体外膈肌起搏对ICU获得性衰弱患者膈肌功能障碍有效性的研究分析

Effects of external diaphragm pacer on diaphragmatic dysfunction in patients with intensive care unit-acquired weakness

目的:观察体外膈肌起搏对ICU获得性衰弱患者膈肌功能的疗效。方法:收集ICU获得性衰弱患者61例,随机分成对照组20例、观察组A21例、观察组B20例,分别给予常规治疗,常规治疗+早期心肺康复,常规治疗+早期心肺康复+体外膈肌起搏。在2周后进行膈肌活动度、膈肌厚度、最大吸气压(MIP)、Barthel指数、ICU住院时间测量,并记录。结果:治疗2周后,3组患者膈肌活动度、MIP均较治疗前明显提高(均P<0.05)。膈肌活动度组间两两比较,结果示观察组B>观察组A>对照组(P<0.05),对照组和观察组A无统计学差异(P=0.362),观察组B分别与对照组及观察组A差异有统计学意义(P<0.01)。MIP:观察组B>观察组A>对照组(P<0.01);膈肌厚度及Barthel指数比较:观察组B>观察组A>对照组(P<0.01);ICU住院时间:观察组B<观察组A<对照组(P<0.01)。结论:体外膈肌起搏能够有效增加ICU获得性衰弱患者的膈肌肌力和耐力,改善患者通气功能,提高日常生活活动能力和生活质量,缩短ICU住院时间,具有较高的临床使用价值。

Objective:To study the effect of the external diaphragm pacer(EDP)on intensive care unit-acquired weakness(ICU-AW)with diaphragmatic muscle function.Methods:Sixty-one patients with ICU-AW in West China Hospital of Sichuan University were randomly divided into control group(n=20),treatment group A(n=21)and treatment group B(n=20).Three groups were given basic treatment,basic treatment+early cardiopulmonary rehabilitation,basic treatment+early cardiopulmonary rehabilitation+EDP,respectively.Diaphragm mobility,diaphragm thickness,maximal inspiratory pressure,Barthel index,and length of stay in ICU were measured and recorded after 2 weeks.Results:After the treatment for 2 weeks,the diaphragm mobility and MIP in the three groups were significantly increased as compared with those before treatment(P<0.05).The diaphragm mobility was compared within the group,and the results showed that group A>group B>control group.There was no statistically significant difference between the control group and the treatment group A(P=0.362).The difference between group B and control group or group A was statistically significant(P<0.01).Diaphragm thickness and Barthel index showed an order of group B>group A>control group.The length of stay in ICU was shortest in group B,followed by group A,and longest in control group.Conclusion:EDP can effectively increase the diaphragmatic muscle strength and endurance of ICU-AW patients,improve the ventilation function of patients,improve the ability of daily life activities and quality of life,and shorten the length of ICU hospitalization.