体外膈肌起搏联合早期康复对机械通气患者竖脊肌面积及脱机时间的影响  

Effects of external diaphragm pacing combined with early rehabilitation on erector spinae area and weaning

作　　者：唐苏予 郑华[1] 曾东[1] 郑鸿翔[1] 王真珍 李璐[1] 孙雯雯 陈光辉 TANG Su-yu;ZHENG Hua;ZENG Dong;ZHENG Hong-xiang;WANG Zhen-shen;LI Lu;SUN Wen-wen;CHEN Guang-hui(GICU of the 7^(th)People's Hospial of Zhengzhou,zhengzhou 450000,Henan,China)

机构地区：[1]郑州市第七人民医院GICU,河南郑州450000

出　　处：《广东医学》2023年第5期602-606,共5页Guangdong Medical Journal

基　　金：河南省医学科技攻关计划项目(LHGJ20210741)。

摘　　要：目的 探讨体外膈肌起搏联合早期康复对机械通气患者竖脊肌面积及脱机时间的影响。方法 选取2020年1月至2022年1月接受治疗的机械通气患者110例,随机数字表法分为观察组(n=55)和对照组(n=55)。对照组给予常规和早期康复治疗,观察组在对照组基础上给予体外膈肌起搏治疗。观察两组脱机成功率、竖脊肌面积变化等。结果 观察组机械通气时间和ICU住院时间分别为(11.43±2.01)d和(20.20±2.54)d,明显短于对照组(P<0.05);1次脱机成功率为70.91%,明显高于对照组(P<0.05)。观察组治疗后竖脊肌面积、吸气末膈肌厚度、呼气末膈肌厚度和膈肌移动度分别为(2 101.18±333.40)mm2、(3.16±0.81)mm、(2.20±0.90)mm和(1.89±0.40)cm,明显大于对照组(P<0.05)。观察组转出ICU时动脉血二氧化碳分压(PaCO_(2))、气道峰压、呼气压力和气道阻力分别为(44.40±9.12)mmHg、(23.39±6.89)cmH_(2)O、(18.29±6.04)cmH2O和(27.82±6.68)cmH_(2)O·L-1·s-1,明显低于对照组(P<0.05)。动脉血氧分压(PaO_(2))为(67.76±9.15)mmHg,氧合指数为(248.24±10.27)mmHg,明显高于对照组(P<0.05)。观察组并发症总发生率为7.27%,明显低于对照组(P<0.05)。结论 体外膈肌起搏联合早期康复有助于机械通气患者脱机成功,缩短脱机时间,减少竖脊肌面积损失,改善动脉血气指标和呼吸参数。Objective To investigate the effects of external diaphragm pacing combined with early rehabilitation on erector spinae area and weaning time in patients with mechanical ventilation.Methods From January 2020 to January 2022,110 patients with mechanical ventilation were selected and randomly divided into observation group(n=55)and control group(n=55).Patients in the control group received routine and early rehabilitation treatment,while those in the observation group received external diaphragm pacing treatment on the basis of the control group.The success rate of weaning and the area of erector spinal muscle were observed.Results The duration of mechanical ventilation)and ICU stay in the observation group[(11.43±2.01)d and(20.20±2.54)d]were significantly shorter than those in the control group(P<0.05).The success rate of weaning once was 70.91%,which was significantly higher than that in the control group(P<0.05).After treatment,the area of the vertical spinal muscle,the thickness of the diaphragm at the end of inspiration,the thickness of the diaphragm at the end of expiration and the degree of movement of the diaphragm in the observation group were(2101.18±333.40)mm^(2),(3.16±0.81)mm,(2.20±0.90)mm and(1.89±0.40)cm,respectively;which were significantly greater than those in the control group(P<0.05).The arterial partial pressure of carbon dioxide(PaCO_(2)),airway peak pressure,and expiratory pressure and airway resistance in the observation group were(44.40±9.12)mmHg,(23.39±6.89)cmH_(2)O,(18.29±6.04)cmH_(2)O and(27.82±6.68)cmH_(2)O/Ls when transferred out of the ICU,respectively;which were lower than those in the control group(P<0.05).The PaO_(2)[(67.76±9.15)mmHg]and oxygenation index[(248.24±10.27)mmHg]were significantly higher in the observation group than those in the control group(P<0.05).The total incidence of complications in the observation group was 7.27%,which was significantly lower than that in the control group(P<0.05).Conclusion External diaphragm pacing combined with early rehabilitation

关 键 词：体外膈肌起搏 早期康复 机械通气 竖脊肌面积 脱机时间 

分 类 号：R563.1[医药卫生—呼吸系统] R743.3[医药卫生—内科学]