目的明确脓毒症机械通气患者的膈肌功能障碍及与预后的关系。
方法采用前瞻性研究，纳入2017年1—10月浙江大学医学院附属邵逸夫医院重症医学科收治的符合脓毒症诊断标准的、建立有创机械通气24 h内的患者。当患者恢复自主呼吸能力后通过床旁超声测量呼气末和吸气末膈肌厚度，并计算膈肌增厚分数(DTF)。记录入组前主要治疗措施，入组时生理参数和检验指标，以及主要临床结局。依据DTF<20%将患者分为膈肌功能障碍组和膈肌功能正常组，采用独立样本 t检验统计分析两组间的一般资料、临床资料和临床结局差异。
结果共53例患者纳入本研究，膈肌功能障碍的发生率为41.5%(22/53)。两组的一般资料、入组前主要治疗措施、入组时生理参数和检验指标差异无统计学意义(均 P>0.05)。两组的呼气末膈肌厚度差异无统计学意义( t＝1.328， P>0.05)，膈肌功能障碍组的吸气末膈肌厚度[(2.2±0.4)mm]明显低于膈肌功能正常组[(2.8±0.8)mm， t＝3.677， P<0.05]。膈肌功能障碍组的机械通气时间、总机械通气时间及ICU住院时间[分别为(10±8)、(15±8)和(18±8)d]均明显高于膈肌功能正常组[分别为(6±5)、(11±6)和(14±7)d，均 P<0.05]。两组的住院病死率差异无统计学意义(χ 2＝0.366， P>0.05)。
结论脓毒症机械通气患者常伴有膈肌功能障碍，主要表现为膈肌收缩力下降。膈肌功能障碍患者的机械通气时间及ICU住院时间延长。
ObjectiveTo investigate the prevalence of diaphragmatic dysfunction in mechanical ventilated subjects with sepsis and the relationship between diaphragmatic dysfunction and clinical outcomes.
MethodsNewly intubated patients with sepsis diagnosed according to "Sepsis-3" were enrolled from January 2017 to October 2017 in Intensive Care Unit (ICU) of Sir Run Run Shaw Hospital. Diaphragm thickness was recorded ultrasonographically at end-inspiration and end-expiration when the patients′ spontaneous breathing recovered. The diaphragmatic thickening fraction (DTF) was calculated as the percentage from the following formula: (Thickness at end-inspiration-Thickness at end-expiration) / Thickness at end-expiration. The subjects were stratified into a diaphragmatic dysfunction group and a non-diaphragmatic dysfunction group based on whether DTF was < 20%.
ResultsFifty-three subjects were included, and the prevalence of diaphragmatic dysfunction was 41.5%(22/53). The diaphragm thickness at end-expiration of the 2 groups were similar( t=1.328, P>0.05). A significant difference of diaphragm thickness at end-inpiration was observed between the 2 groups[(2.2±0.4)mm vs. (2.8±0.8)mm, t=3.677, P<0.05]. Ventilation time after inclusion [(10±8)d vs. (6±5)d, t=2.340, P<0.05], mechanical ventilation durations [(15±8)d vs. (11±6)d, t=2.201, P<0.05] and ICU length of stay [(18±8)d vs. (14±7)d, t=2.039, P<0.05]were all significantly longer in the diaphragmatic dysfunction group than in the non-diaphragmatic dysfunction group. There was no significant difference in the mortality between these 2 groups(χ 2=0.366, P>0.05).
ConclusionsDiaphragmatic dysfunction was common in patients with sepsis treated by mechanical ventilation and was the consequence of contractile force damages. Subjects with such diaphragmatic dysfunction showed longer mechanical ventilation durations and ICU stays.
陆志华,郭丰,张舸,等. 脓毒症机械通气患者膈肌功能障碍的临床研究[J]. 中华结核和呼吸杂志,2018,41(9)：696-700.
DOI:10.3760/cma.j.issn.1001-0939.2018.09.009版权归中华医学会所有。
未经授权，不得转载、摘编本刊文章，不得使用本刊的版式设计。
除非特别声明，本刊刊出的所有文章不代表中华医学会和本刊编委会的观点。
文档即答
智问智答
机器翻译
你好，我可以帮助您更好的了解本文，请向我提问您关注的问题。
