2025 年第 9 期 第 20 卷

急性呼吸窘迫综合征患者肺保护性通气策略优化进展

Progress in optimization of lung protective ventilation strategy in patients with acute respiratory distress syndrome

作者：雷慧1宋盛仁2张先明2

英文作者：Lei Hui1 Song Shengren2 Zhang Xianming2

单位：1贵州医科大学，贵阳550000；2贵州医科大学附属医院呼吸与危重症医学科，贵阳550000

英文单位：1Guizhou Medical University Guiyang 550000 China; 2Department of Respiratory and Critical Care Medicine the Affiliated Hospital of Guizhou Medical University Guiyang 550000 China

关键词：急性呼吸窘迫综合征；呼吸力学；肺保护性通气策略；呼吸肌电图；食管压力监测

英文关键词：Acuterespiratorydistresssyndrome;Respiratorymechanics;Lungprotectiveventilationstrategy;Respiratoryelectromyography;Esophagealpressuremonitoring

• 摘要：

• 急性呼吸窘迫综合征（ARDS）因其复杂的病理生理特点，对机械通气治疗提出了严峻挑战。肺保护性通气策略的优化被认为是降低通气诱导性肺损伤发生率、改善患者预后的关键。然而，由于ARDS患者肺部病变的区域异质性，单一的通气参数设置难以满足个体需求。近年来，基于呼吸力学的监测技术（如呼吸肌电图和食管压力测量）为个性化通气参数的精准调控提供了可能。呼吸肌电图可实时量化膈肌活动与呼吸肌疲劳，从而优化呼吸机同步性；食管压力测量则通过评估跨肺压差，指导呼气末正压和潮气量的合理设置，减少肺泡的过度膨胀和反复开放风险。这些技术的联合应用不仅能够显著降低ARDS患者的通气诱导性肺损伤发生率，还可改善氧合水平和肺顺应性。本文系统梳理了基于呼吸力学的ARDS患者肺保护性通气策略优化的研究进展，重点探讨呼吸肌电图与压力监测技术在个体化治疗中的应用优势及未来发展方向。

• Acute respiratory distress syndrome (ARDS) poses a severe challenge to the treatment of mechanical ventilation due to its complex pathophysiological characteristics. Optimization of lung protective ventilation strategy is considered to be the key to reduce the incidence of ventilation-induced lung injury and improve the prognosis of patients. However, due to the regional heterogeneity of lung lesions in ARDS patients, a single ventilation parameter setting is difficult to meet individual needs. In recent years, monitoring techniques based on respiratory mechanics, such as respiratory electromyography and esophageal manometry, have made it possible to accurately regulate personalized ventilation parameters. Respiratory electromyography can quantify diaphragm activity and respiratory muscle fatigue in real time, so as to optimize ventilator synchrony. By assessing the transpulmonary pressure gradient, esophageal manometry can guide the reasonable setting of positive end-expiratory pressure and tidal volume to reduce the risk of alveolar overdistension and repeated opening. The combination of these technologies can not only significantly reduce the incidence of ventilation-induced lung injury in patients with ARDS, but also improve oxygenation level and lung compliance. This article systematically reviews the research progress of lung protective ventilation strategy optimization in ARDS patients based on respiratory mechanics, focusing on the application advantages and future development direction of respiratory electromyography and pressure monitoring technology in individualized treatment.