中华护理杂志 ›› 2025, Vol. 60 ›› Issue (11): 1394-1399.DOI: 10.3761/j.issn.0254-1769.2025.11.018
陈天超(
), 冯悦颖, 兰元梅, 吴昊琪, 柳馨怡, 白云锋, 赵明曦, 罗红波, 李尊柱, 吴欣娟(
)
收稿日期:2024-05-06
出版日期:2025-06-10
发布日期:2025-06-03
通讯作者:
吴欣娟,E-mail:wuxinjuan@sina.com作者简介:陈天超:男,本科(硕士在读),护士,E-mail:ctc_organic@163.com
基金资助:
CHEN Tianchao(
), FENG Yueying, LAN Yuanmei, WU Haoqi, LIU Xinyi, BAI Yunfeng, ZHAO Mingxi, LUO Hongbo, LI Zunzhu, WU Xinjuan(
)
Received:2024-05-06
Online:2025-06-10
Published:2025-06-03
摘要:
膈肌功能障碍是机械通气患者常出现的问题,与多种不良结局密切相关。该文通过对膈肌功能的评估方式、膈肌功能障碍与机械通气患者临床不良结局的关联、减少机械通气患者膈肌功能对临床不良结局影响的干预策略进行综述,以期为临床护理人员优化评估技术、制订个性化护理方案、提升患者生活质量和改善其健康结局提供参考。
陈天超, 冯悦颖, 兰元梅, 吴昊琪, 柳馨怡, 白云锋, 赵明曦, 罗红波, 李尊柱, 吴欣娟. 机械通气患者膈肌功能对临床结局影响的研究进展及护理启示[J]. 中华护理杂志, 2025, 60(11): 1394-1399.
CHEN Tianchao, FENG Yueying, LAN Yuanmei, WU Haoqi, LIU Xinyi, BAI Yunfeng, ZHAO Mingxi, LUO Hongbo, LI Zunzhu, WU Xinjuan. Research progress on the impact of diaphragmatic function on clinical outcomes in mechanically ventilated patients and nursing implications[J]. Chinese Journal of Nursing, 2025, 60(11): 1394-1399.
| [1] | Zhang J, Xie Q, Jiang R, et al. Role of diaphragmatic dysfunc-tion in extubation failure among patients at high risk of reintubation:a prospective cohort study[J]. J Crit Care, 2025, 86:154983. |
| [2] | Dubé BP, Dres M, Mayaux J, et al. Ultrasound evaluation of dia-phragm function in mechanically ventilated patients:compari-son to phrenic stimulation and prognostic implications[J]. Tho-rax, 2017, 72(9):811-818. |
| [3] |
陈一媛, 林敏, 黄美春, 等. 福建省ICU护士对呼吸机相关性膈肌功能障碍护理知信行的现状调查[J]. 中华护理杂志, 2022, 57(7):841-845.
DOI |
| Chen YY, Lin M, Huang MC, et al. Study on the status of nurses’ knowledge,attitude,practice toward ventilator-induced diaphragm dysfunction care in intensive care unit of Fujian[J]. Chin J Nurs, 2022, 57(7):841-845. | |
| [4] | 陈天超, 冯悦颖, 柳馨怡, 等. 基于Web of Science的膈肌功能障碍文献计量学和可视化分析[J]. 中华急危重症护理杂志, 2024, 5(4):367-373. |
| Chen TC, Feng YY, Liu XY, et al. Bibliometric and visual analysis of diaphragm dysfunction based on Web of Science[J]. Chin J Emerg Crit Care Nurs, 2024, 5(4):367-373. | |
| [5] | Umbrello M, Formenti P, Lusardi AC, et al. Oesophageal pres-sure and respiratory muscle ultrasonographic measurements indicate inspiratory effort during pressure support ventilation[J]. Br J Anaesth, 2020, 125(1):e148-e157. |
| [6] |
Scholten AJ, van Leuteren RW, de Jongh FH, et al. Transcu-taneous electromyography as a tool to assess recovery of hemi-diaphragmatic paresis:a case report[J]. J Neonatal Perinatal Med, 2023, 16(4):725-729.
DOI PMID |
| [7] | Deshmukh MP, Baxi G, Wadhokar OC, et al. Determining the optimal position of surface electrodes for diaphragm electrom-yography:a cross-sectional study[J]. Cureus, 2024, 16(2):e55176. |
| [8] |
Farghaly S, Hasan AA. Diaphragm ultrasound as a new method to predict extubation outcome in mechanically ventilated patients[J]. Aust Crit Care, 2017, 30(1):37-43.
