EAdi及膈肌功能监测在机械通气撤机中的应用  

Application of EAdi and diaphragmatic function monitoring on weaning from mechanical ventilation

作　　者：陈梅琴 王丹琼[1] 方红龙[1] 罗建[1] 吴华勇[1] 张伟文[1] CHEN Meiqin;WANG Danqiong;FANG Honglong;LUO Jian;WU Huayong;ZHANG Weiwen(ICU,Quzhou People＇s Hospital in Zhejiang Province,Quzhou 324000,China)

机构地区：[1]浙江省衢州市人民医院重症监护室,浙江衢州324000

出　　处：《中国现代医生》2018年第22期8-11,15,共5页China Modern Doctor

基　　金：浙江省科技计划项目(2014C33250);浙江省卫生计生委项目(2016KYB331)

摘　　要：目的观察机械通气患者在SBT过程中EAdi的变化以及膈肌厚度位移变化,分析结合二者参数预测脱机拔管的预后。方法选取2016年1月~2017年6月入住重症监护病房符合COPD诊断标准需要进行机械通气患者采用NAVA呼吸模式,按照患者是否成功脱机拔管分为撤机成功组和失败组。观察比较两组患者SBT前、SBT30 min的呼吸参数变化及SBT时(基线)、10 min、30 min的EAdi值和膈肌厚度及位移变化。结果纳入40例接受机械通气并计划进行SBT的患者,其中32例成功撤机,脱机失败者8例中,6例不得不在SBT过程中重新上机,2例在拔管后48 h内再插管。(1)两组患者撤机前呼吸机参数及血气内PO2和PCO2变化差异无明显统计学意义。而SBT 30 min后再次比较两组患者呼吸机相关参数显示成功组HR、RR、PCO2比失败组低,均有统计学意义。而Vt、PO2/Fi O2比失败组高(P<0.01)。成功者中SBT各时间点的EAdimax和EAdiAUC均比失败组低,且失败组中随着SBT时间延长,EAdimax和EAdiAUC呈增加趋势。两组患者不同时间点膈肌厚度及位移变化在不同时间段自主呼吸实验成功撤机组中tdi膈肌厚度及右侧膈肌位移指标方面,显著大于撤机失败组,差异具有统计学意义(P<0.05)。结论 EAdi联合膈肌功能可监测撤机拔管,提高撤机成功率。Objective To observe the changes of EAdi during SBT and the changes of thickness and displacement of diaphragm in patients who were treated with mechanical ventilation in order to combine and analyze two indicators to predict the prognosis after weaning.Methods Patients who met the criteria of COPD diagnosis and needed to be treated with mechanical ventilation of NAVA breathing pattern in ICU from January 2016 to June 2017 were selected.Patients were divided into successful weaning group and failing weaning group according to that whether they were weaned successfully.The changes of respiratory parameters at SBT 30 min,the values of EAdi at SBT（baseline）,10 min and 30 min and the changes of thickness and displacement of diaphragm.Results 40 patients who were treated with mechanical ventilation and planned to conduct SBT were included.32 patients of them successfully weaned.Out of 8 patients who failed to wean from mechanical ventilation,6 patients had to wear the machine again during the progress of SBT and 2 patients were intubated 48 h after extubation.（1）Parameters of respiratory machine before weaning and the changes of PO_2 and PCO_2 in blood gas analysis between two groups were not statistically different.Parameters of respiratory machine 30 min after SBT were compared again and the results showed HR,RR and PCO_2 in successful weaning group were statistically lower than those in failing weaning group.Vt,PO_2/FiO_2 in successful weaning group were higher than those in failing weaning group（P〈0.01）.EAdi_（max） and EAdiAUCin successful weaning group at each time point of SBT were lower than those in failing weaning group.EAdi_（max） and EAdi_（AUC） in failing weaning group turned to be uptrend as the time of SBT increased.tdi,the thickness of diaphragm and the displacement of right diaphragm at different time point and in different period of spontaneous breathing experiment in successful weaning group were significantly higher than those in failing weaning group（P〈0.05）.Conclusion

关 键 词：EAdi 膈肌功能 COPD 机械通气 

分 类 号：R459.7[医药卫生—急诊医学]