床旁超声评价不同通气模式对膈肌功能的影响

发布时间：2018-07-03 00:11

本文选题：膈肌 + 床旁超声　；参考：《青岛大学》2017年硕士论文

【摘要】：目的:通过床旁超声测量辅助控制通气模式和压力支持通气模式下膈肌厚度和膈肌位移,并计算膈肌增厚分数。这将有助于监测膈肌活动能力和发现膈肌萎缩,从而比较两种不同通气模式对膈肌收缩能力的影响。并分别探讨辅助控制通气和压力支持通气各12小时后膈肌形态学和活动能力的变化。方法:采用前瞻性随机对照研究,选择2016年1月1日~2016年6月31日期间连续入住青岛大学附属医院重症医学科的外科择期全麻手术后的患者。约30分钟,患者达相对稳定状态时(t0)记为研究起点,两组患者各通气12小时后(t12)记为研究终点。本研究中同时符合纳入标准及排除标准的71例,根据计算机生成的随机数字表法将患者随机分配入辅助控制通气组和压力支持通气组,研究过程中不符合条件的予以剔除,最终共56例患者入选,其中辅助控制通气组29例,压力支持通气组27例。使用床旁超声分别测量两组患者t0和t12时的吸气末膈肌厚度、呼气末膈肌厚度和位移,并计算膈肌增厚分数。采用SPSS 19.0软件对所得实验数据进行统计学分析。结果:1.组间比较:t12时,辅助控制通气组患者吸气末膈肌厚度、呼气末膈肌厚度、膈肌位移和膈肌增厚分数均明显小于压力支持通气组患者,差异有统计学意义,分别为(t=2.395、2.038、3.235、2.891,p=0.020、0.043、0.002、0.005)。2.组内比较:辅助控制通气组患者t12时与t0时比较吸气末膈肌厚度、呼气末膈肌厚度、膈肌位移和膈肌增厚分数均明显减小,差异有统计学意义,分别为(t=17.048、9.715、3.380、2.077,p=0.000、0.000、0.002、0.010);压力支持通气组患者t12时与t0时比较吸气末膈肌厚度、呼气末膈肌厚度、膈肌位移和膈肌增厚分数略减小,差异无统计学意义,分别为(t=1.724、0.686、1.962、1.807,p=0.097、0.499、0.061、0.082)。3.PEEP对膈肌厚度和膈肌增厚分数的影响:两种通气模式下呼气末厚度与PEEP水平均无显著相关性,分别为(t0:辅助控制通气:R=-0.021,p=0.922,压力支持通气:R=0.096,p=0.294;t12:辅助控制通气:R=-0.097,p=0.668,压力支持通气:R=0.033,p=0.875)。膈肌增厚分数与PEEP水平亦无显著相关性,分别为(t0:辅助控制通气:R=0.168,p=0.422,压力支持通气:R=0.057,p=0.359;t12:辅助控制通气:R=0.254,p=0.253,压力支持通气:R=0.031,p=0.884)。结论:1.辅助控制通气模式与压力支持通气模式比较,由于膈肌废用程度更重,所以可能更容易导致膈肌变薄、萎缩、收缩力下降及功能障碍。2.辅助控制通气在短时间内(12小时)即可引起膈肌变薄、萎缩及活动能力下降。压力支持通气12小时尚未引起明显的膈肌厚度及活动能力的变化。
[Abstract]:Objective: to measure the diaphragm thickness and diaphragm displacement under the bedside ultrasound assisted ventilation mode and pressure supporting ventilation mode, and to calculate the diaphragm thickening fraction. This will help to monitor the activity of the diaphragm and discover the atrophy of the diaphragm, and then compare the effects of the two different ventilation modes on the contractility of the diaphragm. Changes in the morphology and activity of the diaphragmatic muscle after 12 hours of gas and pressure support. Methods: a prospective randomized controlled study was used to select the patients who were admitted to the Department of intensive medicine of the Affiliated Hospital of Qiingdao University in June 31st ~2016 January 1, 2016. About 30 minutes, the patients reached a relatively stable state (t0 The study point was recorded as the starting point. Two groups of patients were given 12 hours after ventilation (T12) as the end point. In this study, 71 cases were conformed to the inclusion criteria and exclusion criteria, and the patients were randomly assigned to the auxiliary control ventilation group and the pressure support ventilation group according to the computer generated random digital table method. A total of 56 patients were selected, including 29 cases in the auxiliary control ventilation group and 27 cases in the pressure support ventilation group. The thickness of the inhalation phrenic muscle, the thickness and displacement of the phrenic muscle at the end of the expiratory and the thickness of the diaphragmatic muscle were measured by bedside ultrasound, and the diaphragmatic thickening fraction was calculated by the bedside ultrasound. The results of the experimental data were statistically analyzed with the SPSS 19 software. The results were the 1. groups. In T12, the thickness of the phrenic muscle at the end of inhalation, the thickness of the phrenic muscle at the end of the expiratory, the diaphragm and the thickening of the diaphragm were significantly lower than those in the pressure support ventilation group in the auxiliary control ventilation group, and the difference was statistically significant, respectively, in the.2. group (t=2.395,2.038,3.235,2.891, p= 0.020,0.043,0.002,0.005), respectively: the patients in the auxiliary control ventilation group were T12. The thickness of the end of the phrenic muscle, the thickness of the phrenic muscle at the end of the expiratory, the diaphragm and the thickening of the diaphragm were significantly decreased, and the difference was statistically significant (t=17.048,9.715,3.380,2.077, p=0.000,0.000,0.002,0.010), and the thickness of the end of the phrenic muscle, the thickness of the phrenic muscle at the end of the expiratory, the diaphragm position, and the thickness of the phrenic muscle at the time of T12 and t0 in the pressure support ventilation group. There was no significant difference in the thickness of the migration and diaphragmatic thickening, and the difference was not statistically significant. The effect of (t=1.724,0.686,1.962,1.807, p=0.097,0.499,0.061,0.082).3.PEEP on the thickness of diaphragm and the thickening fraction of diaphragm: there was no significant correlation between the thickness of the expiratory end and the level of PEEP under the two ventilation modes, respectively (t0: assisted control ventilation: R=-0.021, p=0.922, pressure. Force support ventilation: R=0.096, p=0.294; t12: assisted control ventilation: R=-0.097, p=0.668, pressure support ventilation: R=0.033, p=0.875). There is no significant correlation between the thickening fraction of the diaphragm and the level of PEEP, respectively (t0: assisted control ventilation: R=0.168, p=0.422, pressure support ventilation: R=0.057, and stress support ventilation: Qi: R=0.031, p=0.884) conclusion: the 1. auxiliary control ventilation mode compared with the pressure support ventilation mode, because of the greater degree of diaphragmatic use, it may be more likely to cause the thinning of the diaphragm, atrophy, the decrease of contractile force and the dysfunction of.2. assisted control ventilation in a short time (12 hours) can cause the thinning of the diaphragm, atrophy and decreased activity ability. Force support ventilation in 12 small fashion did not cause significant diaphragm thickness and mobility changes.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R459.7

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