体外膈肌起搏治疗对慢性阻塞性肺病急性加重期患者内环境的影响  

Effect of Extracorporeal Diaphragmatic Pacing on Internal Environment of Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease

作　　者：陈绪池 黄娟[1] 刘畅[1] 代剑 Chen Xuchi;Huang Juan;Liu Chang(Department of Intensive Care Unit,Wuhan Wuchang Hospital Affiliated to Wuhan University of Science and Technology,Wuhan,Hubei 430061,China)

机构地区：[1]武汉科技大学附属武汉市武昌医院重症医学科,湖北武汉430061

出　　处：《四川医学》2023年第6期570-574,共5页Sichuan Medical Journal

基　　金：武汉市卫健委科研基金资助项目(编号:WX20Z29)。

摘　　要：目的探讨体外膈肌起搏(EDP)治疗对慢性阻塞性肺病急性加重期(AECOPD)患者内环境的影响。方法收集我院2019年10月至2021年10月收治的符合纳入标准的伴有轻-中度低钠血症的Ⅱ型呼吸衰竭AECOPD患者87例,随机分为对照组和观察组,其中对照组42例,观察组45例,对照组予无创正压通气及药物治疗,观察组在对照组治疗基础上加用EDP治疗,比较两组患者治疗前后的膈肌移动度、pH值、PaO_(2)、PaCO_(2)的变化,同时记录两组患者在治疗前、治疗后1 d、3 d和7 d的钠离子浓度,通过重复测量方差分析Mauchly球形度(P<0.001)·多变量检验,并行事后两两比较及简单效应分析。结果两组患者治疗后较治疗前膈肌移动度、PaO_(2)和PaCO_(2)均有显著改善(P<0.05);与对照组相比,观察组的膈肌移动度和PaCO_(2)改善更显著[观察组vs.对照组(膈肌移动度:Z=-2.739,P=0.006;PaCO_(2):Z=-2.664,P=0.008)],治疗后,观察组PaO_(2)相较于对照组改善不显著(P=0.054);两组患者治疗前后的pH改善无统计学意义(P>0.05);通过重复测量方差分析Mauchly球形度(P<0.001)·多变量检验结果显示:两组患者治疗后较治疗前钠离子浓度升高有显著改善(P<0.05),并且治疗方案和时间之间存在交互效应,随着时间的延长,与对照组相比,观察组的钠离子度升高幅度更大(P<0.001)。结论EDP治疗可改善伴有轻-中度低钠血症的Ⅱ型呼吸衰竭AECOPD患者的膈肌移动度和血气分析,对改善电解质紊乱尤其是低钠血症有一定的临床疗效。Objective To investigate the effect of extracorporeal diaphragmatic pacing(EDP)on the internal environment of patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD).Methods 87 AECOPD patients with type II respiratory failure with mild to moderate hyponatremia who met the inclusion criteria were collected from October 2019 to October 2021 in our hospital.They were randomly divided into the control group and the observation group,including 42 cases in the control group and 45 cases in the observation group.The control group was given non-invasive positive pressure ventilation and drug treatment.The observation group was treated with EDP on the basis of the treatment of the control group.The changes of diaphragm mobility,pH,PaO_(2)and PaCO_(2)before and after treatment were compared between the two groups,At the same time,the sodium ion concentration of the two groups of patients before treatment,on the first day,the third day and the seventh day after treatment was recorded.Through repeated measurement ANOVA and Mauchly sphericity(P<0.001)·multivariable test,and after two comparisons and simple effect analysis.Results After treatment,the degree of movement of diaphragm,PaO_(2)and PaCO_(2)in both groups were significantly improved compared with those in the treatment group(P<0.05);Compared with the control group,the diaphragm mobility and PaCO_(2)in the observation group improved more significantly[the observation group vs the control group(diaphragm mobility:Z=-2.739,P=0.006;PaCO_(2):Z=-2.664,P=0.008)],but after treatment,PaO_(2)in the observation group did not improve significantly compared with the control group(P=0.054);There was no significant difference in pH value between the two groups before and after treatment(P>0.05);The results of repeated measurement ANOVA of Mauchly sphericity(P<0.001)·Multivariate test showed that the sodium ion concentration in the two groups after treatment was significantly improved compared with that before treatment(P<0.05),and there was an interactio

关 键 词：慢性阻塞性肺疾病 急性加重期 Ⅱ型呼吸衰竭 体外膈肌起搏 低钠血症 膈肌移动度 

分 类 号：R563[医药卫生—呼吸系统]