| 摘要: |
| 目的：床边膈肌超声评价电针早期干预治疗对于脓毒症机械通气患者ICU获得性肌无力的临床效果研究。方法：本研究纳入了2019年6月至2020年3月于我院重症医学科住院治疗的脓毒症机械通气患者共75例,随机分为对照组(n=25)、早期干预组(n=25)和后期干预组(n=25)。早期干预组和后期干预组患者分别在机械通气24h和72h内开始电针治疗。所有患者脱机前进行MRC评分。在入组的第0、3、7天通过床边超声,测量右侧膈肌活动度、双侧膈肌增厚分数(DTF)和双侧膈肌移动-时间指数(E-T指数)。结果：早期干预组和后期干预组患者机械通气时间(t早期=4.387,P<0.001；t后期=3.350,P<0.001)和ICU滞留时间(t早期=2.796,P=0.004；t后期=3.027,P=0.002)明显低于对照组。早期干预组患者在脱机时MRC评分均明显高于对照组(t=3.433,P<0.001)和后期干预组(t=1.804,P=0.040)。早期干预组和后期干预组T2时膈肌活动度(t早期=8.607,P<0.001；t后期=4.331,P<0.001)、右侧DTF(t早期=3.416,P<0.001；t后期=1.730,P=0.046)、左侧DTF(t早期=6.792,P<0.001；t后期=7.581,P=0.046)、右侧E-T指数(t早期=4.335,P<0.001；t后期=2.940,P=0.003)和左侧E-T指数(t早期=3.663,P<0.001；t后期=2.403,P=0.011)均明显高于对照组T2时水平。电针干预相关系数r波动在0.249-0.598,电针早期干预相关系数r波动在0.288-0.623,两者均与右侧DTF相关性最大。结论：通过床边膈肌超声可以观察到电针早期干预治疗有助于改善脓毒症机械通气患者预防膈肌功能障碍,减少机械通气时间和ICU滞留时间。 |
| 关键词: 床边膈肌超声，电针，脓毒症，机械通气，获得性肌无力 |
| DOI： |
| 投稿时间：2020-05-17修订日期：2020-06-21 |
| 基金项目: |
|
| The effects of early stage electro-acupuncture treatment to ICUAW in sepsis patients with mechanism ventilation via bedside diaphragmatic ultrasoundSong Wei1 Wang Ming-ming2 Lin Shou-yi1 Wu Zeng-bin3 Jiao Yun1 |
| songwei |
| () |
| Abstract: |
| Objective：To evaluate the effects of early stage electro-acupuncture treatment to ICUAW in sepsis patients with mechanism ventilation(MV) via bedside diaphragmatic ultrasound. Methods：Seventy-five sepsis patients with mechanism ventilation were enrolled in this study and divided into 3 groups: early-stage intervention group(n=25, Group A), late-stage intervention group(n=25, Group B) and control group(n=25, Group C). Electro-acupuncture treatment was performed within 24h and 72h in group A and B, respectively. All the patients were under MRC score evaluation before weaning. The activity of the right diaphragm, bilateral diaphragmatic thickening fraction(DTF) and bilateral diaphragmatic excursion-time(E-T) index were measured via bedside diaphragmatic ultrasound on day 0, 3, and 7 of enrollment. Results：MV time(tA=4.387,P<0.001；tB=3.350,P<0.001) and ICU days(tA=2.796,P=0.004；tB=3.027,P=0.002) in group A and B were lower than those in group C. The levels of MRC in group A were higher than those in group C(t=3.433,P<0.001) and group B(t=1.804,P=0.040). The levels of right diaphragm activity, right DFT, left DFT, right E-T and left E-T were higher than those in group C on T2(P<0.05). The relation index between electroacupuncture treatment or early-stage electroacupuncture treatment and diaphragm ultrasound indexes were range from 0.249 to 0.598 and 0.288 to 0.623, respectively. Conclusion：Based on the results of beside diaphragm ultrasound, electro-acupuncture will improve diaphragm dysfunction and reduce MV time and ICU days in sepsis patients with MV. |
| Key words: Bedside diaphragm ultrasound, Electro-acupuncture, Sepsis, Mechanism ventilation, Acquired myasthenia |