DOI PMID |
| [9] | Gok F, Mercan A, Kilicaslan A, et al. Diaphragm and lung ul-trasonography during weaning from mechanical ventilation in critically ill patients[J]. Cureus, 2021, 13(5):e15057. |
| [10] | Zhang P, Jiang HJ, Zhou Q, et al. The predictive value of ul-trasonic measurement of the diaphragmatic thickening fraction combined with the maximal inspiratory pressure in mecha-nical ventilation patients[J]. Dept Critical Care Med, 2020, 43(9):778-783. |
| [11] |
Khurana J, Gartner SC, Naik L, et al. Ultrasound identification of diaphragm by novices using ABCDE technique[J]. Reg Anesth Pain Med, 2018, 43(2):161-165.
DOI PMID |
| [12] | Capdevila M, De Jong A, Belafia F, et al. Ultrasound-guided transcutaneous phrenic nerve stimulation in critically ill patients:a new method to evaluate diaphragmatic function[J]. Anesthesiology, 2025, 142(3):522-531. |
| [13] | Neagu A, Zah CA, Bucur A, et al. Ultrasound guided phrenic nerve block for percutaneous computer tomography guided lung biopsy[J]. Intern Med, 2024, 21(1):59-64. |
| [14] |
Bachasson D, Dres M, Niérat MC, et al. Diaphragm shear mo-dulus reflects transdiaphragmatic pressure during isovolume-tric inspiratory efforts and ventilation against inspiratory load-ing[J]. J Appl Physiol, 2019, 126(3):699-707.
DOI PMID |
| [15] | Aarab Y, Flatres A, Garnier F, et al. Shear wave elastography,a new tool for diaphragmatic qualitative assessment:a transla-tional study[J]. Am J Respir Crit Care Med, 2021, 204(7):797-806. |
| [16] |
Orde SR, Boon AJ, Firth DG, et al. Diaphragm assessment by two dimensional speckle tracking imaging in normal subjects[J]. BMC Anesthesiol, 2016, 16(1):43.
DOI PMID |
| [17] |
Oppersma E, Hatam N, Doorduin J, et al. Functional assess-ment of the diaphragm by speckle tracking ultrasound during inspiratory loading[J]. J Appl Physiol, 2017, 123(5):1063-1070.
DOI PMID |
| [18] |
白云锋, 陈天超, 孙建华, 等. 重症患者膈肌功能障碍评估的范围综述[J]. 中华护理杂志, 2023, 58(15):1913-1920.
DOI |
| Bai YF, Chen TC, Sun JH, et al. Critical illness-related diaph-ragmatic dysfunction assessment:a scoping review[J]. Chin J Nurs, 2023, 58(15):1913-1920. | |
| [19] | Chang YJ, Bae J, Kim N, et al. Three-dimensional quadratic modeling and quantitative evaluation of the diaphragm on a volumetric CT scan in patients with chronic obstructive pul-monary disease[J]. Med Phys, 2016, 43(7):4273. |
| [20] | Laghi FA Jr, Saad M, Shaikh H. Ultrasound and non-ultra-sound imaging techniques in the assessment of diaphragmatic dysfunction[J]. BMC Pulm Med, 2021, 21(1):85. |
| [21] | Chen J, Zhong W, Li S. Quantitative evaluation of diaphrag-matic motion during forced breathing in COPD patients[J]. Front Integr Neurosci, 2022, 16:842404. |
| [22] | Hao Y, Udupa JK, Tong Y, et al. Regional diaphragm motion analysis via dynamic MRI[J]. Proc SPIE Int Soc Opt Eng, 2022, 12031:120313F. |
| [23] | Islam O, Lin AW, Bharatha A. Potential application of ultra-low field portable MRI in the ICU to improve CT and MRI access in Canadian hospitals:a multi-center retrospective ana-lysis[J]. Front Neurol, 2023, 14:1220091. |
| [24] | Demoule A, Molinari N, Jung B, et al. Patterns of diaphragm function in critically ill patients receiving prolonged me-chanical ventilation:a prospective longitudinal study[J]. Ann Intensive Care, 2016, 6(1):75. |
| [25] |
Saccheri C, Morawiec E, Delemazure J, et al. ICU-acquired weak-ness,diaphragm dysfunction and long-term outcomes of criti-cally ill patients[J]. Ann Intensive Care, 2020, 10(1):1.
