A12-吸气肌锻炼对膈肌功能恢复的影响-马少林.pdfVIP

吸气肌锻炼对膈肌功能恢复的影响 同济大学东方医院ICU 马少林 前言  In the US, about 300,000 patients/yrs receive prolonged life support in the ICU  and this number is likely to double within a decade, with associated costs of more than US$ 50 billion  10% - 15% of pts experience failure to wean  FTW patients account for approximately 40% of all MV days Zilberberg MD, et al. BMC Health Serv Res 2008, 8:242. Zilberberg MD, et al. Crit Care Med 2008, 36:724-730. “Should patients with COPD receive PR?”  The NETT (National Institute of Health National Emphysema Treatment Trial, 2003) are strong encouragement for the implement of PR for pts with COPD: PR is an essential preparatory step before lung volume reduction surgery; PR after surgery are beneficial as well  Today the question is no long “ should patients with COPD receive PR” but rather “ how should PR be delivered to pats with COPD” and “which components form the basis of the success of PR” Thierry Troosters AJRCCM 19-38, 2005 ATS/ERS statement on pulmonary rehabilitation AJRCCM DOI: 10.1164/rccm.201309-1634ST 呼吸肌肉 呼吸肌群 呼吸肌  吸气： –主要吸气肌-膈肌 •辅助吸气肌-胸肌等  呼气： –安静呼气：不需要肌肉 胸廓和膈肌的弹性回缩力 –用力呼气机制：非弹性回缩 需要腹肌 吸气肌功能减退主要是膈肌 吸气肌 膈肌萎缩 吸气肌无力 功能减退 不仅是膈肌… muscles change their structure: the disease progression leads to a significant reduction in mass and strength (especially at the lower limb level)