Mechanical ventilation, diaphragm weakness and weaning: a rehabilitation perspective.
Mechanical ventilation, diaphragm weakness and weaning: a rehabilitation perspective.
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DOI：
10.1016/j.resp.2013.05.012
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发表时间：
2013-11-01
影响因子：
2.3
通讯作者：
Gabrielli, Andrea
中科院分区：
文献类型：
--
作者：
Martin, A. Daniel;Smith, Barbara K.;Gabrielli, Andrea
大多数患者在呼吸衰竭缓解和自主呼吸试验成功后，很容易摆脱机械通气(MV)，但约25%的患者经历了困难的脱机。使用机械通气会导致细胞改变和虚弱，这与脱机困难有关，已被标记为呼吸机诱导的横隔膜功能障碍(VIDD)。在人类研究中，长期断奶的加重因素包括营养不良、慢性电解质异常、高血糖、过多的阻力和弹性负荷、皮质类固醇、肌肉松弛药暴露、败血症和心脏功能受损。许多动物研究已经调查了MV对横隔膜功能的影响。几乎所有这些研究都得出结论，使用MV会迅速导致VIDD，并确定了VIDD的细胞和分子机制。关于MV对人体横隔膜影响的分子和功能研究已经在很大程度上证实了动物的结果，并确定了潜在的治疗策略。直到最近，潜在的VIDD治疗方法才在人类身上进行了测试，包括药物干预和横隔膜“训练”。有限数量的人体研究发现，特定的横隔膜训练可以增加FTW患者的呼吸肌力量，并有助于脱机，但需要进行更大规模的多中心试验。
Most patients are easily liberated from mechanical ventilation (MV) following resolution of respiratory failure and a successful trial of spontaneous breathing, but about 25% of patients experience difficult weaning. MV use leads to cellular changes and weakness, which has been linked to weaning difficulties and has been labeled ventilator induced diaphragm dysfunction (VIDD). Aggravating factors in human studies with prolonged weaning include malnutrition, chronic electrolyte abnormalities, hyperglycemia, excessive resistive and elastic loads, corticosteroids, muscle relaxant exposure, sepsis and compromised cardiac function. Numerous animal studies have investigated the effects of MV on diaphragm function. Virtually all of these studies have concluded that MV use rapidly leads to VIDD and have identified cellular and molecular mechanisms of VIDD. Molecular and functional studies on the effects of MV on the human diaphragm have largely confirmed the animal results and identified potential treatment strategies. Only recently have potential VIDD treatments been tested in humans, including pharmacologic interventions and diaphragm “training”. A limited number of human studies have found that specific diaphragm training can increase respiratory muscle strength in FTW patients and facilitate weaning, but larger, multicenter trials are needed.
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