体外膈肌起搏对老年神经调节辅助通气患者预后的改善作用

目的 探讨体外膈肌起搏(external diaphragm pacemaker,EDP)对老年神经调节辅助通气(neurally adjusted ventilatory assist,NAVA)患者预后的改善作用.方法 选择2017年1月至2019年6月浙江医院收治的60例老年机械通气患者,采用随机数字表法分为NA...

Effect of external diaphragm pacemaker on the prognosis of elderly patients with neurally adjusted ventilatory assist

ObjectiveTo investigate the effect of external diaphragm pacemaker (EDP) on the prognosis of elderly patients with neurally adjusted ventilatory assist (NAVA). Methods60 elderly patients with mechanical ventilation admitted to Zhejiang Hospital from January 2017 to June 2019 were selected, and divided into NAVA group (25 cases) and NAVA+EDP group (35 cases). Patients in NAVA group were treated with conventional therapy, and patients in NAVA+EDP group were given EDP on the basis of conventional treatment. The respiratory mechanics indexes, diaphragmatic excursion (DE), diaphragmatic thickening fraction (DTF), mechanical ventilation time, and success rate of weaning in 14 days were observed and compared between the two groups. T test was used to compare the measurement data between groups, and χ² test was used to compare the enumeration data. ResultsAt the beginning, there was no significant difference in respiratory mechanics indexes, DE and DTF between the two groups (t=0.505, 0.026, 0.506, 1.203, 0.561, 0.979; P > 0.05). When evacuating the ventilator, the respiratory mechanics indexes of the two groups were significantly decreased (t=20.560, 13.389, 20.206, 8.237, 12.488, 8.961, 12.478, 4.919; P < 0.01), DE and DTF were significantly increased (t=23.839, 16.982, 10.336, 8.688; P < 0.01); and compared with the NAVA group, the respiratory mechanics indexes in the NAVA+EDP group were significantly decreased (t=12.488, 8.961, 12.478, 4.919; P < 0.01), DE and DTF were significantly increased (t=9.943, 5.919; P < 0.01). The mechanical ventilation time of patients in the NAVA+EDP group was significantly shorter than that in the NAVA group, and the success rate of weaning in 14 days was significantly higher than that in the NAVA group, the differences were statistically significant (t=4.033, χ²=5.350; P < 0.05 or P < 0.01). ConclusionFor elderly patients with mechanical ventilation using the NAVA model, EDP can improve lung function and diaphragm function.