体外膈肌起搏对呼吸机相关膈肌功能障碍的有效性研究

Effectiveness of External Diaphragm Pacing on Ventilator-Related Diaphragm Dysfunction

摘要: 目的：呼吸机相关膈肌功能障碍在临床应用呼吸机患者中普遍存在，与ICU患者的脱机拔管及病死率密切相关，本研究通过对全麻术后转入ICU继续应用呼吸机患者应用体外膈肌起搏器刺激膈神经来间断锻炼膈肌功能，通过超声、呼吸肌力学指标来评估对膈肌功能的影响。方法：研究对象为全麻术后转入ICU继续呼吸机治疗的患者，试验组间断应用体外膈肌起搏器，对照组不予膈神经刺激，在0 h、5 h、10 h、15 h、20 h分别在PSV模式下测量膈肌增厚率、最大吸气负压来评估膈肌功能。结果：t0时对照组和试验组的膈肌增厚率：(15.47 ± 0.67)%、(15.48 ± 0.44)%和最大吸气负压：(−4.29 ± 0.61) cm H2O、(−4.30 ± 0.52) cm H2O，t检验，差异无统计学意义；在5 h、10 h、15 h、20 h时试验组TFdi依次为：(17.59 ± 0.50)%、(22.98 ± 0.83)%、(24.95 ± 0.63)%、(28.28 ± 0.58)%；对照组为：(17.36 ± 0.64)%、(22.55 ± 0.92)%、(24.69 ± 0.94)%、(28.04 ± 0.61)%；两组间进行独立样本t检验，差异有明显的统计学意义(P < 0.05)。结论：在完全性控制通气数小时后膈肌收缩功能即明显下降。完全性控制通气术后患者早期进行体外膈肌起搏治疗能改善呼吸机相关膈肌功能障碍的进展。

Abstract: Ventilator-related diaphragmatic dysfunction is common in patients with clinical use of ventilators, and is closely related to the weaning and extubation of ICU patients and the mortality rate. This study used external diaphragm for patients who were transferred to ICU after general anesthesia and continued to use ventilators. The pacemaker stimulates the phrenic nerve to exercise the diaphragm function intermittently, and evaluates the impact on the diaphragm function through ultrasound and respiratory muscle mechanics. Method(s): The subjects of the study were patients who were transferred to ICU after general anesthesia to continue ventilator treatment. The test group was intermittently applied with external diaphragm pacemaker, and the control group was not given phrenic nerve stimulation. They were in PSV mode at 0 h, 5 h, 10 h, 15 h, and 20 h, respectively to measure the thickening rate of the diaphragm and the maximum negative inspiratory pressure to evaluate the function of the diaphragm. Result(s): Diaphragm thickening rate of control group and test group at t0 was: (15.47 ± 0.67)%, (15.48 ± 0.44)%, and maximum negative inspiratory pressure was: (−4.29 ± 0.61) cm H2O, (−4.30 ± 0.52) cm H2O, for independent samples t test between the two groups, the difference was not statistically significant; at 5 h, 10 h, 15 h, and 20 h, the TFdi of the test group was: (17.59 ± 0.50)%, (22.98 ± 0.83)%, (24.95 ± 0.63)%, (28.28 ± 0.58)%. The control group was: (17.36 ± 0.64)%, (22.55 ± 0.92)%, (24.69 ± 0.94)%, (28.04 ± 0.61)%; independent sample t test was performed between the two groups, and the difference was statistically significant (P < 0.05). Conclusion(s): After several hours of fully controlled ventilation, the contraction function of the diaphragm decreased significantly. Early external diaphragm pacing therapy in patients after complete controlled ventilation can improve the progression of ventilator-related diaphragm dysfunction.