自动触发颤搐性气道内压对机械通气撤机患者膈肌功能及相关影响因素的分析

Analysis of the function of diaphragm and its influencing factors in mechanical ventilation patients by using fully automatic trigger twitch tracheal pressure

目的通过测量机械通气撤机患者的颤搐性气道内压(TwPtr)了解膈肌功能并分析影响膈肌功能的临床因素。方法纳入2015年12月至2017年3月入住广州医科大学附属第一医院重症医学科有创机械通气时间超过48 h、病情稳定且开始进入撤机阶段的患者进行研究,于患者进入撤机阶段后,利用双向无重复全自动呼吸触发装置监测TwPtr,分析机械通气时间、重症肺部感染、镇静药物使用以及慢性阻塞性肺疾病(COPD)等因素对撤机的影响。结果共纳入62例患者,其中男性45例,女性17例;年龄(66.8±11.7)岁;23例存在重症肺炎。重症肺炎患者TwPtr绝对值明显低于非重症肺炎患者〔cmH2O(1 cmH2O=0.098 kPa):10.40±5.81比14.35±5.22,P=0.021〕,但机械通气时间与非重症肺炎患者差异无统计学意义〔d:26(17,43)比15(11,36),P=0.091〕。在62例机械通气患者中,TwPtr与机械通气时间呈负相关(r=0.414,P=0.002),并且膈肌功能评估后仍需机械通气的时间与TwPtr同样呈负相关性(r=0.277,P=0.039);TwPtr与镇静药物存在线性关系(r=0.220,P=0.040),与是否存在COPD基础疾病无相关性(r=-0.178,P=0.166)。结论对于机械通气撤机患者,重症肺部感染是影响膈肌功能的因素之一,膈肌功能障碍与镇静药物使用存在一定的相关性。

Objective To understand the function of diaphragm and analyze the clinical factors affecting the function of diaphragm by measuring twitch tracheal pressure(TwPtr)in patients with mechanical ventilation and in the weaning phase.Methods Patients with more than 48 hours of invasive mechanical ventilation admitted to the department of critical care medicine of the First Affiliated Hospital of Guangzhou Medical University from December 2015 to March 2017 were enrolled.After the patient entered the weaning stage,TwPtr of patients was monitored by two-way non repetitive automatic respiratory trigger device,the effects of duration of mechanical ventilation,severe pulmonary infection,sedative application and chronic obstructive pulmonary disease(COPD)on weaning were analyzed.Results A total of 62 patients were included,of which 45 were male and 17 were female.The average age was(66.8±11.7)years old.Twenty-three cases had severe pneumonia.The absolute value of TwPtr in severe pneumonia group was lower than that in non-severe pneumonia group[cmH2O(1 cmH2O=0.098 kPa):10.40±5.81 vs.14.35±5.22,P=0.021].However,there was no significant difference in the duration of mechanical ventilation between the severe pneumonia group and non-severe pneumonia group[days:26(17,43)vs.15(11,36),P=0.091].In 62 patients with mechanical ventilation,there was a negative correlation between TwPtr and duration of mechanical ventilation(r=0.414,P=0.002),there was also a negative correlation between the duration of mechanical ventilation and TwPtr after the assessment of diaphragm function(r=0.277,P=0.039).There was a linear relationship between TwPtr and sedatives(r=0.220,P=0.040),but there was no correlation between TwPtr and COPD(r=-0.178,P=0.166).Conclusions For patients in the weaning stage of mechanical ventilation,severe pulmonary infection is one of the factors that affect the diaphragm dysfunction.There is a certain correlation between the diaphragm dysfunction and the use of sedatives.