长期机械通气患者膈肌功能的超声评估研究  

Ultrasonographic assessment of diaphragm function in long-term mechanical ventilation patients

作　　者：徐建桥[1] 温若譞 赵瑛 解立新[1] Xu Jianqiao;Wen Ruoxuan;Zhao Ying;Xie Lixin(Department of Pulmonary&Critical Care Medicine,Chinese People Liberation Army(PLA)General Hospital,Beijing 100082,China)

机构地区：[1]解放军总医院第一医学中心呼吸与危重症医学科,北京100082

出　　处：《中华结核和呼吸杂志》2020年第2期132-135,共4页Chinese Journal of Tuberculosis and Respiratory Diseases

基　　金：国家老年疾病临床医学研究中心课题(NCRCG-PLAGH-2017003)。

摘　　要：目的 明确影响长期机械通气患者膈肌功能变化的原因.方法 选择解放军总医院呼吸科2018年6月1日到2019年4月30日的机械通气患者(32例).将入组的患者按机械通气时间分为短期机械通气组(7 d≤机械通气时间<1个月,20例)和长期机械通气组(机械通气时间≥1个月,12例).比较两组患者膈肌的运动幅度、收缩时间、收缩速、E-T指数(运动幅度×收缩时间)、呼气末膈肌厚度、膈肌厚度变化率及胫骨前肌厚度.对所有患者的机械通气时间与呼气末膈肌厚度进行相关性分析.结果 长期机械通气组患者的平均呼气末膈肌厚度[(0.13±0.04)cm]和膈肌厚度变异率(0.22±0.04)明显小于短期机械通气组[分别为(0.17±0.05)cm和0.27±0.08](均P<0.05),但两组膈肌收缩幅度、收缩时间、收缩速度、E-T指数差异无统计学意义,两组平均胫骨前肌厚度差异也无统计学意义(均P>0.05).所有患者的机械通气时间与呼气末膈肌厚度有明显相关性(P<0.01),但呼气末膈肌厚度与胫骨前肌厚度无明显相关性(P>0.05).结论 长期机械通气患者的膈肌厚度及膈肌收缩功能明显减低,且与机械通气时间相关,营养状况不是影响膈肌厚度的主要因素.Objective To evaluate the condition of the diaphragm in patients with long-term mechanical ventilation using ultrasound technology and to analyze its relationship with ventilation time and muscle atrophy in order to clarify the reasons for diaphragm dysfunction in long-term mechanical ventilation patients.Methods Patients admitted to the respiratory department at the Chinese PLA General Hospital between June 2018 and April 2019 with mechanical ventilation were included in this study.The enrolled patients were divided into a short-term mechanical ventilation group(7 days≤ventilation time<1 month)and a long-term mechanical ventilation group(mechanical ventilation time≥1 month).The diaphragmatic excursion,inspiratory time,contraction rate,E-T index,diaphragm thickness,diaphragm thickness fraction(DTF),and tibialis anterior thickness were compared between the two groups.The correlation between ventilation time and diaphragm thickness was analyzed in all patients.Results The mean diaphragm thickness and DTF were significantly lower in the long-term mechanical ventilation group than in the short-term mechanical ventilation group[(0.13±0.036)vs(0.17±0.05)cm and(0.22±0.045)vs(0.27±0.075)](all P<0.05).However,there was no significant difference in diaphragmatic excursion,inspiratory time,contraction rate,E-T index or tibialis anterior thickness between the two groups(all P>0.05).There was a significant linear correlation between ventilation time and diaphragm thickness(P<0.01).Tibialis anterior thickness was not significantly correlated with ventilation time(P>0.05).Conclusion Diaphragm thickness and function were significantly reduced in patients with long-term mechanical ventilation,which was correlated with the duration of ventilation.Nutritional status was not the main factor affecting diaphragm thickness.

关 键 词：膈 超声检查 呼吸 人工 

分 类 号：R45[医药卫生—治疗学]