体外膈肌起搏用于慢性呼吸衰竭治疗对患者肺功能和运动耐力的影响

目的研究体外膈肌起搏用于慢性呼吸衰竭治疗对患者肺功能和运动耐力的影响。方法选取首都医科大学大兴医院2017年5月至2018年5月收治的120例慢性阻塞性肺疾病患者纳入研究对象,以随机数表法分为观察组与对照组,各60例。对照组患者给予常规治疗,观察组在对照组基础上加用体外膈肌起搏治疗。比较2组治疗前后第一秒用力呼气容积、第一秒用力呼气容积与用力肺活量比值、用力肺活量、动脉血氧分压、动脉血氧饱和度、动脉血二氧化碳分压、肌红蛋白、肌酸磷酸激酶、乳酸脱氢酶。比较2组治疗前后慢性阻塞性肺疾病评估测试及改良版英国医学研究会呼吸问卷(mMRC)评分。结果观察组治疗后第一秒用力呼气容积、第一秒用力呼气容积与用力肺活量比值、用力肺活量水平均显著高于治疗前及对照组治疗后,差异均有统计学意义(P值均<0.05)。观察组治疗后动脉血氧分压、动脉血氧饱和度水平均显著高于治疗前及对照组治疗后,差异均有统计学意义(P值均<0.05);观察组治疗后动脉血二氧化碳分压均显著低于治疗前及对照组治疗后,差异均有统计学意义(P值均<0.05)。观察组治疗后肌红蛋白、肌酸磷酸激酶、乳酸脱氢酶水平显著低于治疗前及对照组治疗后,差异均有统计学意义(P值均<0.05)。观察组治疗后咳嗽、咳痰、胸闷、爬坡、家务活动、户外活动信心、睡眠、精神各项评分均显著低于治疗前及对照组治疗后,差异均有统计学意义(P值均<0.05)。2组治疗前mMRC分级比较差异无统计学意义(Z=0.283,P=0.963);观察组治疗后mMRC分级显著降低,与对照组比较差异有统计学意义(Z=9.318,P=0.025)。结论体外膈肌起搏用于慢性阻塞性肺疾病的治疗可改善患者肺功能,缓解患者临床症状,提高运动耐力,值得临床应用。

Effects of extracorporeal diaphragmatic pacing on pulmonary function and exercise endurance in patients with chronic respiratory failure

Objective To study the effect of external diaphragmatic pacing on lung function and exercise endurance in patients with chronic respiratory failure.Methods There were 120 patients with chronic obstructive pulmonary disease admitted to Daxing Teaching Hospital,Capital Medical University from May 2017 to May 2018 selected as study subjects,and divided into observation group and control group by random number table method,with 60 cases in each group.Patients in the control group were given conventional treatment,and patients in the observation group were treated with extracorporeal diaphragmatic pacing on the basis of the control group.The indexes of forced expiratory volume in the first second,forced expiratory volume in the first second/forced vital capacity,forcad vital capacity,partical pressure of oxygen in artery,arterial oxygen saturation,partical pressure of carbon dioxide in artery,myoglobin,creatine kinase and lactate dehydrogenase before and after treatment in the two groups were compared.Chronic obstructive pulmonary disease assessment test and modified British medical research council(mMRC)scores before and after treatment were compared between the two groups.Results After treatment,the levels of forced expiratory volume in the first second,forced expiratory volume in the first second/forced vital capacity and maximum ventilation per minute in the observation group were significantly higher than those before treatment and after treatment in the control group(all P<0.05).The levels of partical pressure of oxygen in artery and arterial oxygen saturation in the observation group after treatment were significantly higher than those before treatment and after treatment in the control group(all P<0.05).Partical pressure of carbon dioxide in artery in the observation group was significantly lower than that before treatment and after treatment in the control group(all P<0.05).After treatment,the levels of myoglobin,creatine kinase and lactate dehydrogenase in the observation group were significantly lower than those before treatment and after treatment in the control group(all P<0.05).After treatment,the scores of cough,sputum,chest tightness,climbing,housework,confidence in outdoor activities,sleep and spirit in the observation group were significantly lower than those before treatment and after treatment in the control group(all P<0.05).There was no significant difference in mMRC grade between the two groups before treatment(Z=0.283,P=0.963).After treatment,the mMRC grade of the observation group was significantly lower than that of the control group(Z=9.318,P=0.025).Conclusions Extracorporeal diaphragmatic pacing for the treatment of chronic obstructive pulmonary disease can improve the patient′s lung function,relieve the patient′s clinical symptoms,improve exercise endurance,worthy of clinical application.