床边超声对机械通气患者膈肌功能评估的研究进展

膈肌功能障碍在重症患者中发病率高,是导致患者呼吸衰竭和延迟机械通气撤离的重要原因,且易被忽视。以往传统评估膈肌结构和功能的方法具有创伤性,缺乏特异性,且不便于床旁应用,而超声评估膈肌功能和结构具有准确、安全、无创等优点。床旁超声通过测量膈肌活动度、膈肌厚度和膈肌厚度变化率评估膈肌功能,临床用于鉴定膈肌功能障碍及膈肌功能丧失,监测膈肌萎缩程度和做功能力及人机同步性,并用于预测撤机结果。本文阐述床边超声对机械通气患者膈肌功能评估的进展及存在的问题,为临床采用该技术提供指导和帮助。

Bedside ultrasound evaluation of diaphragmatic function in mechanically ventilated patients

Diaphragm dysfunction has a high incidence in critically ill patients, which is the cause of respiratory failure and prolonged weaning, and is easily overlooked. In the past, traditional methods to evaluate the structure and function of diaphragm were traumatic, lacking specificity and not convenient for bedside application. Ultrasound evaluation of diaphragmatic function and structure is accurate, safe and non-invasive. Bedside ultrasound assessed diaphragm function could be diaphragmatic inspiratory excursion, thickness of diaphragm (Tdi), and thickening fraction (TF). Diaphragm ultrasound is used to identify diaphragmatic dysfunction or diaphragmatic paralysis, to monitor the degree of diaphragm atrophy and the capability of respiratory muscles workload and patient-ventilator synchrony, and also to predict weaning. This article reviewed the progress and problems with bedside ultrasound assessment of the diaphragmatic function in mechanical ventilated patients and provided guidance to the clinical use of this technique.