DOI PMID |
| [26] | Hamel RN, Smoliga JM. Physical activity intolerance and car-diorespiratory dysfunction in patients with moderate-to-severe traumatic brain injury[J]. Sports Med, 2019, 49(8):1183-1198. |
| [27] | 黄佳伟, 焦宇倩, 王娴雅, 等. 不同通气模式对妇科腹腔镜手术患者膈肌功能的影响[J]. 临床麻醉学杂志, 2023, 39(11):1125-1130. |
| Huang JW, Jiao YQ, Wang XY, et al. Effects of different ven-tilation modes on diaphragm function in patients undergoing laparoscopic gynecological surgery[J]. J Clin Anesthesiol, 2023, 39(11):1125-1130. | |
| [28] | Demoule A, Jung B, Prodanovic H, et al. Diaphragm dysfunc-tion on admission to the intensive care unit. Prevalence,risk factors,and prognostic impact:a prospective study[J]. Am J Re-spir Crit Care Med, 2013, 188(2):213-219. |
| [29] | Huang DZ, Ma H, Zhong WZ, et al. Using M-mode ultrasono-graphy to assess diaphragm dysfunction and predict the success of mechanical ventilation weaning in elderly patients[J]. J Thorac Dis, 2017, 9(9):3177-3186. |
| [30] | Omara ISM, Nagi HK, El Aziz Mohamed KA, et al. Periope-rative assessment of diaphragmatic dysfunction in cardiac surgery patients and its effect on outcome:a prospective ob-servational study[J]. Anaesth Pain Intensive Care, 2024, 28(5):816-823. |
| [31] | Menis AA, Tsolaki V, Papadonta ME, et al. The relationship of diaphragmatic ultrasound-based and manometric indices with difficult weaning in tracheostomized patients[J]. Respir Care, 2024, 69(10):1323-1331. |
| [32] | Chung E, Leem AY, Lee SH, et al. Predicting successful wean-ing through sonographic measurement of the rapid shallow breathing index[J]. J Clin Med, 2024, 13(16):4809. |
| [33] | Cavayas YA, Eljaiek R, Rodrigue é, et al. Preoperative diaph-ragm function is associated with postoperative pulmonary complications after cardiac surgery[J]. Crit Care Med, 2019, 47(12):e966-e974. |
| [34] | Lincoln U UCM, Sahar W, Elengoe A, et al. Impact of preope-rative diaphragmatic breathing exercise on postoperative oxy-genation and hospital length of stay in patients with elective coronary artery bypass graft:a narrative review[J]. T Rehabili J, 2024, 8(3):44-52. |
| [35] |
Goligher EC, Brochard LJ, Darlene Reid W, et al. Diaphragma-tic myotrauma:a mediator of prolonged ventilation and poor patient outcomes in acute respiratory failure[J]. Lancet Respir Med, 2019, 7(1):90-98.
DOI PMID |
| [36] | de Vries HJ, Jonkman AH, de Grooth HJ, et al. Lung- and dia-phragm-protective ventilation by titrating inspiratory support to diaphragm effort:a randomized clinical trial[J]. Crit Care Med, 2022, 50(2):192-203. |
| [37] | Wu Y, Wang SQ, Zhang J, et al. Effects of diaphragm elec-trical stimulation in treating respiratory dysfunction on mechanical ventilation after intracerebral hemorrhage:a single-center retrospective study[J]. Medicine, 2024, 103(1):e36767. |
| [38] |
刘秀, 刘滨滨, 权明桃, 等. ICU机械通气患者膈肌锻炼方案的构建及应用研究[J]. 中华护理杂志, 2023, 58(3):261-267.
DOI |
|
Liu X, Liu BB, Quan MT, et al. Construction and application of a diaphragm exercise program in patients with mechanical ventilation in ICU[J]. Chin J Nurs, 2023, 58(3):261-267.
