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目的监测重症监护室(ICU)机械通气患者的膈肌功能。方法纳入2013年5月至2013年11月机械通气≥72 h、病情稳定、通过撤机筛查、拟行自主呼吸试验的患者进行前瞻性研究。运用新型多功能食管电极管结合双颈前外侧膈神经磁刺激(BAMPS),监测膈神经传导时间(PNCT)、膈肌复合动作电位(CMAP)和颤触性跨膈压(TwPdi)。结果共入选14例患者,1例不能耐受磁刺激,2例无膈肌肌电信号,1例未刺激到膈神经,1例未获得有效颤触性跨膈压(PNCT、CMAP分别为7.2 ms、1.26 mV),9例取得完整检查数据的ICU机械通气患者PNCT、CMAP、TwPdi分别为(8.5±1.5)ms、(1.01±0.35)mV、(11.2±4.7)cm H2O。结论新型多功能食管电极管结合膈神经磁刺激可客观综合评估ICU患者的膈肌功能,但不是所有患者都适用。
Purpose To monitor diaphragmatic function in patients with intensive care unit (ICU) mechanical ventilation. Methods From May 2013 to November 2013, mechanical ventilation ≥72 h, stable condition, prospective study of patients who underwent spontaneous breathing test by weaning screening. The phrenic nerve conduction time (PNCT), diaphragm combined action potential (CMAP) and flutter-transdiaphragmatic pressure (TwPdi) were monitored with a novel multifunctional esophageal electrode combined with bilateral anterior phrenic magnetic stimulation (BAMPS). Results A total of 14 patients were enrolled. One patient was unable to tolerate magnetic stimulation, two patients had no EMG signal, one patient did not stimulate the phrenic nerve, and one patient did not receive effective flutter diaphragmatic pressure (PNCT, CMAP, 7.2 ms , 1.26 mV respectively), PNCT, CMAP and TwPdi were (8.5 ± 1.5) ms, (1.01 ± 0.35) mV and (11.2 ± 4.7) cm H2O in 9 ICU patients with complete examination data. Conclusion The new multifunctional esophageal electrode combined with phrenic nerve stimulation can objectively and comprehensively evaluate the diaphragmatic function of ICU patients, but not all patients are suitable.