体外膈肌起搏预防无创机械通气患者膈肌功能障碍的效果研究

doi:10.3761/j.issn.0254-1769.2022.09.001

摘要/Abstract

摘要：

目的制订体外膈肌起搏康复方案,探讨其对ICU无创机械通气患者呼吸机相关膈肌功能障碍（ventilator-induced diaphragmatic dysfunction,VIDD）的预防效果。方法通过文献回顾、小组会议制订体外膈肌起搏康复方案。便利选取2020年9月—2021年6月入住河南省某三级甲等医院呼吸重症病区的无创机械通气患者作为研究对象,采用随机数字表法将其分2组。试验组在常规护理的基础上,实施体外膈肌起搏康复方案;对照组给予常规护理,共干预5 d。比较两组干预后VIDD发生率、膈肌厚度分数、膈肌位移以及血气分析指标。结果共纳入74例患者,脱落10例,最终纳入64例,其中试验组、对照组各32例。干预后,试验组VIDD发生率为6.25%,对照组为43.75%,两组比较,差异具有统计学意义（P=0.001）;试验组膈肌厚度分数、膈肌位移大于对照组,PaO₂、K⁺高于对照组（两组K⁺均在正常范围内）,差异均具有统计学意义（P<0.05）。结论实施体外膈肌起搏康复方案能降低ICU无创机械通气患者VIDD的发生率,有助于改善其膈肌与呼吸功能。

关键词: 危重病, 体外膈肌起搏, 呼吸机相关膈肌功能障碍, 机械通气, 预防, 护理

Abstract:

Objective To establish the rehabilitation program of external diaphragm pacer and to explore its preventive effect on ventilator-induced diaphragmatic dysfunction（VIDD） in patients with ICU non-invasive mechanical ventilation. Methods Through the literature review,group meeting and pre-experiment,a program was formulated to prevent VIDD in patients with non-invasive ventilation in ICU. Patients with non-invasive ventilation were conveniently selected from September 2020 to June 2021 in a respiratory intensive care unit of a tertiary hospital in Henan province. They were divided into 2 groups by random number table method. On the basis of routine nursing care,the experimental group was given the external diaphragm pacer training program,and the control group was given routine nursing program. The incidence of VIDD,diaphragm thickness score,diaphragm displacement and blood gas analysis were compared between 2 groups after the intervention. Results A total of 74 patients were included with 10 cases fallen off,and finally 64 cases were included with 32 cases in the experimental group and 32 cases in the control group. After the intervention,the incidence of VIDD was 6.25% in the experimental group,while that was 43.75% in the control group. The difference between 2 groups was statistically significant（P=0.001）. Conclusion The external diaphragm pacer rehabilitation program can reduce the incidence of VIDD and improve diaphragm and respiratory function in patients with ICU non-invasive mechanical ventilation.

Key words: Critical Illness, External Diaphragm Pacer, Ventilator-Induced Diaphragmatic Dysfunction, Mechanical Ventilation, Prevention, Nursing Care

吴月红, 梁红霞, 席芳, 李成, 李莹莹, 贾育萌, 郑云云, 冯珍珍. 体外膈肌起搏预防无创机械通气患者膈肌功能障碍的效果研究[J]. 中华护理杂志, 2022, 57(9): 1029-1034.

WU Yuehong, LIANG Hongxia, XI Fang, LI Cheng, LI Yingying, JIA Yumeng, ZHENG Yunyun, FENG Zhenzhen. Effect of external diaphragm pacer on prevention of ventilator-induced diaphragmatic dysfunction in patients with ICU non-invasive ventilation[J]. Chinese Journal of Nursing, 2022, 57(9): 1029-1034.

图/表 3

表1 两组一般资料的比较

Table 1 Baseline information of participants in 2 groups

表2 两组膈肌厚度分数、膈肌位移比较[M（P25,P75）]

Table 2 Comparison of diaphragm thickness fraction and diaphragm displacement between the 2 groups[M（P25,P75）]

表3 两组血气分析指标比较[M（P25,P75）]

Table 3 Comparison of blood gas analysis index between the 2 groups[M（P25,P75）]

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