体外膈肌起搏器辅助重症患者呼吸机撤离的临床研究  

Clinical Study of External Diaphragm Pacemaker Assisted Ventilator Withdrawal in Critically Ill Patients

作　　者：黄庭龙[1] 刘玉琪[1] 郑超敏 HUANG Tinglong;LIU Yuqi;ZHENG Chaomin(The Second Affiliated Hospital of Fujian Medical University,Quanzhou 362000,China)

机构地区：[1]福建医科大学附属第二医院,福建泉州362000

出　　处：《中外医学研究》2021年第1期1-3,共3页CHINESE AND FOREIGN MEDICAL RESEARCH

基　　金：泉州市科技计划项目(2018Z104)。

摘　　要：目的:探讨体外膈肌起搏器(external diaphragm pacemaker,EDP)辅助重症患者呼吸机撤离的应用价值。方法:选取2018年1月-2019年6月福建医科大学附属第二医院重症医学科收治的90例机械通气患者作为研究对象。采用简单随机分组法将入选患者分为治疗组和对照组,每组45例。患者均进行原发病对症治疗,同时予以呼吸机辅助通气。在此基础上,治疗组于机械通气48 h后开始采用体外膈肌起搏器EDP治疗。分别记录两组机械通气前、通气48、72 h及1周时膈肌厚度率,并统计其基础生命体征,包括心率、血压、呼吸频率,分析干预48、72 h时氧合功能指标(PaO2/FiO2、FiO2、PEEP),比较两组机械通气天数、ICU住院时间及二次插管率。结果:干预前、干预48 h,两组膈肌增厚率及基础生命体征比较差异无统计学意义(P>0.05);干预72 h,治疗组膈肌增厚率高于对照组,心率和呼吸频率均低于对照组,差异均有统计学意义(P<0.05),收缩压与对照组比较差异无统计学意义(P>0.05);干预1周,观察组膈肌增厚率高于对照组,差异有统计学意义(P<0.05),但基础生命体征指标与对照组比较差异无统计学意义(P>0.05)。干预48 h,两组PaO2/FiO2、FiO2、PEEP指标比较差异无统计学意义(P>0.05),干预72 h,治疗组PaO2/FiO2高于对照组,FiO2、PEEP均低于对照组,差异均有统计学意义(P<0.05)。治疗组机械通气天数短于对照组,差异有统计学意义(P<0.05),两组ICU住院时间、二次插管率比较差异无统计学意义(P>0.05)。结论:EDP辅助机械通气有助于重症患者膈肌和肺功能保护,并缩短撤机时间。Objective:To explore the application value of external diaphragm pacemaker assisted ventilator evacuation on critically ill patients.Method:From January 2018 to June 2019,90 mechanically ventilated patients admitted to the Department of Critical Care Medicine of the Second Affiliated Hospital of Fujian Medical University were selected as the research objects.The patients were divided into the treatment group and the control group by simple random grouping method,with 45 patients in each group.All patients were treated with symptomatic treatment for the primary disease,and at the same time they were given ventilator-assisted ventilation.On this basis,the treatment group was treated with external diaphragmatic pacemaker EDP 48 h after mechanical ventilation.The diaphragmatic muscle thickness rates before mechanical ventilation,48 h,72 h and 1 week of ventilation were recorded,and basic vital signs,including heart rate,blood pressure and respiratory rate,were recorded.The oxygen function indicators (PaO2/FiO2,FiO2,PEEP) were analyzed at 48 and 72 h of intervention,and the days of mechanical ventilation,length of ICU stay,and secondary intubation rate were compared between the two groups.Result:Before intervention and 48 h after intervention,there were no statistically significant differences in diaphragmic muscle thickening rate and underlying vital signs between the two groups (P>0.05).After 72 h of intervention,the diaphragmatic muscle thickening rate in the treatment group was higher than that in the control group,heart rate and respiratory rate were lower than that in the control group,the differences were statistically significant (P<0.05),the difference between systolic blood pressure and control group was not statistically significant (P>0.05).After 1 week of intervention,the diaphragmatic muscle thickening rate in the treatment group was higher than that in the control group,the difference was statistically significant (P<0.05),but there was no statistically significant difference between the basic vital sig

关 键 词：体外膈肌起搏器 机械通气 膈肌 生命体征 氧合功能 

分 类 号：R459.7[医药卫生—急诊医学]