体外膈肌起搏刺激对单孔胸腔镜肺癌术后患者膈肌功能的作用观察  

Effect of external diaphragmatic pacing stimulation on diaphragmatic function in patients after uniportal video⁃assisted thoracoscopic surgery

作　　者：欧建英 李家豪[2] 王晓进 张芷滢[2] 詹鸿锐 王康玲 OU Jianying;LI Jiahao;WANG Xiaojin;ZHANG Zhiying;ZHAN Hongrui;WANG Kangling(Department of Rehabilitation Medicine,Zhujiang Hospital,Southern Medical University,Guangzhou,Guangdong 510280,China;Department of Rehabilitation Medicine,the Fifth Affiliated Hospital of Sun Yat-sen University,Zhuhai,Guangdong 519000,China;Thoracic Surgery Department,the Fifth Affiliated Hospital of Sun Yat-sen University,Zhuhai,Guangdong 519000,China)

机构地区：[1]南方医科大学珠江医院康复医学科,广东广州510280 [2]中山大学附属第五医院康复医学科,广东珠海519000 [3]中山大学附属第五医院胸外科,广东珠海519000

出　　处：《热带医学杂志》2024年第8期1115-1119,共5页Journal of Tropical Medicine

基　　金：广东省自然科学基金面上项目(2021A1515010135)。

摘　　要：目的研究体外膈肌起搏(EDP)刺激对单孔胸腔镜肺癌根治术后患者进行治疗,能否促进肺癌术后患者的膈肌功能快速恢复,从而改善其肺功能,加快术后康复进程。方法纳入2023年3-7月间在中山大学附属第五医院住院手术的121例肺癌患者,排除不符合入组标准及无法完成的43例后,最终入组78例,随机分为EDP组和对照组,均予术后常规康复治疗。EDP组再给予体外膈肌起搏刺激治疗,对照组则予体外膈肌起搏空白刺激。对比两组患者不同时间点的膈肌超声参数、手术后并发症、疼痛评分、胸液引流量和胸腔引流管拔管时间。结果T0时间段两组患者膈肌超声参数平静呼吸膈肌增厚变化率(DTF)、平静呼吸吸气末膈肌厚度(DTei)、平静呼吸膈肌移动度(DE)值比较,差异均无统计学意义(P均>0.05),提示两组患者膈肌功能术前相似。与T0相比,T1时间段两组患者DTei、DE值显著下降,差异均有统计学意义(DTei:t对照组=5.337、t_(EDP组)=6.935,DE:t对照组=13.494、t_(EDP组)=15.382,P均<0.001),T1时间点两组DTei、DE比较,差异均无统计学意义(P均>0.05)。与T1时间点比较,两组患者T2时间点DTei、DE明显上升,差异均有统计学意义(DTei:t对照组=2.969、t_(EDP组)=6.247,DE:t对照组=4.249、t_(EDP组)=15.006,P均<0.05)。T2时间点,EDP组DE较对照组明显升高,差异有统计学意义(t=6.746,P<0.001),而两组同时间点DTei比较,差异无统计学意义(P>0.05)。两组患者术后并发症、引流管留置时间对比,差异均无统计学意义(P均>0.05),但与对照组比较,EDP组视觉模拟评分(VAS)在T2时间点明显下降,差异有统计学意义(t=2.629,P<0.05)。结论体外膈肌起搏刺激可在短时间内显著提高单孔胸腔镜肺癌术后患者的早期膈肌移动度,降低患者疼痛感受,有利于加速肺癌患者术后康复,且无明显不良反应。Objective To study whether external diaphragmatic pacing(EDP)can facilitate the swift recovery of diaphragmatic function in patients with lung cancer post⁃uniportal video⁃assisted thoracoscopic surgery,thereby enhancing respiratory function and accelerating their postoperative recovery.Methods A total of 121 lung cancer patients hospitalized in the Fifth Affiliated Hospital of Sun Yat⁃sen University between March and July 2023 were seclected,after excluding 43 cases who did not meet the enrollment criteria and could not be completed,78 cases were finally enrolled and randomly divided into EDP group and control group.Both groups were given routine rehabilitation after operation.The EDP group was given external diaphragmatic pacing stimulation,while the control group was given external diaphragm pacing blank stimulation.The main outcome measures were the ultrasonic parameters of diaphragm in two groups at different time points.The secondary observation indexes were postoperative complications,pain score,drainage volume of pleural effusion and extubation time of thoracic drainage tube.Results There was no significant difference in the ultrasonic parameters of diaphragm,such as diaphragm thickening fraction(DTF),diaphragm thickness at the end of inspiration(DTei)and diaphragm excursion(DE),between the two groups at T0(P>0.05),suggesting that the diaphragm function of the two groups was similar before operation.Compared with T0 time point,the values of DTei and DE in the two groups at T1 decreased significantly,and the differences were statistically significant(D_(Tei:tcontrol group)=5.337,tEDP group=6.935,DE:tcontrol group=13.494,tEDP group=15.382;all P<0.001),but there was no statistical difference between the two groups at T1(all P>0.05).Compared with T1 time point,DTei,DE at T2 time point in the two groups increased significantly,and the differences were statistically significant(D_(Tei:tcontrol group)=2.969,tEDP group=6.247,DE:tcontrol group=4.249,tEDP group=15.006;all P<0.05).At T2,the DE of EDP group was

关 键 词：体外膈肌起搏 单孔胸腔镜手术 肺癌 平静呼吸膈肌移动度 

分 类 号：R734.2[医药卫生—肿瘤]