机械通气过程中肺结构和功能异质性的评估:方法综述。

Jacob Herrmann, Michaela Kollisch-Singule, Joshua Satalin, Gary F Nieman, David W Kaczka
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引用次数: 2

摘要

哺乳动物肺的结构和功能都具有异质性,包括一个不对称的分支气道树,优化了维持有效的通气、灌注和气体交换。尽管肺部自然存在的异质性有潜在的好处,但病理过程也可能产生有害的影响,这可能导致气体输送和交换的不足。无论病因如何,病理异质性导致局部通气和灌注分布不均匀,气体交换受损,呼吸功增加。在极端情况下,异质性可能导致呼吸衰竭,需要机械呼吸机的支持。本文综述了机械通气过程中用于评估和量化呼吸系统结构和功能异质性的测量技术。这些方法可分为四大类:(1)非均质力学函数的逆建模;(2)测量气体输运非均质性的毛细管造影和冲洗技术;(3)肺表面非均匀变形测量;(4)观测空间分布通风或区域变形的成像技术。每种技术在空间和时间分辨率、侵入程度、对患者构成的风险以及临床实施的适用性方面各不相同。尽管如此,每种技术都为病变肺的力学异质性的表现和后果提供了独特的视角。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Assessment of Heterogeneity in Lung Structure and Function During Mechanical Ventilation: A Review of Methodologies.

The mammalian lung is characterized by heterogeneity in both its structure and function, by incorporating an asymmetric branching airway tree optimized for maintenance of efficient ventilation, perfusion, and gas exchange. Despite potential benefits of naturally occurring heterogeneity in the lungs, there may also be detrimental effects arising from pathologic processes, which may result in deficiencies in gas transport and exchange. Regardless of etiology, pathologic heterogeneity results in the maldistribution of regional ventilation and perfusion, impairments in gas exchange, and increased work of breathing. In extreme situations, heterogeneity may result in respiratory failure, necessitating support with a mechanical ventilator. This review will present a summary of measurement techniques for assessing and quantifying heterogeneity in respiratory system structure and function during mechanical ventilation. These methods have been grouped according to four broad categories: (1) inverse modeling of heterogeneous mechanical function; (2) capnography and washout techniques to measure heterogeneity of gas transport; (3) measurements of heterogeneous deformation on the surface of the lung; and finally (4) imaging techniques used to observe spatially-distributed ventilation or regional deformation. Each technique varies with regard to spatial and temporal resolution, degrees of invasiveness, risks posed to patients, as well as suitability for clinical implementation. Nonetheless, each technique provides a unique perspective on the manifestations and consequences of mechanical heterogeneity in the diseased lung.

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