本文選題：機(jī)械通氣　切入點(diǎn)：膈肌　出處：《寧夏醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:觀察機(jī)械通氣(MV)患者膈肌收縮功能的變化以及MV時間與膈肌收縮力之間的關(guān)系。另外,觀察膈肌收縮力與MV患者預(yù)后的關(guān)系。方法:采用前瞻性研究方法,2015年2月至2016年11月期間入住上海同濟(jì)大學(xué)附屬東方醫(yī)院重癥監(jiān)護(hù)病房(ICU)的患者48例,入選患者在MV 24小時內(nèi)采用胃食道囊管法測量最大跨膈壓(Pdi_(max)),MV第1-3天每天測量,以后每隔48小時測量一次直至患者拔管或者死亡;同時記錄患者血清C-反應(yīng)蛋白(CRP)、血清降鈣素原(PCT)、血清腦鈉肽前體(NT-pro-BNP)、APACHE II評分、血清白蛋白和血清前白蛋白。結(jié)果:(1)MV患者膈肌收縮力降低,所有患者平均Pdi_(max)為23.6±5.6 cmH2O;(2)隨著MV時間的延長患者平均Pdi_(max)逐漸下降,MV第5天較MV第1天平均Pdi_(max)明顯降低(27.7±5.2 vs 21.5±3.2 cmH2O,t=6.375,p=0.000);MV第15天平均Pdi_(max)為17.7±2.9cmH2O,較MV第1天下降約37%;(3)拔管成功患者在拔除氣管插管前平均Pdi_(max)明顯高于死亡患者(26.3±5.7 vs 20.7±3.6 cmH2O,t=8.980,p=0.000)。另外,死亡組MV時間明顯高于拔管成功組(153.8±36.2 vs 82.9±15.1 cmH2O,t=6.941,p=0.000);(4)Pdi_(max)與CRP(r=-0.510,P=0.000)、PCT(r=-0.440,P=0.002)、腦鈉肽前體(NT-pro-BNP)(r=-0.416,P=0.003)和APACHE II評分(r=-0.295,P=0.042)均負(fù)相關(guān);與血清白蛋白(r=0.403,P=0.005)和前白蛋白(r=0.447,P=0.001)正相關(guān)。結(jié)論:MV導(dǎo)致膈肌收縮力下降,且膈肌收縮力降低與MV時間明顯相關(guān)。膈肌收縮功能可能是評估MV患者能否脫機(jī)的一項(xiàng)重要指標(biāo)。炎癥感染,心功能,營養(yǎng)和疾病嚴(yán)重程度也是影響膈肌收縮功能的重要因素。
[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?zhèn)ｈ�呭鉤鍧嘝di_(max)閫愭笎涓嬮檷,MV絎，

本文編號：1708942