本文選題：膈肌電活動　切入點：神經調節(jié)輔助通氣　出處：《廣西醫(yī)科大學》2017年碩士論文　論文類型：學位論文

【摘要】：目的:探究膈肌電活動在神經調節(jié)輔助通氣患者不同撤機結果中的差異,并探討其對神經調節(jié)輔助通氣患者撤機的預測價值。方法:對2013年6月至2016年12月廣西醫(yī)科大學第一附屬醫(yī)院重癥醫(yī)學科二病區(qū)應用神經調節(jié)輔助通氣實施撤機的患者進行回顧性分析,根據(jù)撤機結果分為撤機成功組與撤機失敗組,收集、記錄并比較兩組患者在一般情況(性別、年齡、身體質量指數(shù)、人工氣道方式、導致機械通氣的原因、撤機前住ICU時間)、呼吸力學(撤機前使用機械通氣時間、撤機前使用NAVA時間、撤機前的膈肌電活動、呼吸頻率、潮氣量、淺快呼吸指數(shù)、分鐘通氣量、呼氣末正壓、吸氧濃度、氣道峰壓、平均氣道壓)、循環(huán)力學(撤機前與撤機2小時后的心率、平均動脈壓)、血氣分析(撤機前與撤機2小時后的酸堿度、氧分壓、二氧化碳分壓、碳酸氫根、血氧飽和度、乳酸、氧合指數(shù)、血紅蛋白)的差異,評估各指標對撤機的預測價值。結果:(1)一般情況:應用NAVA患者20例,排除因病情需要未實施撤機患者4例,符合納入標準患者16例,其中撤機成功患者9例(9/16),撤機失敗患者7例(7/16),兩組患者在年齡、性別、BMI、人工氣道方式、導致機械通氣的原因、撤機前住ICU時間等一般情況的差異均無統(tǒng)計學意義(P0.05);(2)呼吸力學:撤機失敗組患者的Edi、Ve、P mean高于撤機成功組,分別為6.5(4.5~9.1)VS 3.1(2.3~3.8)(P=0.005)、9.8(7.7~13.1)VS 6.7(6.0~7.6)(P=0.004)、9.0(8.0~10.0)VS 7.0(4.5~7.4)(P=0.019),差異有統(tǒng)計學意義;(3)循環(huán)力學及血氣分析:兩組患者撤機前、撤機2小時后的循環(huán)力學及血氣分析差異均無統(tǒng)計學意義(P0.05);(4)雙變量相關分析顯示:Edi與撤機前使用NAVA時間(r=-0.596,P=0.015)呈顯著負相關,與Ve(r=0.600,P=0.014)、P mean(r=0.695,P=0.003)呈顯著正相關;(5)單因素Logistic回歸分析顯示:Edi是預測撤機失敗風險的危險因素,相對危險度(OR值)為2.436(P=0.04);(6)ROC曲線分析顯示:Edi的AUC為0.921(P=0.005),預測撤機失敗的最佳截斷值為Edi=3.65uV,其敏感度為1.000,特異性為0.778。結論:膈肌電活動對神經調節(jié)輔助通氣患者撤機失敗具有良好的輔助預測價值。
[Abstract]:Objective: to investigate the difference of diaphragmatic electrical activity in different weaning outcomes in patients with neuroregulatory assisted ventilation. Methods: from June 2013 to December 2016, neuroregulatory assisted ventilation was used in the second ward of the Department of intensive Medicine, the first affiliated Hospital of Guangxi Medical University. A retrospective analysis was carried out in 18% of the patients. According to the results of weaning, the patients were divided into successful weaning group and failed weaning group. The causes of mechanical ventilation were collected, recorded and compared between the two groups in general condition (sex, age, body mass index, artificial airway mode). ICU time, respiratory mechanics (mechanical ventilation time before weaning, NAVA time before weaning, diaphragm electrical activity before weaning, respiratory frequency, tidal volume, shallow rapid breathing index, minute ventilation volume, positive end-expiratory pressure, oxygen concentration, Peak airway pressure, mean airway pressure, cyclic mechanics (heart rate before and 2 hours after weaning, mean arterial pressure, blood gas analysis (pH, partial pressure of oxygen, partial pressure of carbon dioxide, bicarbonate) before and 2 hours after weaning, The difference of blood oxygen saturation, lactate, oxygenation index, hemoglobin), and evaluate the predictive value of each index to weaning machine. Results: 20 cases were treated with NAVA, 4 cases were excluded because of illness. Of the 16 patients who met the inclusion criteria, 9 were successful in weaning, and 7 were failed in weaning. The causes of mechanical ventilation in the two groups were age, sex, BMIs, artificial airway mode. There was no significant difference in ICU duration before weaning. (P 0.05) respiratory mechanics: the EdiI Veg P mean of the patients with failed weaning was higher than that of the successful weaning. The results were as follows: 6.5V 4.5V 9.1VS 3.1U 2.3C 3.8U P 0.005 7.77.713.1 VS 6.76.07.6U P0.004 / 9.08.0VS 7.0V 7.0VS 7.57.4P 0.019, the difference was statistically significant (P < 0.05)) cycle mechanics and blood gas analysis: before the weaning, the patients in the two groups had no significant difference in circulation mechanics and blood gas analysis before the withdrawal of the machine, and the difference was significant (P < 0.05), the difference was significant (P < 0.05). There was no significant difference in circulatory mechanics and blood gas analysis between two hours after weaning. Bivariate correlation analysis showed that there was a significant negative correlation between NAVA duration before weaning and NAVA time before weaning (P 0.015). There was a significant positive correlation between Logistic analysis and Logistic regression analysis. The single factor Logistic regression analysis showed that% EDI was a risk factor for predicting the risk of failure of the weaning machine, and a significant positive correlation was found between 0. 695 and 0. 014 (P < 0. 003), and the single factor Logistic regression analysis showed that: Edi was a risk factor for predicting the risk of failure. The relative risk OR value (OR) was 2.436p 0.04 ~ (0.04) ~ (?) ROC curve analysis showed that the AUC of: EDI was 0.921 ~ P0. 005, and the best truncation value of predicting weaning failure was Edio 3.65 uV.The sensitivity was 1.000 and the specificity was 0.778.Conclusion: diaphragmatic electromyography has a good effect on the failure of weaning in patients with neuroregulatory auxiliary ventilation. Has good auxiliary forecast value.
【學位授予單位】：廣西醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R459.7

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