【作者】 刘鸿；

【导师】 胡东霞；

【作者基本信息】 南昌大学 ， 临床医学硕士（专业学位）， 2025， 硕士

【摘要】 目的:探讨体外膈肌起搏治疗（EDP）对脑卒中后气管切开患者拔管成功率及呼吸功能的影响。方法:采用回顾性队列研究方法,纳入脑卒中后气管切开患者90例,根据是否接受体外膈肌起搏治疗（要求疗程≥42天）分为观察组（46例）和对照组（44例）,比较两组患者住院期间拔管成功率,治疗前及治疗42天后动脉血二氧化碳分压（Pa CO₂）、氧合指数（OI）、肺部感染评分（CPIS）的差异,治疗42天后主要气道功能（包括上气道通畅性、分泌物管理能力、咳嗽能力）改善率,住院期间抗生素使用情况、机械通气时间及ICU住院时间的差异。结果:（1）观察组患者住院期间拔管成功率（22例,47.83%）较对照组（9例,20.45%）提高（p<0.05）,应用体外膈肌起搏治疗≥42天是脑卒中后气管切开患者拔管成功的独立影响因素[相对危险度（RR）=2.338,95%CI（1.213,4.508）];（2）观察组患者治疗后Pa CO₂水平较治疗前降低,氧合指数水平较治疗前增高（均p<0.05）,而对照组Pa CO₂、氧合指数水平治疗前后差异无统计学意义（p>0.05）;（3）两组患者治疗后CPIS评分均较治疗前降低（均p<0.05）,两组患者治疗前后差值比较,CPIS评分差异无区别（p>0.05）,且两组患者住院期间抗生素使用情况无明显差异（p>0.05）;（4）观察组患者治疗后上气道通畅60.87%（28/46）、分泌物管理良好63.04%（29/46）、咳嗽能力良好73.91%（34/46）均高于对照组的25.00%（11/44）、36.36%（16/44）、47.73%（21/44）,观察组主要气道功能改善率均优于对照组（p<0.05）;（5）观察组患者机械通气时间（13.67±8.51）天、ICU住院时间[22.00（16.00,29.00）]天均较对照组（18.61±11.12）天、[29.50（22.00,43.75）]减少（p<0.05）;（6）观察组患者住院期间肺不张发生率（8例,17.39%）较对照组（16例,36.36%）减低（p<0.05）。结论:体外膈肌起搏治疗可有效提高卒中后气管切开患者拔管成功率,改善肺部功能,预防肺不张的发生,进而减少机械通气及ICU住院时间,改善患者预后并减少患者费用。更多还原

【Abstract】 Objective:To investigate the impact of extracorporeal diaphragmatic pacing therapy on extubation success and respiratory function in post-stroke tracheotomized patients.Method:A retrospective cohort study was conducted in 90 consecutive patients with post-stroke tracheostomy,stratified into two groups based on adherence to extracorporeal diaphragm pacing（EDP）therapy:the EDP intervention group（n=46,receiving≥42sessions of EDP combined with standard rehabilitation）and the conventional care group（n=44,receiving standard rehabilitation alone）.The two groups were then compared for the rate of successful extubation during hospitalization,arterial partial pressure of carbon dioxide（Pa CO₂）,oxygenation index（OI）,pulmonary infection score（CPIS）,and the rate of improvement in significant airway functions（including upper airway patency,secretion management,and coughing ability）after 42 days of treatment.Differences in antibiotic use during hospitalization,duration of mechanical ventilation,and ICU stay were also evaluated.Result:（1）The extubation success rate during hospitalization was higher in the observation group（22 cases,47.83%）compared to the control group（9 cases,20.45%）（p<0.05）.In post-stroke tracheotomy patients,the application of extracorporeal diaphragmatic pacing therapy for at least 42 days is an independent predictor of successful extubation.[Relative Risk（RR）=2.338,95%CI（1.213,4.508）];（2）The Pa CO₂ level of patients in the observation group decreased,and the oxygenation index increased after treatment,compared to before treatment（both p<0.05）.In contrast,no statistically significant difference was observed in Pa CO₂ and oxygena-tion index levels before and after treatment in the control group（p>0.05）;（3）The CPIS scores in both groups were lower after treatment than before（both p<0.05）.However,when comparing the pre-and post-treatment score differences between the groups,no significant difference was found（p>0.05）,and there was no significant difference in antibiotic use during hospitalization between the two groups（p>0.05）;（4）In the observation group,60.87%（28/46）of patients had smooth upper airways,63.04%（29/46）had good secretion management,and 73.91%（34/46）had good coughing ability after treatment,compared to the control group,where 25.00%（11/44）,36.36%（16/44）,and 47.73%（21/44）had similar improvements.The improvement rates of primary airway functions were significantly better in the observation group than in the control group（p<0.05）;（5）The duration of mecha-nical ventilation in the observation group was longer（13.67±8.51 days）compared to the control group（18.61±8.51 days）.The length of ICU stay was also longer in the observation group[22.00（16.00,29.00）days]than in the control group[29.50（22.00,43.75）days]（p<0.05）;（6）The incidence of pulmonary atelectasis during hospitalization was lower in the observation group（8 cases,17.39%）compared to the control group（16 cases,36.36%）（p<0.05）.Conclusion:Extracorporeal diaphragmatic pacing therapy effectively increases the extubation success rate in post-stroke tracheotomy patients,enhances lung function,prevents pulmonary atelectasis,and reduces mechanical ventilation and ICU stay duration.This leads to improved patient prognosis and lower healthcare costs.更多还原