体外膈肌起搏对慢性阻塞性肺疾病机械通气患者的治疗效果评价

Evaluation of therapeutic effects of external diaphragm pacing on COPD patients undergoing mechanical ventilation

目的探讨体外膈肌起搏对需机械通气的慢性阻塞性肺疾病(COPD)患者的治疗效果。方法选择2014年1月至2017年1月患有COPD且需有创呼吸机辅助通气的患者58例,随机分为2组。Ⅰ组28例:常规抗感染、祛痰、解痉平喘、机械通气、脏器功能支持等综合治疗,符合临床撤机标准后应用PSV模式进行撤机。Ⅱ组30例:在常规综合治疗的基础上,应用体外膈肌起搏,调节频率12次/min,同时调节旋钮使电刺激为患者能耐受为止,连续30 min,2次/d,符合临床撤机标准后应用PSV模式进行撤机。结果 2组第1、3、7、10天血pH值、氧合指数、PaCO2比较,差异无统计学意义(P>0.05);2组第1、3天浅快指数比较,差异无统计学意义(P>0.05)。Ⅱ组第7、10天浅快指数较Ⅰ组降低,差异有统计学意义(P<0.05);2组第1、3、7、10天潮气量、最大吸气压、最大呼气压比较,差异无统计学意义(P>0.05);2组第1、3天膈肌移动度比较,差异无统计学意义(P>0.05)。Ⅱ组第7、10天膈肌移动度较Ⅰ组增加,差异有统计学意义(P<0.05);Ⅱ组机械通气时间、住ICU时间较Ⅰ组缩短、7 d内再插管率降低(P<0.05);Ⅱ组7 d拔管率较Ⅰ组升高,差异有统计学意义(P<0.05)。结论需机械通气的COPD患者应用体外膈肌起搏后机械通气时间、ICU住院时间均缩短,拔管成功率增加。体外膈肌起搏可帮助COPD患者撤离呼吸机。

Objective To investigate the therapeutic effects of external diaphragm pacing on patients with chronic obstructive pulmonary disease(COPD) undergoing mechanical ventilation.Methods A total of 58 patients with COPD who were treated by invasive ventilator assisted ventilation in our hospital from January 2014 to January 2017 were randomly divided into two groups.The patients in group Ⅰ were treated by combined modality therapy including anti-infection,eliminating phlegm,anti-spasmolysis,relieving asthma,mechanical ventilation and organ function support,and the machine was removed by applying PSV mode after reaching the corresponding standard.The patients in group Ⅱ,on the basis of routine therapy,were treated by external diaphragm pacing,and the frequency was adjusted at 12 times/min,and the knob was adjusted to make the electrical stimulation up to the tolerance of patients for 30 minutes,twice a day, and the machine was removed by applying PSV mode after reaching the corresponding standard.Results There were no significant differences in blood pH,oxygenation index and PaCO2 at the 1 st,3 rd,7 th,10 th day between the two groups(P>0.05). There were no significant differences in the rapid shallow breathing indexes at the 1 st,3 rd day between the two groups(P<0.05). The rapid shallow breathing indexes at the 7 th,10 th day in group Ⅱ were significantly lower than those in group Ⅰ(P<0.05). There were no significant differences in the tidal volume,MIP and MEP at the 1 st,3 rd,7 th,10 th day between the two groups(P>0.05). There was no significant differences in the diaphragm movement degree at the 1 st,3 rd day between the two groups(P>0.05).The diaphragm movement degree at the 7 th and 10 th day in group Ⅱ was more significant than that in group Ⅰ(P<0.05).Moreover the mechanical ventilation time,the ICU stay time,and the reintubation rate within 7 days in Group Ⅱ were significantly shorter than those in group I(P<0.05).However the extubation rate at the 7 th day in group Ⅱ was significantly higher than that in group Ⅰ(P<0.05).Conclusion The application of external diaphragm pacing in the patients with COPD who need mechanical ventilation can shorten the mechanical ventilation time,ICU stay time,and improve the success rate of extubation,moreover,which is helpful to remove the breathing machine.