机械通气对膈肌收缩功能的影响

发布时间：2018-04-04 07:22

  本文选题：机械通气　切入点：膈肌　出处：《宁夏医科大学》2017年硕士论文

【摘要】：目的:观察机械通气(MV)患者膈肌收缩功能的变化以及MV时间与膈肌收缩力之间的关系。另外,观察膈肌收缩力与MV患者预后的关系。方法:采用前瞻性研究方法,2015年2月至2016年11月期间入住上海同济大学附属东方医院重症监护病房(ICU)的患者48例,入选患者在MV 24小时内采用胃食道囊管法测量最大跨膈压(Pdi_(max)),MV第1-3天每天测量,以后每隔48小时测量一次直至患者拔管或者死亡;同时记录患者血清C-反应蛋白(CRP)、血清降钙素原(PCT)、血清脑钠肽前体(NT-pro-BNP)、APACHE II评分、血清白蛋白和血清前白蛋白。结果:(1)MV患者膈肌收缩力降低,所有患者平均Pdi_(max)为23.6±5.6 cmH2O;(2)随着MV时间的延长患者平均Pdi_(max)逐渐下降,MV第5天较MV第1天平均Pdi_(max)明显降低(27.7±5.2 vs 21.5±3.2 cmH2O,t=6.375,p=0.000);MV第15天平均Pdi_(max)为17.7±2.9cmH2O,较MV第1天下降约37%;(3)拔管成功患者在拔除气管插管前平均Pdi_(max)明显高于死亡患者(26.3±5.7 vs 20.7±3.6 cmH2O,t=8.980,p=0.000)。另外,死亡组MV时间明显高于拔管成功组(153.8±36.2 vs 82.9±15.1 cmH2O,t=6.941,p=0.000);(4)Pdi_(max)与CRP(r=-0.510,P=0.000)、PCT(r=-0.440,P=0.002)、脑钠肽前体(NT-pro-BNP)(r=-0.416,P=0.003)和APACHE II评分(r=-0.295,P=0.042)均负相关;与血清白蛋白(r=0.403,P=0.005)和前白蛋白(r=0.447,P=0.001)正相关。结论:MV导致膈肌收缩力下降,且膈肌收缩力降低与MV时间明显相关。膈肌收缩功能可能是评估MV患者能否脱机的一项重要指标。炎症感染,心功能,营养和疾病严重程度也是影响膈肌收缩功能的重要因素。
[Abstract]:Objective: To observe the effect of mechanical ventilation (MV) the relationship between the changes of diaphragmatic contractile function in patients with MV and diaphragmatic contractile force. In addition, observe the relationship between diaphragmatic contractility and the prognosis of patients with MV. Methods: using the prospective study method, during the period from February 2015 to November 2016 in Shanghai East Hospital Affiliated to Tongji University ICU (ICU 48) patients enrolled in MV within 24 hours of the stomach and esophagus balloon catheter method to measure the maximal transdiaphragmatic pressure (Pdi_ (max)), MV daily for the first 1-3 days of measurement, 48 hours after every measurement time until extubation or death; while recording serum C- reactive protein in patients with serum (CRP). Procalcitonin (PCT), serum brain natriuretic peptide (NT-pro-BNP), APACHE II score, serum albumin and serum albumin. Results: (1) MV patients reduce the diaphragmatic contractile force, the average Pdi_ of all patients was 23.6 + 5.6 (max) cmH2O; (2) MV with time delay 闀挎偅鑰呭钩鍧嘝di_(max)閫愭笎涓嬮檷,MV绗，

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