体外膈肌起搏对肺部感染脓毒症机械通气患者膈肌功能和撤机的影响

Effect of extracorporeal diaphragm pacing on diaphragm function and weaning in mechanically ventilated patients with pulmonary infection sepsis

目的:探讨体外膈肌起搏对肺部感染脓毒症机械通气患者膈肌功能、临床疗效和撤机的影响。方法:将2021年9月至2022年9月在无锡市中医医院治疗的40例肺部感染脓毒症机械通气患者随机分为观察组和对照组,每组20例。两组均给予常规对症治疗,对照组予单纯机械通气,观察组则在对照组基础上加以体外膈肌起搏。于入组当天和治疗7d后,比较患者SOFA评分和APACHEⅡ评分、膈肌相关参数(呼气末膈肌厚度、膈肌厚度分数、膈肌活动度)、氧合指数、撤机成功率及拔管成功率。结果:研究过程中,观察组脱落1例,对照组脱落2例,最终观察组19例,对照组18例完成统计。治疗后两组患者的APACHEⅡ评分和SOFA评分明显改善(P<0.05),观察组APACHEⅡ评分改善情况优于对照组(t=-2.489,P<0.05),而SOFA评分无明显差异(t=-0.293,P>0.05)。两组患者膈肌相关参数和氧合指数治疗后均有明显提高,且观察组优于对照组(P<0.05)。在撤机成功率方面,观察组明显高于对照组(P<0.05),而在拔管成功率方面,两组则无明显差异(P>0.05)。结论:体外膈肌起搏可以很好地提高肺部感染脓毒症机械通气患者的膈肌功能,改善患者症状,提高临床撤机成功率,值得进一步应用。

Objective:To investigate the effect of external diaphragm pacing on diaphragm function,clinical efficacy and weaning in patients with pulmonary infection and sepsis undergoing mechanical ventilation.Methods:From September 2021 to September 2022,40 patients with pulmonary infection and sepsis were randomly divided into observation group and control group,with 20 patients in each group.Both groups were given routine symptomatic treatment,the control group was given simple mechanical ventilation,and the observation group was given external diaphragm pacing on the basis of the control group.On the day of admission and 7 days after treatment,the patients'SOFA score and APACHEⅡscore,diaphragmatic related parameters(end-expiratory diaphragm thickness,diaphragm thickness score,diaphragm activity),oxygenation index,weaning success rate and extubation success rate were compared.Results:During the study,1 case fell off in the observation group,2 cases fell off in the control group,19 cases in the final observation group and 18 cases in the control group completed the statistics.After treatment,the APACHEⅡscore and SOFA score of the two groups were significantly improved(P<0.05).The diaphragmatic parameters and oxygenation index of the two groups were significantly improved after treatment,and the observation group was better than the control group(P<0.05).In terms of the success rate of weaning,the observation group was significantly higher than the control group(P<0.05).Conclusion:Extracorporeal diaphragm pacing can effectively improve the diaphragm function of patients with pulmonary infection and sepsis undergoing mechanical ventilation,improve their symptoms,and increase the success rate of clinical weaning,which is worthy of further application.