膈肌起搏联合正压机械通气治疗呼吸衰竭患者的疗效观察  

Efficiency observation of diaphragmatic pacing combined with positive pressure mechanical ventilation for patients with respiratory failure

作　　者：史彩雯 刘志光[1] 陈意[1] 施宇佳[1] 毛正道[1] SHI Caiwen;LIU Zhiguang;CHEN Yi;SHI Yujia;MAO Zhengdao(Department of Respiratory and Critical Care Medicine,Yanghu Division of Changzhou Second Hospital Affiliated to Nanjing Medical University,Changzhou,Jiangsu,213100)

机构地区：[1]南京医科大学附属常州二院阳湖院区呼吸与危重症医学科,江苏常州213100

出　　处：《实用临床医药杂志》2019年第3期11-13,17,共4页Journal of Clinical Medicine in Practice

摘　　要：目的探讨膈肌起搏联合正压机械通气治疗呼吸衰竭患者的临床疗效。方法选取呼吸衰竭患者122例,随机分为2组各61例。对照组采用正压机械通气治疗,观察组在对照组基础上联合膈肌起搏。比较2组治疗前后动脉血气指标、血流动力学参数及呼吸力学参数。结果通气30 min后,观察组氧合指数[p(O_2)/FiO_2]、动脉血氧分压[p(O2)]显著高于对照组(P<0.05)。通气30 min后,观察组平均气道压(Paw)、平台压(PP)、呼吸功(WOBp)均显著低于对照组(P<0.05);吸气末跨肺压(PTP)、静态顺应性(Cst)、呼吸机械功(WOBv)均显著高于对照组(P<0.05),气道阻力(Raw)、肺部阻力(RL)与对照组相比无显著差异(P>0.05)。结论膈肌起搏联合正压机械通气可改善呼吸衰竭患者的动脉血气及呼吸系统功能。Objective To investigate the clinical efficacy of diaphragmatic pacing combined with positive pressure mechanical ventilation in patients with respiratory failure.Methods A total of 122 patients with respiratory failure admitted to our hospital were randomly divided into two groups,with 61 cases per group.The control group was treated with positive pressure mechanical ventilation,and the observation group was treated with diaphragmatic pacing.The changes of arterial blood gas index,hemodynamics and respiratory mechanics parameters before and after treatment were compared.Results Oxygenation index[p(O 2)/FiO 2],and arterial partial pressure of oxygen[p(O 2)]were higher in the observation group than that in the control group after 30 minutes of ventilation(P<0.05).The level of mean airway pressure(Paw),plateau pressure(PP),and mechanical work of respiration(WOBv)in the observation group were lower in the observation group than in the control group after 30 minutes of ventilation(P<0.05).Terminal inspiratory pulmonary pressure(PTP),static compliance(Cst),and mechanical work of respiration(WOBp)were higher than the control group(P<0.05).Airway resistance(Raw)and lung resistance(RL)showed no significant difference in the two groups(P>0.05).Conclusion The combination of diaphragmatic pacing and positive pressure mechanical ventilation can effectively improve arterial blood gas and respiratory function of patients with respiratory failure.

关 键 词：膈肌起搏 正压机械通气 呼吸衰竭 动脉血气 血流动力学 呼吸力学 

分 类 号：R563.8[医药卫生—呼吸系统]