Yan B, Chen F, Liu Y F, Zhao G F, Zhang Y S, Yin S M
Jin Zhou Medical University PLA Rocket Force Characterristic Medical Center Graduate Training Base, Beijing 100088, China.
PLA Rocket Force Characterristic Medical Center, Beijing 100088, China.
Zhonghua Yi Xue Za Zhi. 2020 Apr 14;100(14):1091-1094. doi: 10.3760/cma.j.cn112137-20200217-00307.
To investigate the offline clinical effect of external diaphragm pacemaker (EDP) combination with High-flow nasal cannula oxygen therapy in postoperative severe cerebral hemorrhage patients. A total of 123 severe postoperative severe cerebral hemorrhage patients with tracheotomy and mechanical ventilation (MV) were selected, who were admitted in NICU of PLA Rocket Force Characteristic Medical Center from October 2016 to December 2019. These patients were randomly divided into the High-flow nasal cannula (HFNC) group (63) and HFNC+EDP group (60). In the HFNC group, the HFNC was given to the patients who were off ventilator. The HFNC+EDP group was added on the basis of treatment in the HFNC group, once a day and 30 minutes each time. Compared to the HFNC group, the oxygenation index (OI) of the HFNC+EDP group was higher in the next 1, 12, 24 and 48 hour [(209±15) mmHg vs (218±18) mmHg, (215±14) mmHg vs (222±17) mmHg, (223±13) mmHg vs (235±15) mmHg, (236±7) mmHg vs (257±12) mmHg,0.05]. The offline time was shorter [(13±3) d vs (12±3) d,0.05]. The excursion of diaphragm was higher [(1.94±0.08) cm vs (2.91±0.11) cm,0.05]. The length of stay in NICU was shorter [(33±14) d vs (28±9) d,0.05]. The Glasgow Coma Scale (GCS) was higher when being discharged from the NICU (5.9±2.1 vs 7.8±0.4, 0.05) and the hospital (9.9±2.1 vs 11.0±2.0, 0.05). EDP combination with HFNC can increase the excursion of diaphragm, shorten the offline time and length of stay in the NICU, thereby enhancing the early recovery and improving the prognosis.
探讨体外膈肌起搏器(EDP)联合高流量鼻导管给氧疗法对脑出血术后重症患者的临床脱机效果。选取2016年10月至2019年12月解放军火箭军特色医学中心神经重症监护病房(NICU)收治的123例脑出血术后行气管切开并机械通气(MV)的重症患者,将其随机分为高流量鼻导管(HFNC)组(63例)和HFNC+EDP组(60例)。HFNC组患者撤机后给予HFNC治疗;HFNC+EDP组在HFNC组治疗基础上,加用EDP治疗,每日1次,每次30分钟。与HFNC组比较,HFNC+EDP组在撤机后1、12、24及48小时氧合指数(OI)更高[(209±15)mmHg比(218±18)mmHg,(215±14)mmHg比(222±17)mmHg,(223±13)mmHg比(235±15)mmHg,(236±7)mmHg比(257±12)mmHg,P<0.05];脱机时间更短[(13±3)天比(12±3)天,P<0.05];膈肌移动度更大[(1.94±0.08)cm比(2.91±0.11)cm,P<0.05];NICU住院时间更短[(33±14)天比(28±9)天,P<0.05];NICU出院时格拉斯哥昏迷量表(GCS)评分更高(5.9±2.1比7.8±0.4,P<0.05),出院时GCS评分也更高(9.9±2.1比11.0±2.0,P<0.05)。EDP联合HFNC可增加膈肌移动度,缩短脱机时间及NICU住院时间,从而促进患者早期康复,改善预后。