体外膈肌起搏器联合神经肌肉电刺激仪在ICU获得性肌无力机械通气患者中的应用  

Application of Extracorporeal Diaphragm Pacemaker Combined with Neuromuscular Electrical Stimulation Device in Mechanical Ventilation Patients with Acquired Muscle Weakness in ICU

作　　者：谢霜霜 谢丹[1] Xie Shuangshuang;Xie Dan(Taizhou Hospital of Zhejiang Province,Taizhou,Zhejiang 317000,China)

机构地区：[1]浙江省台州医院,浙江临海317000

出　　处：《医疗装备》2024年第24期26-29,34,共5页Medical Equipment

摘　　要：目的探讨体外膈肌起搏器(EDP)联合神经肌肉电刺激仪(NESD)在ICU获得性肌无力(ICU-AW)机械通气患者中的应用效果。方法选取2022年1月至2024年5月医院收治的ICU-AW机械通气患者86例为研究对象,根据随机双盲法分为两组,每组43例。对照组予以NESD治疗,试验组在对照组基础上予以EDP治疗,两组均治疗14 d。比较两组的生命体征[心率(HR)、呼吸频率(RR)、血氧饱和度(SpO_(2))]、肌力评分[采用英国医学研究委员会肌力评分量表(MRC-score)评估]、身体功能[采用切尔西危重监护身体评估工具(CPAx)评估]、生活能力[采用改良Barthel指数(MBI)评估]、膈肌功能(呼气及吸气末膈肌厚度、膈肌活动度)、插管时间、ICU住院天数及撤机成功率。结果治疗后,两组HR和RR均低于治疗前,SpO_(2)水平高于治疗前(P<0.05),且试验组HR和RR低于对照组,SpO_(2)水平高于对照组(P<0.05);治疗后,两组MRC-score、CPAx、MBI评分均高于治疗前(P<0.05),且试验组高于对照组(P<0.05);治疗后,两组呼气及吸气末膈肌厚度、膈肌活动度均大于治疗前,且试验组大于对照组(P<0.05);试验组插管时间、ICU住院天数短于对照组,撤机成功率高于对照组(P<0.05)。结论EDP联合NESD治疗,可降低ICU-AW机械通气患者的HR、RR,提高SpO_(2)水平,改善心肺功能,增强四肢肌力和膈肌功能,改善身体功能和生活能力,从而缩短患者的插管时间,提高撤机成功率。Objective To explore the application of extracorporeal diaphragm pacemaker(EDP)combined with neuromuscular electrical stimulation device(NESD)in mechanical ventilation patients with ICU acquired weakness(ICU-AW).Methods 86 ICU-AW mechanically ventilated patients admitted to the Intensive Care Unit of our hospital from January 2022 to May 2024 were selected for the study,and were divided into two groups of 43 patients each according to the randomised double-blind method.The control group was treated with NESD,and the experimental group was treated with EDP on the basis of the control group,and both groups were treated for 14 days.Vital signs[heart rate(HR),respiratory rate(RR),and blood oxygen saturation(SpO_(2))],muscle strength scores[assessed by the Medical Research Council Muscle Score(MRC-score)],and physical function[assessed by the Chelsea Critical Care Physical Assessment Tool(CPAx)assessment],activities of daily living indicators[assessed using the Modified Barthel Index(MBI)],diaphragmatic function(diaphragm thickness at the end of expiration and inspiration,diaphragm mobility),duration of intubation,days in ICU,and success of withdrawal were compared before and after treatment in two groups.Results After treatment,the HR and RR in two groups were lower than before treatment,and SpO_(2)was higher than before treatment(P<0.05),and HR and RR of the experimental group were lower than that of the control group,and SpO_(2)was higher than that of the control group(P<0.05);after treatment,MRC-score,CPAx scores,and MBI scores of both groups were higher than before treatment(P<0.05),and the experimental group was higher than that of the control group(P<0.05);after treatment,the diaphragm thickness at end-expiration and end-inspiration,as well as diaphragm activity of two groups,were higher than before treatment(P<0.05),with experimental group being higher than control group(P<0.05).The mechanical ventilation time and ICU stay time in experimental group were shorter than in control group,and the successful extubat

关 键 词：机械通气 ICU获得性肌无力 神经肌肉电刺激仪 体外膈肌起搏器 

分 类 号：R473.6[医药卫生—护理学]