The effects of external diaphragm pacemaker on the duration of mechanical ventilation,diaphragm func-tion and other prognosis in coma patients with difficult weaning after brain injury surgery
10.3969/j.issn.1001-1242.2024.11.008
- VernacularTitle:体外膈神经电刺激对脑损伤术后昏迷的脱机困难患者机械通气时间、膈肌功能及其预后的影响
- Author:
Xinxue QI
1
;
Ying WANG
;
Tianle ZHOU
Author Information
1. 江苏省人民医院(南京医科大学第一附属医院),南京市,210029
- Keywords:
coma after brain injury;
mechanical ventilation;
difficult offline;
external phrenic nerve stimula-tion;
diaphragm function
- From:
Chinese Journal of Rehabilitation Medicine
2024;39(11):1613-1619
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the effect of extemal diaphragm pacemaker(EDP)on the duration of mechanical ventilation,diaphragm function,and other prognosis in coma patients with difficult weaning after brain injury surgery. Method:A total of 66 postoperative coma patients with brain injury were enrolled and divided into control group(n=33)and experimental group(n=33)according to the random number table method.The control group was treated with conventional drugs and mechanical ventilation in ICU,and the experimental group was treated with EDP on the basis of the control group,20 minutes each time,twice a day for 14 consecutive days.The mechanical ventilation time and respiratory parameters of the two groups were observed at the start-ing point(within 72-96 hours of mechanical ventilation after operation)and the end point(the day of suc-cessful weaning,and the day after the end of treatment cycle if the patients were not successfully weaned).The changes of diaphragm thickness(DT),diaphragm thickening fraction(DTF),and diaphragm excursion(DE)were observed by ultrasound,and other prognostic parameters were recorded. Result:There was no significant difference between the two groups at the time of enrollment(P＞0.05).After treatment,in terms of respiratory function,except for the control group with no statistical difference in shal-low rapid respiratory index before and after treatment(P＞0.05),the mechanical ventilation time of the experi-mental group was significantly shorter than that of the control group,and the success rate of offline was im-proved.Tidal volume and shallow rapid respiratory index of the two groups were improved compared with that before treatment,and the tidal volume of the control group was increased after treatment with statistical difference(P＜0.05).The tidal volume of experimental group after treatment was increased compared with be-fore treatment,and the shallow rapid respiratory index of experimental group was decreased compared with be-fore treatment,with significant differences(P＜0.001).In terms of diaphragm function,there was no statistical significance in DT,DTF and DE between the two groups before treatment(P＞0.05),and there was a signifi-cant difference in the composition ratio of DT changes between the two groups after treatment(P＜0.001).DTF and DE showed significant differences between the two groups and within the two groups after treatment,(P＜0.001).In terms of prognosis,the rate of recovery,mortality and length of hospital stay in the experimen-tal group were lower than those in the control group,but there was no significant difference(P＞0.05). Conclusion:EDP treatment can shorten the mechanical ventilation time of coma patients with difficult wean-ing after brain injury surgery,improve the success rate of weaning,improve respiratory parameters,and im-prove diaphragm function.However,it did not reduce the probability of recovery,mortality and length of hos-pital stay.
