Assist-control mechanical ventilation attenuates ventilator-induced diaphragmatic dysfunction
Assist-control mechanical ventilation attenuates ventilator-induced diaphragmatic dysfunction
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DOI：
10.1164/rccm.200401-042oc
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发表时间：
2004-09-15
影响因子：
24.7
通讯作者：
Caiozzo, VJ
中科院分区：
文献类型：
--
作者：
Sassoon, CSH;Zhu, EC;Caiozzo, VJ
控制性机械通气引起严重的膈肌功能障碍和萎缩。辅助机械通气的血管收缩对血管等长、等张收缩特性或肌肉萎缩因子盒（MAF盒）（肌肉萎缩的基因）表达的影响尚不清楚。我们假设辅助机械通气可以保护呼吸力并防止MAF盒的过度表达。研究镇静家兔随机分为对照组、辅助通气3天组和控制通气组，我们评估了体外血管等长收缩和等张收缩功能。测量收缩蛋白、肌球蛋白重链亚型和MAF盒mRNA的浓度。辅助通气和控制通气分别使强直力下降14%和48%。与辅助通气和控制相比，控制组的最大缩短速度有增加的趋势。辅助通气的峰值功率输出降低了20%，控制通气降低了41%。收缩蛋白与任何一种通气模式不变;肌球蛋白重链2X mRNA趋于增加，2A的减少与控制通气。控制性通气组MAF盒基因过表达。我们的结论是，在机械通气过程中，保持血管收缩减弱了完全不活动引起的力损失，并保持MAF盒基因表达的控制。
Controlled mechanical ventilation induced a profound diaphragm muscle dysfunction and atrophy. The effects of diaphragmatic contractions with assisted mechanical ventilation on diaphragmatic isometric, isotonic contractile properties, or the expression of muscle atrophy factor-box (MAF-box), the gene responsible for muscle atrophy, are unknown. We hypothesize that assisted mechanical ventilation will preserve diaphragmatic force and prevent overexpression of MAF-box. Studying sedated rabbits randomized equally into control animals, those with 3 days of assisted ventilation, and those with controlled ventilation, we assessed in vitro diaphragmatic isometric and isotonic contractile function. The concentrations of contractile proteins, myosin heavy chain isoform, and MAF-box mRNA were measured. Tetanic force decreased by 14% with assisted ventilation and 48% with controlled ventilation. Maximum shortening velocity tended to increase with controlled compared with assisted ventilation and control. Peak power output decreased 20% with assisted ventilation and 41% with controlled ventilation. Contractile proteins were unchanged with either modes of ventilation; myosin heavy chain 2X mRNA tended to increase and that of 2A to decrease with controlled ventilation. MAF-box gene was overexpressed with controlled ventilation. We conclude that preserving diaphragmatic contractions during mechanical ventilation attenuates the force loss induced by complete inactivity and maintains MAF-box gene expression in control.