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NAVA组（25例）和NAVA+EDP组（35例）。NAVA组患者给予常规治疗，NAVA+EDP组患者在常规治疗的基础上增加EDP，两组患者均符合脱机程序并应用NAVA模式进行脱机。观察比较两组患者入组时和撤机时的呼吸力学指标、膈肌活动度（diaphragm excursion, DE）、膈肌增厚分数（diaphragm thickening fraction, DTF），以及机械通气时间和14 d撤机成功率。组间计量资料的比较采用t检验，计数资料的比较采用χ²检验。 结果两组患者入组时的呼吸力学指标及DE、DTF的差异均无统计学意义（t=0.505、0.026、0.506、1.203、0.561、0.979，P>0.05）。撤机时，两组患者呼吸力学指标均较入组时显著降低（t=20.560、13.389、20.206、8.237，12.488、8.961、12.478、4.919；P<0.01）、DE和DTF均较入组时显著增高（t=23.839、16.982，10.336、8.688；P<0.01）；而且与NAVA患者组比较，NAVA+EDP患者组呼吸力学指标均明显降低（t=12.488、8.961、12.478、4.919，P<0.05）、DE和DTF均显著增高（t=9.943、5.919，P<0.01）。NAVA+EDP组患者机械通气时间显著短于NAVA组、14 d撤机成功率明显高于NAVA组，差异均有统计学意义（t=4.033，χ²=5.350；P<0.05或0.01）。 结论对于采用NAVA模式的老年机械通气患者，EDP能一定程度改善肺功能和膈肌功能，从而改善预后。

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.