膈肌功能障碍的研究进展
Research Progress of Diaphragmatic Dysfunction
DOI: 10.12677/acm.2024.1441017, PDF,   
作者: 鲜俊杰, 杜 权*:重庆医科大学附属第二医院麻醉科,重庆
关键词: 膈肌功能障碍评估Diaphragm Dysfunction Evaluation
摘要: 膈肌是人体最重要的呼吸肌,机械通气、炎症感染、麻醉药物、手术操作等多种因素都可能会引起膈肌形态、功能的改变,严重时会导致膈肌功能障碍(Diaphragmatic Dysfunction, DD),进而影响患者康复。因此,即时识别膈肌功能障碍并采取必要措施进行预防或治疗,在患者恢复中体现出了重要价值。本文就膈肌功能障碍的研究进展进行综述。
Abstract: The diaphragm is the most important respiratory muscle in the human body. Mechanical ventilation, inflammation and infection, anesthetic drugs, surgical operation and other factors may cause changes in the shape and function of the diaphragm, which may lead to diaphragm Dysfunction (Diaphragmatic Dysfunction, DD) in serious cases, and further affect the recovery of the patient. Therefore, the immediate recognition of diaphragmatic dysfunction and the necessary measures for prevention or treatment are of great value in the patient’s recovery. This article reviews the research progress of diaphragmatic dysfunction.
文章引用:鲜俊杰, 杜权. 膈肌功能障碍的研究进展[J]. 临床医学进展, 2024, 14(4): 271-277. https://doi.org/10.12677/acm.2024.1441017

参考文献

[1] Wilson, T.A., Legrand, A., Gevenois, P.A., et al. (2001) Respiratory Effects of the External and Internal Intercostal Muscles in Humans. The Journal of Physiology, 530, 319-330. [Google Scholar] [CrossRef] [PubMed]
[2] Cecconi, M., Evans, L., Levy, M., et al. (2018) Sepsis and Septic Shock. Lancet, 392, 75-87. [Google Scholar] [CrossRef
[3] Fayssoil, A., Behin, A., Ogna, A., et al. (2018) Diaphragm: Pathophysiology and Ultrasound Imaging in Neuromuscular Disorders. Journal of Neuromuscular Diseases, 5, 1-10. [Google Scholar] [CrossRef
[4] 黄嘉炜, 王明军, 韩佳欣, 等. 膈肌功能测定与膈肌超声评估进展[J]. 临床医学研究与实践, 2022, 7(3): 186-190.
[5] Thomason, D.B., Biggs, R.B. and Booth, F.W. (1989) Protein Metabolism and Beta-Myosin Heavy-Chain mRNA in Unweighted Soleus Muscle. Amercian Journal of Physiology, 257, R300-R305. [Google Scholar] [CrossRef
[6] McCool, F.D., Manzoor, K. and Minami, T. (2018) Disorders of the Diaphragm. Clinics in Chest Medicine, 39, 345-360. [Google Scholar] [CrossRef] [PubMed]
[7] Eastwood, P.R., Szollosi, I., Platt, P.R., et al. (2002) Collapsibility of the Upper Airway during Anesthesia with Isoflurane. Anesthesiology, 97, 786-793. [Google Scholar] [CrossRef] [PubMed]
[8] Campbell, C., Weinger, M.B. and Quinn, M. (1995) Alterations in Diaphragm EMG Activity during Opiate-Induced Respiratory Depression. Respiration Physiology, 100, 107-117. [Google Scholar] [CrossRef
[9] Qaseem, A., Snow, V., Fitterman, N., et al. (2006) Risk Assessment for and Strategies to Reduce Perioperative Pulmonary Complications for Patients Undergoing Noncardiothoracic Surgery: A Guideline From the American College of Physicians. Annals of Internal Medicine, 144, 575-580. [Google Scholar] [CrossRef] [PubMed]
[10] Cruz-Jentoft, A.J. and Sayer, A.A. (2019) Sarcopenia. The Lancet, 393, 2636-2646. [Google Scholar] [CrossRef
[11] Decramer, M. and Gayan-Ramirez, G. (2004) Ventilator-Induced Diaphragmatic Dysfunction: Toward a Better Treatment? American Journal of Respiratory and Critical Care Medicine, 170, 1141-1142. [Google Scholar] [CrossRef] [PubMed]
[12] Adhikari, N.K., Fowler, R.A., Bhagwanjee, S. and Rubenfeld, G.D. (2010) Critical Care and the Global Burden of Critical Illness in Adults. The Lancet, 376, 1339-1346. [Google Scholar] [CrossRef
[13] Béduneau, G., Pham, T., Schortgen, F., et al. (2017) Epidemiology of Weaning Outcome According to a New Definition. The WIND Study. American Journal of Respiratory and Critical Care Medicine, 195, 772-783. [Google Scholar] [CrossRef
[14] Goligher, E.C., Dres, M., Fan, E., et al. (2018) Mechanical Ventilation-Induced Diaphragm Atrophy Strongly Impacts Clinical Outcomes. American Journal of Respiratory and Critical Care Medicine, 197, 204-213. [Google Scholar] [CrossRef
[15] Goligher, E.C., Brochard, L.J., Reid, W.D., et al. (2019) Diaphragmatic Myotrauma: A Mediator of Prolonged Ventilation and Poor Patient Outcomes in Acute Respiratory Failure. The Lancet Respiratory Medicine, 7, 90-98. [Google Scholar] [CrossRef
[16] 孙旗, 钱风华. 呼吸机相关性膈肌功能障碍的发病机制及治疗进展[J]. 中国急救医学, 2021, 41(10): 907-910.