DOI |
|
| [39] | Chen XY, Hou L, Zhang YY, et al. The effects of five days of intensive preoperative inspiratory muscle training on posto-perative complications and outcome in patients having cardiac surgery:a randomized controlled trial[J]. Clin Rehabil, 2019, 33(5):913-922. |
| [40] | Waterland JL, McCourt O, Edbrooke L, et al. Efficacy of pre-habilitation including exercise on postoperative outcomes following abdominal cancer surgery:a systematic review and meta-analysis[J]. Front Surg, 2021, 8:628848. |
| [1] | 曾妃, 兰美娟, 顾培培, 梁江淑渊, 王衍蝶, 蔡凌云. 儿童双肺移植术后肺康复护理方案的构建及初步验证[J]. 中华护理杂志, 2025, 60(9): 1029-1035. |
| [2] | 阎寅至, 闻芳, 王敏, 周雪梅, 马金玲, 吴惠芳, 姚文英. 造血干细胞移植患儿运动康复分级护理方案的构建与应用研究[J]. 中华护理杂志, 2025, 60(9): 1036-1042. |
| [3] | 刘曦璇, 刘玉琳, 刘莎, 杨帆, 谢晓虹, 王紫娟, 刘丽芳, 魏红雨. 学龄期支气管哮喘患儿呼吸康复操的研制及效果评价[J]. 中华护理杂志, 2025, 60(9): 1043-1049. |
| [4] | 黄盼盼, 李丽玲, 胡晓静. 先天性心脏病婴儿早期运动康复的研究进展[J]. 中华护理杂志, 2025, 60(9): 1050-1055. |
| [5] | 陈丽鸥, 张文婷, 刘俊其, 王允琮, 王振霖, 齐赛, 杨娜. 肺叶体表投影定位结合肺段引流排痰技术对吸入性肺炎患者气道廓清的效果研究[J]. 中华护理杂志, 2025, 60(9): 1056-1061. |
| [6] | 杨娜娜, 程传丽, 曾慧, 符丹丹, 王燕, 陈悦, 冉宏敏, 范红静, 龙霞. 分级运动康复对慢性阻塞性肺疾病急性加重期患者的效果评价[J]. 中华护理杂志, 2025, 60(9): 1062-1067. |
| [7] | 曹云, 孙国珍, 陈凤, 季学丽, 闫梦婉, 敬雷, 钱堃. 改良式踝泵运动在脑卒中患者中的应用研究[J]. 中华护理杂志, 2025, 60(9): 1068-1074. |
| [8] | 谢敏, 漆文凯, 殷玲, 张旋, 赵如琴. 腹膜透析患者恐动症潜在剖面分析及影响因素研究[J]. 中华护理杂志, 2025, 60(9): 1080-1086. |
| [9] | 陈冰倩, 赵彬, 孙佳蓉, 郝四芳, 侯晓丽. 慢性牙周炎种植义齿患者口腔健康管理困境的质性研究[J]. 中华护理杂志, 2025, 60(9): 1087-1092. |
| [10] | 秦春兰, 吴振云, 钱红英, 赵茜, 孙锦庭. 慢性阻塞性肺疾病患者疾病自我控制体验的质性研究[J]. 中华护理杂志, 2025, 60(9): 1093-1098. |
| [11] | 李子崴, 冯丽娟, 陈旭升, 黄毅, 杨洁. PICC置管患者运动恐惧评估量表的编制及应用[J]. 中华护理杂志, 2025, 60(9): 1099-1106. |
| [12] | 程志强, 张宝珍, 汤利萍, 李静, 夏娇云, 魏雪岩, 龚智娴, 张美珍, 黎露思. 尿失禁患者疾病认知与态度量表的汉化及初步应用[J]. 中华护理杂志, 2025, 60(9): 1107-1112. |
| [13] | 杨静, 王华芬, 卢芳燕, 鲍瑞洁, 朱莉. 肝移植患儿术后营养状况变化的影响因素分析及护理启示[J]. 中华护理杂志, 2025, 60(9): 1113-1119. |
| [14] | 石美琴, 吴建芳, 张铎, 吴春萍, 陈玲, 陶磊. 1例全喉切除辅助发音管Ⅰ期植入患者术后喉功能康复的护理[J]. 中华护理杂志, 2025, 60(9): 1120-1123. |
| [15] | 谷茜, 黄玺, 施伟雄, 吴静, 谭若铭, 王枫. 1例T细胞免疫治疗后并发细胞因子释放综合征患者的护理[J]. 中华护理杂志, 2025, 60(9): 1124-1127. |
| 阅读次数 | ||||||
|
全文 |
|
|||||
|
摘要 |
|
|||||