机械通气时间对机械通气撤机患者膈肌功能的影响分析  

Duration of mechanical ventilation on the result of diaphragmatic function in weaning

作　　者：郭伟光[1] 刘火根[1] 刘玲[1] 黄英姿[1] 杨毅[1] 邱海波[1] 

机构地区：[1]东南大学附属巾大医院重症医学科,南京210009

出　　处：《国际呼吸杂志》2012年第16期1240-1244,共5页International Journal of Respiration

基　　金：基金项目：江苏省自然科学基金（BK2008298）;江苏省科技发展计划（BS2007045）;江苏省135重点人才基金（2007）;江苏省医学领军人才基金（2006）

摘　　要：目的探讨机械通气时间对机械通气患者膈肌功能的影响。方法以2008年12月至2009年12月人住东南大学附属中大医院ICU行机械通气超过24h，且准备撤机的患者为研究对象，根据机械通气时间分为机械通气≤3d组（A组）及机械通气〉3d组（B组）。行自主呼吸实验（SBT）30min，监测SBT 0、5及30min时膈肌电位（Edi）、神经肌肉强度指数（NMS）、神经机械耦连指数（NMC）及神经通气耦连指数（NVC）等膈肌功能指标。结果44例患者纳入研究，A组患者25例（56．8％），B组患者19例（43．2％）。①SBT0min时A、B两组患者间Edi、NMS、NMC及NVC差异均无统计学意义。②SBT5min时B组患者Edi和NMS显著高于A组。③SBT30min时B组患者Edi显著高于A组[（23±11） μV比（15±8） μVP〈0．05]；与A组患者NMS相比，B组患者NMS显著增高[（598±309）μV·cpm比（363±224）μV·cpm]（P＜0．05），而B组患者NVC则明显低于A组。结论SBT30min时机械通气〉3d的患者膈肌收缩能力、耐力均下降；提示机械通气时间增加可能是导致膈肌功能下降的重要原因。Objective To investigate the influence of duration of mechanical ventilation on the diaphragmatic function. Methods Patients included in this study were those who mechanically ventilated for at least 24 h and were preparing to wean from December 2008 to December 2009 in ICU of Nanjing Zhong da Hospital. Patients, according to the duration of mechanical ventilation, were divided into group A （ventilated less than three days） and group B （ventilated more than three days）. 30 min Spontaneous breathing test （SBT） was carried on the patients satisfying the weaning permission. Indices of diaphragm function, such as electrical activity of diaphragm （Edi）, neuro-muscular strength index （NMS）, neuromechanical coupling （NMC） and neuro-ventilatory coupling （NVC） at 0 rain,5 rain and 30 min of SBT were monitored. Results 44 patients were included finally, of whom 19 patients （43.2%） ventilated more than three days （group B）. 44 patients ventilated less than three days （group A）. ①There was no significant difference in Edi, NMS, NMC or NVC at 0 min of SBT between the two groups.②Edi and NMS in group B were largely more than group A at 5 min of SBT. ③At SBT 30 min, Edi and NMS in group B both were significantly higher than group A [（23±11） μV vs （15±8） μV, （598±309） μV · clam vs （363±224） uV · cpm, P 〈0. 05]. Whereas, NVC in group B was lower than group A （ P 〈0.05）. Conclusions The contractility and endurance of diaphragm decreased in patients whom ventilated more than three days at 30 min of SBT. It seemed that incremental duration of mechanical ventilation could exacerbate the diaphragm dysfunction, which might be one of the important factors leading to failed weaning.

关 键 词：机械通气时间 膈肌功能 膈肌电位 神经肌肉强度指数 神经机械耦连指数 神经通气耦连指数 

分 类 号：R563.9[医药卫生—呼吸系统]