膈肌超声评估急性呼吸窘迫综合征患者脱机的应用价值

Application Value of Diaphragmatic Ultrasound in Assessing Deconditioning in Patients with Acute Respiratory Distress Syndrome

摘要: 急性呼吸窘迫综合征(ARDS)是一种由多个内部和外部因素引起的临床综合征，其显著特征包括急性弥漫性肺损伤和顽固性低氧血症。在影像学检查中，ARDS通常表现为双肺的弥漫性渗出性改变。大多数ARDS患者可能需要有创机械通气支持来维持氧合和通气，尽管机械通气在抢救生命中起到了重要作用，但也可能导致某些并发症。因此，及时且准确的撤机对于改善重症患者的预后极为重要。膈肌作为撤机后自主呼吸的主要吸气肌，其功能对于脱机的成功具有决定性作用。膈肌超声被认为是一种无侵入性且容易在床边使用的检测工具，已有研究证明它可以准确并迅速地判断膈肌的功能问题。这项技术是通过观察膈肌的活动性、厚度和增厚率来评估其功能的，这为确定撤机的时机提供了重要的依据。本文探讨了使用膈肌超声在评估急性呼吸窘迫综合征患者脱机过程中的应用价值。

Abstract: Acute respiratory distress syndrome (ARDS) is a clinical syndrome caused by multiple internal and external factors, and its distinguishing features include acute diffuse lung injury and persistent hypoxemia. On imaging, ARDS usually presents as diffuse exudative changes in both lungs. Most patients with ARDS may require invasive mechanical ventilation support to maintain oxygenation and ventilation, and although mechanical ventilation plays an important role in saving lives, it may also lead to certain complications. Therefore, timely and accurate machine withdrawal is extremely important to improve the prognosis of critically ill patients. The function of the diaphragm, as the main inspiratory muscle for spontaneous breathing after machine withdrawal, is decisive for the success of deconditioning. Diaphragmatic ultrasound is recognized as a noninvasive and easy-to-use testing tool at the bedside, and has been shown to accurately and rapidly determine functional problems of the diaphragm. This technique assesses the function of the diaphragm by looking at its mobility, thickness and rate of thickening, which provides an important basis for determining the timing of withdrawal. This article discusses the value of using diaphragmatic ultrasound in assessing the process of deconditioning in patients with acute respiratory distress syndrome.