体外膈肌起搏器联合胸部物理治疗对重症肺炎有创机械通气患者呼吸功能的影响

Effect of external diaphragm pacemaker combined with thoracic physical therapy on respiratory function in patients with severe pneumonia undergoing invasive mechanical ventilation

摘要

目的 观察体外膈肌起搏器联合胸部物理治疗对重症肺炎有创机械通气患者呼吸功能的影响。方法 将90例重症肺炎有创机械通气患者随机分为体外膈肌起搏器组(EDP组)、胸部物理治疗组(CPT组)和联合组(ET组),每组各30例。3组患者均给予重症肺炎监护室内常规对症治疗。在此基础上,EDP组给予体外膈肌起搏器治疗,CPT组给予胸部物理治疗,ET组给予体外膈肌起搏器联合胸部物理治疗。于治疗前和治疗后分别采用膈肌移动度(DD)、膈肌增厚分数(DTF)、膈肌浅快呼吸指数(D-RSBI)、用力呼气量占用力肺活量比值(FEV₁/FVC)、峰值呼气流速(PEF)、氧合指数(OI)、机械通气时间、撤机成功率、28 d死亡率对3组患者膈肌功能、肺功能及预后情况进行评定。结果 治疗前,3组患者的DD、DTF、D-RSBI、FEV₁/FVC、PEF及OI评分均无明显差异(P>0.05);治疗后,3组患者的DD、DTF、D-RSBI、FEV₁/FVC、PEF及OI评分均较治疗前改善(P<0.05);且ET组的各项评分均较EDP组及CPT组改善更明显(P<0.05);治疗后,ET组患者的机械通气时间、撤机成功率、28 d死亡率均较EDP组及CPT组改善明显(P<0.05)。结论 在常规治疗的基础上联合应用体外膈肌起搏器与胸部物理治疗,能更有效改善重症肺炎有创机械通气患者的膈肌功能、肺功能和临床预后,对患者呼吸功能恢复具有重要临床价值。

Abstract

Objective To observe the effect of external diaphragm pacemaker combined with thoracic physical therapy on respiratory function in patients with severe pneumonia undergoing invasive mechanical ventilation. Methods 90 patients with severe pneumonia undergoing invasive mechanical ventilation were randomly divided into external diaphragmatic pacemaker group (EDP group),thoracic physical therapy group (CPT group),and combination group (ET group),with 30 patients in each group. All patients in the three groups were given routine symptomatic treatment in the intensive care unit for severe pneumonia. On this basis,the EDP group was given external diaphragmatic pacemaker treatment,the CPT group was given thoracic physical therapy,and the ET group was given external diaphragmatic pacemaker combined with thoracic physical therapy. Diaphragmatic mobility (DD),diaphragm thickening fraction (DTF),diaphragm shallow rapid breathing index (D-RSBI),forced expiratory volume to forced vital capacity ratio (FEV1/FVC),peak expiratory flow rate (PEF),oxygenation index (OI),mechanical ventilation time,weaning success rate,and 28-day mortality rate were used to evaluate diaphragm function,pulmonary function and prognosis of the three groups before and after treatment. Results Before treatment,there was no significant difference in DD,DTF,D-RSBI,FEV1/FVC,PEF and OI scores among the three groups (P>0.05);after treatment,the DD,DTF,D-RSBI,FEV1/FVC,PEF and OI scores among the three groups were all improved compared with before treatment (P<0.05);and all scores in the ET group were improved more significantly than those in the EDP group and the CPT group (P<0.05);After treatment,the mechanical ventilation time,successful weaning rate,and 28-day mortality rate of patients in the ET group were significantly improved compared with the EDP group and the CPT group (P<0.05). Conclusion The combined application of external diaphragmatic pacemaker and thoracic physical therapy on the basis of routine treatment can further improve diaphragmatic function,pulmonary function and clinical prognosis of patients with severe pneumonia undergoing invasive mechanical ventilation,and has important clinical value for the recovery of patients′ respiratory function.

关键词

体外膈肌起搏器 / 胸部物理治疗 / 重症肺炎 / 有创机械通气 / 呼吸功能

Key words

External diaphragm pacemaker / Thoracic physical therapy / Severe pneumonia / Invasive mechanical ventilation / Respiratory function

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基金资助

济宁医学院附属医院“苗圃”科研计划项目(MP-MS-2022-010)

济宁市重点研发计划(2024YXNS081)