压力支持通气时吸气触发灵敏度对膈肌功能的影响

Effect of Inspiratory Trigger Sensitivity on Diaphragm Function During Pressure Support Ventilation

目的利用床旁超声评价不同触发灵敏度的机械通气对膈肌功能产生影响,从而为临床合理设置机械通气参数提供数据支撑。方法方便选取2019年1—12月于厦门市第五医院就诊的且连续住院的重症监护室预择期行外科手术患者共有60例作为研究对象,采用抽签法进行随机分组,每组20例,A组:PSV通气的触发灵敏度设置为2 L/min。B组:PSV通气的触发灵敏度设置为5 L/min。C组:PSV通气的触发灵敏度设置为8 L/min。分别于PSV通气开始时、通气6、12、18、24、36、48、60、72 h及脱机拔管时测量膈肌活动度,测量膈肌厚度。结果 A组72 h Tdi-ei、Tdi-ee、DE和TFdi分别为(1.18±0.38)mm、(1.16±0.42)mm、(12.45±4.13)mm、(15.04±3.16)%;B组72 h Tdi-ei、Tdi-ee、DE和TFdi分别为(1.23±0.40)mm、(1.18±0.45)mm、(12.45±4.12)mm、(15.07±3.12)%;C组72 h Tdi-ei、Tdi-ee、DE和TFdi分别为(1.44±0.41)mm、(1.31±0.41)mm、(12.75±4.19)mm、(15.17±3.12)%;随着通气时间的增加A组、B组和C组Tdi-ei、Tdi-ee、DE和TFdi均出现下降,通气12、18、24、36、48、60、72 h C组Tdi-ei、Tdi-ee、DE和TFdi均明显高于B组和A组,差异有统计学意义(P<0.05),通气12、18、24、36、48、60、72 h A组和B组Tdi-ei、Tdi-ee、DE和TFdi差异均无统计学意义(P>0.05)。结论随着通气时间的延长,患者Tdi-ei、Tdi-ee、DE和TFdi均明显下降。PSV通气的触发灵敏度越高,Tdi-ei、Tdi-ee、DE和TFdi降低的就越少。

Objective To use bedside ultrasound to evaluate the impact of mechanical ventilation with different trigger sensitivities on diaphragm function,so as to provide data support for clinically reasonable setting of mechanical ventilation parameters.Methods A total of 60 patients in the intensive care unit who were consecutively hospitalized in the intensive care unit from January to December 2019 in Xiamen City Fifth Hospital were selected as the research objects.The lottery method was used for random grouping,with 20 cases in each group,Group A:the trigger sensitivity of PSV ventilation is set to 2 L/min.Group B:the trigger sensitivity of PSV ventilation is set to 5 L/min.Group C:the trigger sensitivity of PSV ventilation is set to 8 L/min.Diaphragm activity and diaphragm thickness were measured at the beginning of PSV ventilation,6 hours,12 hours,18 hours,24 hours,36 hours,48 hours,60 hours,72 hours,and at the time of offline extubation.Results 72 h Tdi-ei,Tdi-ee,DE and TFdi in group A were(1.18±0.38)mm,(1.16±0.42)mm,(12.45±4.13)mm,(15.04±3.16)%,respectively;group B 72h Tdi-ei,Tdi-ee,DE and TFdi were(1.23±0.40)mm,(1.18±0.45)mm,(12.45±4.12)mm,(15.07±3.12)%,respectively;Group C 72 h Tdi-ei,Tdi-ee,DE and TFdi were(1.44±0.41)mm,(1.31±0.41)mm,(12.75±4.19)mm,(15.71±3.12)%,respectively;with the increase of ventilation time,the Tdi-ei of groups A,B and C,Tdi-ee,DE,and TFdi all decreased,with ventilation for 12 h,18 h,24 h,36 h,48 h,60 h and 72 h Tdi-ei,Tdi-ee,DE and TFdi in group C were significantly higher than those in group B and A,the difference was statistically significant(P<0.05).There was not statistically significant difference in Tdi-ei, Tdi-ee, DE and TFdi between groups A and B during ventilation for 12 h, 18 h, 24 h, 36 h, 48 h, 60 h and 72 h(P>0.05). Conclusion With the prolonged ventilation time, the patients' Tdi-ei, Tdi-ee, DE and TFdi decreased significantly. The higher the trigger sensitivity of PSV ventilation, the less the decrease of Tdi-ei, Tdi-ee, DE and TFdi.