本文選題：膈肌 + 床旁超聲　； 參考：《青島大學(xué)》2017年碩士論文

【摘要】：目的:通過床旁超聲測量輔助控制通氣模式和壓力支持通氣模式下膈肌厚度和膈肌位移,并計算膈肌增厚分?jǐn)?shù)。這將有助于監(jiān)測膈肌活動能力和發(fā)現(xiàn)膈肌萎縮,從而比較兩種不同通氣模式對膈肌收縮能力的影響。并分別探討輔助控制通氣和壓力支持通氣各12小時后膈肌形態(tài)學(xué)和活動能力的變化。方法:采用前瞻性隨機對照研究,選擇2016年1月1日~2016年6月31日期間連續(xù)入住青島大學(xué)附屬醫(yī)院重癥醫(yī)學(xué)科的外科擇期全麻手術(shù)后的患者。約30分鐘,患者達相對穩(wěn)定狀態(tài)時(t0)記為研究起點,兩組患者各通氣12小時后(t12)記為研究終點。本研究中同時符合納入標(biāo)準(zhǔn)及排除標(biāo)準(zhǔn)的71例,根據(jù)計算機生成的隨機數(shù)字表法將患者隨機分配入輔助控制通氣組和壓力支持通氣組,研究過程中不符合條件的予以剔除,最終共56例患者入選,其中輔助控制通氣組29例,壓力支持通氣組27例。使用床旁超聲分別測量兩組患者t0和t12時的吸氣末膈肌厚度、呼氣末膈肌厚度和位移,并計算膈肌增厚分?jǐn)?shù)。采用SPSS 19.0軟件對所得實驗數(shù)據(jù)進行統(tǒng)計學(xué)分析。結(jié)果:1.組間比較:t12時,輔助控制通氣組患者吸氣末膈肌厚度、呼氣末膈肌厚度、膈肌位移和膈肌增厚分?jǐn)?shù)均明顯小于壓力支持通氣組患者,差異有統(tǒng)計學(xué)意義,分別為(t=2.395、2.038、3.235、2.891,p=0.020、0.043、0.002、0.005)。2.組內(nèi)比較:輔助控制通氣組患者t12時與t0時比較吸氣末膈肌厚度、呼氣末膈肌厚度、膈肌位移和膈肌增厚分?jǐn)?shù)均明顯減小,差異有統(tǒng)計學(xué)意義,分別為(t=17.048、9.715、3.380、2.077,p=0.000、0.000、0.002、0.010);壓力支持通氣組患者t12時與t0時比較吸氣末膈肌厚度、呼氣末膈肌厚度、膈肌位移和膈肌增厚分?jǐn)?shù)略減小,差異無統(tǒng)計學(xué)意義,分別為(t=1.724、0.686、1.962、1.807,p=0.097、0.499、0.061、0.082)。3.PEEP對膈肌厚度和膈肌增厚分?jǐn)?shù)的影響:兩種通氣模式下呼氣末厚度與PEEP水平均無顯著相關(guān)性,分別為(t0:輔助控制通氣:R=-0.021,p=0.922,壓力支持通氣:R=0.096,p=0.294;t12:輔助控制通氣:R=-0.097,p=0.668,壓力支持通氣:R=0.033,p=0.875)。膈肌增厚分?jǐn)?shù)與PEEP水平亦無顯著相關(guān)性,分別為(t0:輔助控制通氣:R=0.168,p=0.422,壓力支持通氣:R=0.057,p=0.359;t12:輔助控制通氣:R=0.254,p=0.253,壓力支持通氣:R=0.031,p=0.884)。結(jié)論:1.輔助控制通氣模式與壓力支持通氣模式比較,由于膈肌廢用程度更重,所以可能更容易導(dǎo)致膈肌變薄、萎縮、收縮力下降及功能障礙。2.輔助控制通氣在短時間內(nèi)(12小時)即可引起膈肌變薄、萎縮及活動能力下降。壓力支持通氣12小時尚未引起明顯的膈肌厚度及活動能力的變化。
[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.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R459.7

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本文編號：2091494