Xu J Q, Wen R X, Zhao Y, Xie L X
Department of Pulmonary & Critical Care Medicine, Chinese People Liberation Army (PLA) General Hospital, Beijing 100082, China.
Zhonghua Jie He He Hu Xi Za Zhi. 2020 Feb 12;43(2):132-135. doi: 10.3760/cma.j.issn.1001-0939.2020.02.011.
To evaluate the condition of the diaphragm in patients with long-term mechanical ventilation using ultrasound technology and to analyze its relationship with ventilation time and muscle atrophy in order to clarify the reasons for diaphragm dysfunction in long-term mechanical ventilation patients. Patients admitted to the respiratory department at the Chinese PLA General Hospital between June 2018 and April 2019 with mechanical ventilation were included in this study. The enrolled patients were divided into a short-term mechanical ventilation group (7 days ≤ ventilation time<1 month) and a long-term mechanical ventilation group (mechanical ventilation time ≥ 1 month). The diaphragmatic excursion, inspiratory time, contraction rate, E-T index, diaphragm thickness, diaphragm thickness fraction (DTF), and tibialis anterior thickness were compared between the two groups. The correlation between ventilation time and diaphragm thickness was analyzed in all patients. The mean diaphragm thickness and DTF were significantly lower in the long-term mechanical ventilation group than in the short-term mechanical ventilation group [(0.13±0.036) vs (0.17±0.05) cm and (0.22±0.045) vs (0.27±0.075)](all 0.05). However, there was no significant difference in diaphragmatic excursion, inspiratory time, contraction rate, E-T index or tibialis anterior thickness between the two groups (all 0.05). There was a significant linear correlation between ventilation time and diaphragm thickness (0.01). Tibialis anterior thickness was not significantly correlated with ventilation time (0.05). Diaphragm thickness and function were significantly reduced in patients with long-term mechanical ventilation, which was correlated with the duration of ventilation. Nutritional status was not the main factor affecting diaphragm thickness.
运用超声技术评估长期机械通气患者的膈肌状况，并分析其与通气时间及肌肉萎缩的关系，以阐明长期机械通气患者膈肌功能障碍的原因。选取2018年6月至2019年4月在中国人民解放军总医院呼吸科住院并行机械通气的患者纳入本研究。将入选患者分为短期机械通气组（通气时间7天≤通气时间＜1个月）和长期机械通气组（机械通气时间≥1个月）。比较两组患者的膈肌移动度、吸气时间、收缩率、E-T指数、膈肌厚度、膈肌厚度分数（DTF）及胫前肌厚度。分析所有患者通气时间与膈肌厚度的相关性。长期机械通气组的平均膈肌厚度和DTF显著低于短期机械通气组[（0.13±0.036） vs （0.17±0.05）cm以及（0.22±0.045） vs （0.27±0.075）]（均P＜0.05）。然而，两组患者的膈肌移动度、吸气时间、收缩率、E-T指数或胫前肌厚度差异均无统计学意义（均P＞0.05）。通气时间与膈肌厚度呈显著线性相关（P＜0.01）。胫前肌厚度与通气时间无显著相关性（P＞0.05）。长期机械通气患者的膈肌厚度及功能显著降低，且与通气时长相关。营养状况并非影响膈肌厚度的主要因素。