[17] Powers, S.K., Shanely, R.A., Coombes, JS.., et al. (2002) Mechanical Ventilation Results in Progressive Contractile Dysfunction in the Diaphragm. Journal of Applied Physiology, 92, 1851-1858. [Google Scholar] [CrossRef] [PubMed]
[18] Whidden, M.A., Smuder, A.J., Wu, M., et al. (2010) Oxidative Stress Is Required for Mechanical Ventilation-Induced Protease Activation in the Diaphragm. Journal of Applied Physiology, 108, 1376-1382. [Google Scholar] [CrossRef] [PubMed]
[19] Goll, D.E., Thompson, V.F., Li, H., et al. (2003) The Calpain System. Physiological Reviews, 83, 731-801. [Google Scholar] [CrossRef] [PubMed]
[20] Van Hees, H.W., Schellekens, W.J., Andrade Acuña, G.L., et al. (2012) Titin and Diaphragm Dysfunction in Mechanically Ventilated Rats. Intensive Care Medicine, 38, 702-709. [Google Scholar] [CrossRef] [PubMed]
[21] Tang, H., Smith, I.J., Hussain, S.N., et al. (2015) The JAK-STAT Pathway Is Critical in Ventilator-Induced Diaphragm Dysfunction. Molecular Medicine, 20, 579-589. [Google Scholar] [CrossRef] [PubMed]
[22] Font, M.D., Thyagarajan, B. and Khanna, A.K. (2020) Sepsis and Septic Shock—Basics of Diagnosis, Pathophysiology and Clinical Decision Making. Medical Clinics of North America, 104, 573-585. [Google Scholar] [CrossRef] [PubMed]
[23] Petrof, B.J. (2018) Diaphragm Weakness in the Critically Ill: Basic Mechanisms Reveal Therapeutic Opportunities. Chest, 154, 1395-1403. [Google Scholar] [CrossRef] [PubMed]
[24] Khan, J., Harrison, T.B., Rich, M.M., et al. (2006) Early Development of Critical Illness Myopathy and Neuropathy in Patients with Severe Sepsis. Neurology, 67, 1421-1425. [Google Scholar] [CrossRef] [PubMed]
[25] 王帅, 柯旭, 杨晓纲, 王水利. 脓毒症相关膈肌功能障碍的发病机制[J]. 医学综述, 2020, 26(4): 733-737.
[26] Van Hees, H.W., Schellekens, W.J., Linkels, M., et al. (2011) Plasma from Septic Shock Patients Induces Loss of Muscle Protein. Critical Care, 15, R233. [Google Scholar] [CrossRef] [PubMed]
[27] Demoule, A., Divangahi, M., Yahiaoui, L., et al. (2006) Endotoxin Triggers Nuclear Factor-κB-Dependent Up-Regu-lation of Multiple Proinflammatory Genes in the Diaphragm. American Journal of Respiratory and Critical Care Medicine, 174, 646-653. [Google Scholar] [CrossRef
[28] Lu, Z., Ge, H., Xu, L., et al. (2019) Alterations in Diaphragmatic Function Assessed by Ultrasonography in Mechanically Ventilated Patients with Sepsis. Journal of Clinical Ultrasound, 47, 206-211. [Google Scholar] [CrossRef] [PubMed]
[29] 胡健. 超声评估膈肌功能在神经重症患者撤机中的应用[D]: [硕士学位论文]. 长春: 吉林大学, 2021.
[30] Bösel, J. (2017) Use and Timing of Tracheostomy after Severe Stroke. Stroke, 48, 2638-2643. [Google Scholar] [CrossRef
[31] Robba, C., Bonatti, G., Battaglini, D., et al. (2019) Mechanical Ventilation in Patients with Acute Ischaemic Stroke: From Pathophysiology to Clinical Practice. Critical Care, 23, Article No. 388. [Google Scholar] [CrossRef] [PubMed]
[32] Catalá-Ripoll, J.V., Monsalve-Naharro, J.Á. and Hernández-Fernández, F. (2020) Incidence and Predictive Factors of Diaphragmatic Dysfunction in Acute Stroke. BMC Neurology, 20, Article No. 79. [Google Scholar] [CrossRef] [PubMed]
[33] 苏丹. 超声监测膈肌位移预测ICU械通气患者撤机能力的临床研究[D]: [硕士学位论文]. 石家庄: 河北医科大学, 2015.
[34] Laveneziana, P., Albuquerque, A., Aliverti, A., et al. (2019) ERS Statement on Respiratory Muscle Testing at Rest and during Exercise. European Respiratory Journal, 53, Article ID: 1801214. [Google Scholar] [CrossRef] [PubMed]
[35] Hermans, G., Agten, A., Testelmans, D., et al. (2010) Increased Duration of Mechanical Ventilation Is Associated with Decreased Diaphragmatic Force: A Prospective Observational Study. Critical Care, 14, Article No. R127. [Google Scholar] [CrossRef] [PubMed]
[36] Liu, L., Liu, H., Yang, Y., et al. (2012) Neuroventilatory Efficiency and Extubation Readiness in Critically Ill Patients. Critical Care, 16, Article No. R143. [Google Scholar] [CrossRef] [PubMed]
[37] Dres, M., Schmidt, M., Ferre, A., et al. (2012) Diaphragm Electromyographic Activity as a Predictor of Weaning Failure. Intensive Care Medicine, 38, 2017-2025. [Google Scholar] [CrossRef] [PubMed]