摘要
随着医学的不断发展与进步,全麻手术总量日益增加,术后并发症的发生也不断增多,尤其是围手术期肺损伤导致的术后肺部并发症(PPCs)。PPCs是导致全麻手术患者住院时间延长、病死率增高、预后不良及医疗负担加重的主要原因。随着对机械通气认识的加深及加速康复外科(ERAS)理念的实施,肺保护性通气策略(LPVS)越来越受到人们的重视。然而,关于如何有效应用LPVS仍存在争议。最近,膈肌保护性通气作为一个新颖的概念被提出并使人们意识到,保护性通气策略的应用应该在肺保护性通气的范围内限制机械通气对膈肌功能的不利影响。如何有效应用保护性通气策略来预防呼吸机相关性肺损伤(VILI)、呼吸机相关性膈肌功能障碍(VIDD),降低PPCs的发生率,改善患者的预后,并减轻医疗负担是机械通气患者管理中的重要挑战。本文就肺和膈肌联合保护的通气策略,结合LPVS的最新进展,对个体化通气策略的应用研究及VILI、VIDD的发生机制进行阐述,并对未来保护性通气策略的研究方向进行展望。
With the continuous development and progress of medicine,the total number of general anesthetic surgery is increasing,and postoperative complications are also on the rise,especially postoperative pulmonary complications(PPCs)caused by perioperative lung injury.PPCs are the main cause of prolonged hospitalization,increased morbidity and mortality,poor prognosis,and increased medical burden in patients undergoing general anesthesia.With the enhancement of awareness of mechanical ventilation and the implementation of the enhanced recovery after surgery(ERAS)concept,lung-protective ventilation strategies(LPVS)are receiving more and more attention.However,the debate continues on how to apply the LPVS effectively.The recent introduction of diaphragm-protective ventilation as a novel concept has led to the realization that the application of protective ventilation strategies should limit the adverse effects of mechanical ventilation on diaphragm function within the context of lung protective ventilation.How to apply protective ventilation strategies effectively to prevent the development of ventilator-induced lung injury(VILI)and ventilator-induced diaphragm dysfunction(VIDD),reduce the incidence of PPCs,improve patient prognosis,and reduce the medical burden is an important challenge in the management of mechanically ventilated patients.In this paper,we will focus on ventilation strategies of lung and diaphragm combined with the latest progress of LPVS,to elaborate the research on the application of individualized ventilation strategies and the mechanisms of VILI and VIDD occurrence.Finally,prospecting the future research direction of protective ventilation strategies.
作者
叶婷
肖华平
Ye Ting;Xiao Hua-Ping(Department of Anesthesiology,Medical College of Nanchang University,Nanchang,Jiangxi 330006,China;Department of Anesthesiology,Jiangxi Cancer Hospital,Nanchang,Jiangxi 330029,China)
出处
《解放军医学杂志》
CAS
CSCD
北大核心
2023年第11期1276-1286,共11页
Medical Journal of Chinese People's Liberation Army
基金
江西省重点研发计划项目(S2020ZPYFB1754)。
关键词
全麻
机械通气
肺部并发症
肺保护
膈肌保护
general anesthesia
mechanical ventilation
pulmonary complications
lung-protective
diaphragm-protective
