体外膈肌起搏器在重症脑出血术后患者脱机中的临床应用

Application of external diaphragm pacemaker in offline patients with postoperative severe cerebral hemorrhage

目的探讨体外膈肌起搏器(EDP)对辅助重症脑出血机械通气(MV)患者脱机的临床疗效。方法前瞻性选择2016年3月至2017年3月火箭军特色医学中心神经重症监护病房(NICU)收治的需行MV的重症脑出血气管切开患者40例,按随机数字表法分为低流量吸氧(LFNC)组(n=20)和LFNC+EDP组(n=20)。LFNC组在患者脱离呼吸机后序贯LFNC;LFNC+EDP组在LFNC组基础上加用EDP治疗。记录患者脱机0、1、12、24、48 h的氧合指数、脱机时间、膈肌移动度;记录住神经重症加强治疗病房(NICU)时间,出NICU格拉斯哥评分(GCS)、出院GCS。结果LFNC+EDP组患者脱机后1、12、24、48 h的氧合指数为(213.65±19.38)、(222.20±17.76)、(224.85±13.75)、(257.30±12.09)mmHg,均高于LFNC组[(199.60±22.44)、(208.45±20.10)、(214.75±16.67)、(229.75±7.92)mmHg],差异均有统计学意义(P<0.05)。LFNC+EDP组患者的脱机时间、住NICU时间为(11.15±2.815)、(32.00±7.98)d,均短于LFNC组[(15.15±3.30)、(39.75±12.92)d],膈肌移动度、出NICU GCS、出院GCS为(2.91±0.11)cm、(7.75±0.44)分、(11.00±2.03)分,均高于LFNC组[(1.92±0.085)cm、(6.80±1.20)分、(7.45±2.63)分],差异均有统计学意义(P<0.05)。结论EDP能增加神外重症脑出血气管切开患者的膈肌移动度,缩短脱机时间和入住NICU的时间,从而早日康复,改善预后。

Objective To investigate the offline clinical effect of external diaphragm pacemaker(EDP)in postoperative severe cerebral hemorrhage patients.Methods A total of 40 severe postoperative severe cerebral hemorrhage patients with tracheotomy and mechanical ventilation(MV)were selected,who were admitted in NICU of PLA Rocket Force Characterristic Medical Center from March 2016 to March 2017.These patients were randomly divided into the ligh-flow nasal cannula(LFNC)group(n=20)and LFNC+EDP group(n=20)according to random number table method.In the LFNC group,the LFNC was given to the patients who were off ventilator.The LFNC+EDP group was added on the basis of treatment in the HFNC group,once a day and 30 minutes each time.Oxygenation index,off-line time,and diaphragmatic mobility of patients were recorded at 0,1,12,24,and 48 hours offline;the time of admission to neurointensive intensive care unit(NICU),NICU Glasgow score(GCS),and discharge GCS were recorded.Results The oxygenation index of patients in the LFNC+EDP group at 1,12,24,and 48 hours after weaning were(213.65±19.38),(222.20±17.76),(224.85±13.75),(257.30±12.09)mmHg,which were higher than those in the LFNC group[(199.60±22.44),(208.45±20.10),(214.75±16.67),(229.75±7.92)mmHg],the differences were statistically significant(P<0.05).The off-line time and NICU stay time of patients in the LFNC+EDP group were(11.15±2.815)and(32.00±7.98)d,which were shorter than those in the LFNC group[(15.15±3.30),(39.75±12.92)d],and the mobility of diaphragm,NICU GCS,discharge GCS were(2.91±0.11)cm,(7.75±0.44)points,(11.00±2.03)points,which were higher than those in the LFNC group[(1.92±0.085)cm,(6.80±1.20)points,(7.45±2.63)points],the differences were statistically significant(P<0.05).Conclusion EDP can increase the excursion of diaphragm,shorten the offline time and length of stay in the NICU,thereby enhancing the early recovery and improving the prognosis.