体外膈肌起搏联合肺康复治疗老年慢性阻塞性肺疾病急性加重期机械通气患者的临床观察

Clinical observation of extracorporeal diaphragmc pacing combined with pulmonary rehabilitation therapy in treatment of elderly patients with acute exacerbation of chronic obstructive pulmonary disease undergoing mechanical ventilation

中文关键词: 老年  慢性阻塞性肺疾病急性加重期  体外膈肌起搏  肺康复治疗  机械通气  气道通气功能  骨骼肌功能  预后

英文关键词: elderly  acute exacerbation of chronic obstructive pulmonary disease  extracorporeal diaphragm pacing  pulmonary rehabilitation therapy  mechanical ventilation  airway ventilation function  skeletal muscle function  prognosis

中文摘要:

      目的 观察体外膈肌起搏(EDP)联合肺康复治疗对老年慢性阻塞性肺疾病急性加重期(AECOPD)机械通气患者气道通气功能、骨骼肌功能及预后的影响.方法 回顾性选取 2022 年 1 月至 2023 年 12 月成都市第六人民医院收治的128 例接受机械通气治疗的老年 AECOPD 患者的临床资料,根据不同治疗方法将患者分为对照组(n=64)和观察组(n=64).对照组患者行肺康复治疗,观察组患者在与对照组相同治疗的基础上联合 EDP 进行治疗,2 组患者均连续治疗5 d.比较2 组患者气道通气功能、骨骼肌功能、机械通气情况及预后情况.结果 治疗后,观察组患者气道通气功能指标值、机械通气时间、膈神经及股神经传导时间、出院30 d 再入院率均低于对照组,膈神经及股神经动作电位幅度和撤机成功率均高于对照组,差异均有统计学意义(P<0.05);2 组患者死亡率差异无统计学意义(P>0.05).结论 EDP 联合肺康复治疗可有效改善老年 AECOPD 机械通气患者气道通气功能及骨骼肌功能,缩短机械通气时间,有助于降低短期再入院风险.

英文摘要:

      Objective To observe the effects of extracorporeal diaphragm pacing(EDP)combined with pulmonary rehabilitation therapy on airway ventilation function,skeletal muscle function,and prognosis in elderly patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)undergoing mechanical ventilation.Methods The clinical data of 128 elderly AECOPD patients who received mechanical ventilation in Sixth People's Hospital of Chengdu City between January 2022 and December 2023 were retrospectively selected.According to different treatment methods,they were divided into control group(n=64)and observation group(n=64).The control group received pulmonary rehabilitation therapy,while the observation group received EDP in addition to the same therapy as the control group.Both groups were treated continuously for 5 days.The airway ventilation function,skeletal muscle function,mechanical ventilation status,and prognosis were compared between the two groups.Results After treatment,the values of airway ventilation function indicators,mechanical ventilation time,phrenic nerve and femoral nerve conduction time,and readmission rate within 30 days after discharge in the observation group were lower or shorter than those in the control group,while the amplitude of action potentials of the phrenic nerve and femoral nerve and the success rate of ventilator withdrawal were higher than those in the control group.The differences were statistically significant(P<0.05).There was no significant difference in mortality between the two groups(P>0.05).Conclusion EDP combined with pulmonary rehabilitation therapy can effectively improve airway ventilation function and skeletal muscle function in elderly AECOPD patients undergoing mechanical ventilation,and shorten the duration of mechanical ventilation.It is helpful to reduce the risk of short-term readmission.