AECOPD机械通气患者膈肌超声监测下吸气肌锻炼研究

Ultrasound-guided inspiratory muscle training for mechanically ventilated patients with acute COPD exacerbation

目的探讨慢性阻塞性肺疾病急性期(AECOPD)机械通气患者脱机前膈肌超声监测下吸气肌锻炼效果。方法将呼吸重症监护室74例AECOPD机械通气患者随机分为观察组和对照组各37例;对照组进行常规机械通气护理,逐渐降低呼吸机压力值和PEEP值,按经验撤机;观察组由医护团队按计划每日调整呼吸机吸气触发灵敏度,配合使用沙袋加压锻炼吸气肌,行床旁右侧膈肌超声监测。结果观察组吸气末膈肌厚度、膈肌增厚分数显著高于对照组,机械通气时间显著短于对照组(P<0.05,P<0.01),未发生吸气肌锻炼相关不良事件。结论对AECOPD机械通气患者,在膈肌超声监测下行吸气肌锻炼,效果较好,安全。

Objective To discuss the effect of ultrasound-guided inspiratory muscle training（IMT）before weaning for ventilated patients with acute exacerbation of chronic obstructive pulmonary disease（AECOPD）.Methods A total of 74 patients with AECOPD requiring mechanical ventilation were randomly divided into a control group and an intervention group,with 37 cases in each group.The control group was given conventional nursing care in which ventilator pressure and positive end-expiratory pressure（PEEP）were gradually decreased and then weaning from mechanical ventilation was empirically implemented,while the intervention group received alternative care：trigger sensitivity was adjusted daily according to a definitive protocol and bedside ultrasonography of the diaphragm was performed to monitor the sandbag-assisted IMT.Results Thickness of the diaphragm during end of inspiration and the degree of diaphragmatic thickening were significantly higher,whereas the ventilation duration was significantly shorter in the intervention group than the control group（P〈0.05,P〈0.01）.There were no IMT related adverse events.Conclusion Ultrasoundguided IMT can be a safe and effective exercise training for AECOPD patients with mechanical ventilation.