經皮橫膈膜電刺激對長期呼吸器病患之急性成效

Acute effects of transcutaneous electrical diaphragmatic stimulation in patients with prolonged mechanical ventilation

忻宜霏(Yi-Fei Hsin) ； 陳淑馨(Shu-Hsin Chen) ； 游騰仁(Teng-Jen Yu) ； 陳妍慧(Yen-Huey Chen)

《呼吸治療》 19卷1期 (2020/07) Pp. 31-40

https://doi.org/10.6269/JRT.202007_19(1).0004

摘要

研究背景：呼吸器依賴患者常因長期使用機械通氣、疾病等原因而有呼吸肌力下降、橫膈肌功能失常等問題，造成脫離呼吸器成功率低，住院天數延長。肌肉電刺激是臨床常見的非侵入性治療，藉由特定模式的電流刺激肌肉，誘發肌肉收縮。文獻已證實經皮橫膈膜電刺激（transcutaneous electric diaphragmatic stimulation, TEDS）有助於維持呼吸肌力及胸腔擴張，本研究目的為探討經皮橫膈膜電刺激對於呼吸器依賴（prolonged mechanical ventilation, PMV）病患在肺功能之急性成效。研究方法：本研究於亞急性呼吸照護中心招募呼吸器使用＞21天之患者。受試者隨機分為實驗組（n=15）與對照組（n=14）。實驗組接受TEDS30分鐘，對照組無接受TEDS，介入前後記錄受試者訓練前後測量病患之呼吸器脫離參數及生命徵象。結果：TEDS後30分鐘後，受試者的潮氣容積（tidal volume, Vt）從（391.0（343.0-459.0）ml顯著上升至444.0（344.0-485.0）ml（p＜0.05），而對照組則無顯著變化（346.0（330.0--460.0）ml對380.0（341.0-471.0）ml，p＞0.05）。TEDS組的受試者在介入後生命徵象則無顯著變化（p＞0.05）。結論：PMV患者接受TEDS後潮氣容積顯著增加，且對於生命徵象無顯著影響。TEDS或許可被考慮作為肺復健計畫之輔助。

關鍵字

電刺激 ； 橫膈膜 ； 長期機械通氣 ； 肺功能

並列摘要

BACKGROUND AND PURPOSE: Diaphragm dysfunction is one of common complication in patients with prolonged mechanical ventilation (PMV) and is often associated with increased rate of weaning failure and days of hospitalization. Electrical stimulation (ES) has been shown to be beneficial in the improvement of muscle strength in patients with COPD. The purpose of this study is to examine the acute effects of transcutaneous electric diaphragmatic stimulation(TEDS) on pulmonary function in patients with PMV. METHODS: Patients who have been ventilated for＞21 days were recruited from respiratory care center. Subjects were randomly assigned into TEDS group (n=15) or control group (n=14). The TEDS group received muscle electrical stimulation for 30 min/session. Before and after intervention, subjects were assessed weaning parameters (tidal volume (Vt), minute volume (MV), respiratory rate (RR), and rapid shallow breathing index(RSBI)) and respiratory muscle strength. The vital sign during intervention was also recorded. RESULTS: After 30 min TEDS, subjects in TEDS group have significant improvement in Vt (391.0(343.0-459.0) ml vs 444.0(344.0-485.0) ml, p＜0.05), whereas no significant changes was found in control group (346.0(330.0-460.0) ml vs 380.0(341.0-471.0) ml, p＞0.05).After intervention, subjects in TEDS group demonstrated no significant changes in vital signs (p＞0.05). CONLCUSION: In patients with PMV, the application of TEDS results in a immediately increase f tidal volume. This application did not induce any significant changes of vital sign and may consider as one of the supplement rehabilitation program for prolonged ventilated patients.

並列關鍵字

electrical stimulation ； diaphragm ； prolonged mechanical ventilation ； pulmonary function