新型冠状病毒肺炎治疗中机械通气的生物力学问题
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常州大学

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R454

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国家自然科学基金重点项目(11532003),国家自然科学基金面上项目(31670950),江苏省自然科学基金(BK20151186)


Biomechanical risk factors in Covid-19 with mechanical ventilation
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Changzhou University

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    摘要:

    新型冠状病毒肺炎(Covid-19)危重症患者常表现出急性呼吸道窘迫症乃至急性呼吸衰竭,需要通过机械通气提供呼吸支持。但临床观察发现机械通气后患者死亡率非常高(>50%)。鉴于机械通气的力学本质,机械通气后的高死亡率很可能与通气条件下机械拉伸刺激引起的肺损伤相关,因而从生物力学的角度理解机械通气条件下呼吸系统的病理变化及其机理和潜在对抗措施,对完善Covid-19危重症患者的治疗方法具有十分重要的意义和紧迫性。因此,本文针对Covid-19爆发的基本情况,简要介绍了机械通气中与肺损伤相关的生物力学因素及其作用机制,包括机械通气力学参数的变化、炎症因子风暴、纤毛-黏液系统、气道平滑肌的作用、肺纤维化、细胞对于拉伸的感应机制等,期望以此引起对这些生物力学问题的重视和研究,为完善新冠肺炎等呼吸疾病的治疗方案提供新思路。

    Abstract:

    Coronavirus disease 2019 (Covid-19) is an evolving pandemic that threatens public health in the whole world. The current therapy for critically ill Covid-19 patients in the intensive care unit (ICU) relay on mechanical ventilation (MV) to provide respiratory and life support. However, MV is also known to induce lung injury, which is called ventilator-induced lung injury (VILI). Clinical studies indicate an extraordinarily high mortality rate (>50%) for those Covid-19 patients underwent MV in ICU, suggesting a link between the high mortality rate and the mechanical stretch during MV considering the mechanical nature of MV. Thus, it is imperative to understand the MV-induced pathological alterations in the respiratory system and corresponding mitigation measures in order to improve the treatment of critically ill Covid-19 patients. Therefore, we briefly reviewed the situation of Covid-19, and then summarized the biomechanical risk factors and their roles and mechanisms related lung injuries during MV, including changes in respiratory parameters, inflammatory cytokines storm, ciliary-mucus system, airway smooth muscle cells, lung fibrosis, and stretch-activated cell signaling. It is hoped that these biomechanical questions can be greatly attended and investigated, of which the findings can provide insights for optimizing the therapy for Covid-19 as well as other respiratory diseases.

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  • 收稿日期:2020-05-12
  • 最后修改日期:2020-05-12
  • 录用日期:2020-05-13
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