新型多功能食管电极管和双颈前膈神经磁刺激评估机械通气患者膈肌功能的应用研究

Assessment of Diaphragm Function with A Newly Designed Multi-function Esophageal Electrode Catheter and Bilateral Anterolateral Magnetic Stimulation of Phrenic Nerves in Patients Underwent Mechanical Ventilation

目的监测重症监护室(ICU)机械通气患者的膈肌功能。方法纳入2013年5月至2013年11月机械通气≥72 h、病情稳定、通过撤机筛查、拟行自主呼吸试验的患者进行前瞻性研究。运用新型多功能食管电极管结合双颈前外侧膈神经磁刺激(BAMPS),监测膈神经传导时间(PNCT)、膈肌复合动作电位(CMAP)和颤触性跨膈压(TwPdi)。结果共入选14例患者,1例不能耐受磁刺激,2例无膈肌肌电信号,1例未刺激到膈神经,1例未获得有效颤触性跨膈压(PNCT、CMAP分别为7.2 ms、1.26 mV),9例取得完整检查数据的ICU机械通气患者PNCT、CMAP、TwPdi分别为(8.5±1.5)ms、(1.01±0.35)mV、(11.2±4.7)cm H2O。结论新型多功能食管电极管结合膈神经磁刺激可客观综合评估ICU患者的膈肌功能,但不是所有患者都适用。

Objective To monitor the diaphragm function of mechanical ventilated patients in the intensive care unit. Methods A prospective study was conducted on mechanical ventilation patients who had been evaluated by ventilation weaning screening test and planning to underwent spontaneous breathing trial between May 2013 and November 2013. A newly designed multi-function esophageal electrode was used to record the phrenic nerve conduction time （PNCT）, diaphragm compound muscle action potential （CMAP） and twitch transdiaphragmatic pressure （TwPdi） elicited by bilateral anterolateral magnetic phrenic nerve stimulation. Results 14 patients were recruited in this study. 1 case exited because of intolerance of repetitive magnetic stimulation,2 cases had no diaphragmatic electromyographic signals nor twitch signals, 1 case had diaphragmatic electromyographic signal but could not be elicited by magnetic stimulation, 1 case had no available TwPdi value with PNCT of 7.2 ms and CMAP of 1.26 inV. In the rest 9 cases, the PNCT, CMAP and TwPdi were （ 8. 5 ± 1.5 ） ms, （ 1.01± 0. 35 ） mY, （ 11.2 ± 4.7 ） cm H：O, respectively. Conclusion Newly designed multi-function esophageal electrode catheter combined with bilateral anterolateral magnetic phrenic nerve stimulation can be used for non-volitional comprehensive assessment of diaphragm in critically ill patients, but not suitable for all subjects.