乘积即为相位角(θ)
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