膈肌电活动对神经调节辅助通气患者撤机的预测价值

发布时间：2018-03-16 18:16

本文选题：膈肌电活动　切入点：神经调节辅助通气　出处：《广西医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:探究膈肌电活动在神经调节辅助通气患者不同撤机结果中的差异,并探讨其对神经调节辅助通气患者撤机的预测价值。方法:对2013年6月至2016年12月广西医科大学第一附属医院重症医学科二病区应用神经调节辅助通气实施撤机的患者进行回顾性分析,根据撤机结果分为撤机成功组与撤机失败组,收集、记录并比较两组患者在一般情况(性别、年龄、身体质量指数、人工气道方式、导致机械通气的原因、撤机前住ICU时间)、呼吸力学(撤机前使用机械通气时间、撤机前使用NAVA时间、撤机前的膈肌电活动、呼吸频率、潮气量、浅快呼吸指数、分钟通气量、呼气末正压、吸氧浓度、气道峰压、平均气道压)、循环力学(撤机前与撤机2小时后的心率、平均动脉压)、血气分析(撤机前与撤机2小时后的酸碱度、氧分压、二氧化碳分压、碳酸氢根、血氧饱和度、乳酸、氧合指数、血红蛋白)的差异,评估各指标对撤机的预测价值。结果:(1)一般情况:应用NAVA患者20例,排除因病情需要未实施撤机患者4例,符合纳入标准患者16例,其中撤机成功患者9例(9/16),撤机失败患者7例(7/16),两组患者在年龄、性别、BMI、人工气道方式、导致机械通气的原因、撤机前住ICU时间等一般情况的差异均无统计学意义(P0.05);(2)呼吸力学:撤机失败组患者的Edi、Ve、P mean高于撤机成功组,分别为6.5(4.5~9.1)VS 3.1(2.3~3.8)(P=0.005)、9.8(7.7~13.1)VS 6.7(6.0~7.6)(P=0.004)、9.0(8.0~10.0)VS 7.0(4.5~7.4)(P=0.019),差异有统计学意义;(3)循环力学及血气分析:两组患者撤机前、撤机2小时后的循环力学及血气分析差异均无统计学意义(P0.05);(4)双变量相关分析显示:Edi与撤机前使用NAVA时间(r=-0.596,P=0.015)呈显著负相关,与Ve(r=0.600,P=0.014)、P mean(r=0.695,P=0.003)呈显著正相关;(5)单因素Logistic回归分析显示:Edi是预测撤机失败风险的危险因素,相对危险度(OR值)为2.436(P=0.04);(6)ROC曲线分析显示:Edi的AUC为0.921(P=0.005),预测撤机失败的最佳截断值为Edi=3.65uV,其敏感度为1.000,特异性为0.778。结论:膈肌电活动对神经调节辅助通气患者撤机失败具有良好的辅助预测价值。
[Abstract]:Objective: to investigate the difference of diaphragmatic electrical activity in different weaning outcomes in patients with neuroregulatory assisted ventilation. Methods: from June 2013 to December 2016, neuroregulatory assisted ventilation was used in the second ward of the Department of intensive Medicine, the first affiliated Hospital of Guangxi Medical University. A retrospective analysis was carried out in 18% of the patients. According to the results of weaning, the patients were divided into successful weaning group and failed weaning group. The causes of mechanical ventilation were collected, recorded and compared between the two groups in general condition (sex, age, body mass index, artificial airway mode). ICU time, respiratory mechanics (mechanical ventilation time before weaning, NAVA time before weaning, diaphragm electrical activity before weaning, respiratory frequency, tidal volume, shallow rapid breathing index, minute ventilation volume, positive end-expiratory pressure, oxygen concentration, Peak airway pressure, mean airway pressure, cyclic mechanics (heart rate before and 2 hours after weaning, mean arterial pressure, blood gas analysis (pH, partial pressure of oxygen, partial pressure of carbon dioxide, bicarbonate) before and 2 hours after weaning, The difference of blood oxygen saturation, lactate, oxygenation index, hemoglobin), and evaluate the predictive value of each index to weaning machine. Results: 20 cases were treated with NAVA, 4 cases were excluded because of illness. Of the 16 patients who met the inclusion criteria, 9 were successful in weaning, and 7 were failed in weaning. The causes of mechanical ventilation in the two groups were age, sex, BMIs, artificial airway mode. There was no significant difference in ICU duration before weaning. (P 0.05) respiratory mechanics: the EdiI Veg P mean of the patients with failed weaning was higher than that of the successful weaning. The results were as follows: 6.5V 4.5V 9.1VS 3.1U 2.3C 3.8U P 0.005 7.77.713.1 VS 6.76.07.6U P0.004 / 9.08.0VS 7.0V 7.0VS 7.57.4P 0.019, the difference was statistically significant (P < 0.05)) cycle mechanics and blood gas analysis: before the weaning, the patients in the two groups had no significant difference in circulation mechanics and blood gas analysis before the withdrawal of the machine, and the difference was significant (P < 0.05), the difference was significant (P < 0.05). There was no significant difference in circulatory mechanics and blood gas analysis between two hours after weaning. Bivariate correlation analysis showed that there was a significant negative correlation between NAVA duration before weaning and NAVA time before weaning (P 0.015). There was a significant positive correlation between Logistic analysis and Logistic regression analysis. The single factor Logistic regression analysis showed that% EDI was a risk factor for predicting the risk of failure of the weaning machine, and a significant positive correlation was found between 0. 695 and 0. 014 (P < 0. 003), and the single factor Logistic regression analysis showed that: Edi was a risk factor for predicting the risk of failure. The relative risk OR value (OR) was 2.436p 0.04 ~ (0.04) ~ (?) ROC curve analysis showed that the AUC of: EDI was 0.921 ~ P0. 005, and the best truncation value of predicting weaning failure was Edio 3.65 uV.The sensitivity was 1.000 and the specificity was 0.778.Conclusion: diaphragmatic electromyography has a good effect on the failure of weaning in patients with neuroregulatory auxiliary ventilation. Has good auxiliary forecast value.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R459.7

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