Kim Won-Young, Lim Chae-Man
Department of Internal Medicine, Pusan National University School of Medicine, Busan, Republic of Korea.
Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Respir Care. 2017 Nov;62(11):1485-1491. doi: 10.4187/respcare.05622. Epub 2017 Jul 11.
The use of controlled mechanical ventilation results in a major reduction of diaphragmatic contractile force together with atrophy of diaphragm muscle fibers, which is a condition known as ventilator-induced diaphragmatic dysfunction. Ventilator-induced diaphragmatic dysfunction is one of the major contributors to weaning difficulties and even increased mortality. This review summarizes the current data on the pathogenesis and diagnosis of ventilator-induced diaphragmatic dysfunction, and it outlines the use of ultrasonography for diaphragm evaluation. In addition, current pharmacologic agents used to mitigate ventilator-induced diaphragmatic dysfunction are described, with a particular emphasis on the therapeutic potential of theophylline in patients with ventilator-induced diaphragmatic dysfunction-associated weaning difficulties.
控制性机械通气的使用会导致膈肌收缩力大幅下降以及膈肌肌纤维萎缩，这种情况被称为呼吸机诱发的膈肌功能障碍。呼吸机诱发的膈肌功能障碍是导致撤机困难甚至死亡率增加的主要因素之一。本综述总结了目前关于呼吸机诱发的膈肌功能障碍的发病机制和诊断的数据，并概述了超声检查在膈肌评估中的应用。此外，还描述了目前用于减轻呼吸机诱发的膈肌功能障碍的药物，特别强调了茶碱在患有与呼吸机诱发的膈肌功能障碍相关撤机困难患者中的治疗潜力。
