肌肉電刺激對於呼吸器依賴患者在肺功能及住院預後的影響－前驅研究

Effects of electrical stimulation on pulmonary function and hospitalization outcomes in patients with prolong mechanical ventilator─Pilot study

陳妍慧(Yen-Huey Chen) ； 蕭秀鳳(Hsiu-Feng Hsiao) ； 李立夫(Li-Fu Li) ； 陳濘宏 ； 黃崇旂

《呼吸治療》 17卷1期 (2018/07) Pp. 1-9

https://doi.org/10.6269/JRT.201807_17(1).0001

摘要

研究背景：呼吸器依賴患者因長期使用呼吸器容易有呼吸肌肉功能下降等合併症，造成脫離呼吸器成功率低、死亡率的增加。電刺激已被證實對於長期臥床的病患有避免肌肉萎縮、增強肌力等療效。本研究目的在探討電刺激對於呼吸器依賴病患在肺功能以及住院預後的影響。研究方法：呼吸器依賴病患隨機分為電刺激(n=8)與對照組(n=8)，電刺激組接受30min/天，5天/週，共2週的腹部肌肉電刺激訓練。所有病患在訓練前後測量肺功能（潮氣容積、呼吸速率、最大吸氣壓等）。並記錄病患的呼吸器脫離率、住院天數。結果：電刺激組病患潮氣容積顯著增加(208.6±39.7 ml vs 497.4±118.2 ml, p＜0.05)、呼吸速率顯著下降(24.7±10.5 bpm vs15.4±8.0bpm, p＜0.05)，對照組病患肺功能則無顯著變化，兩組呼吸器脫離與住院天數無顯著差異。結論：短期的肌肉電刺激對於呼吸器依賴病患有助改善其呼吸型態，但對於病患住院預後的影響，則有賴進一步的研究探討。

關鍵字

電刺激 ； 呼吸器脫離困難 ； 肌肉訓練

並列摘要

BACKGROUND AND PURPOSE: Muscle atrophy and diaphragm dysfunction are common complication in patients with prolong mechanical ventilator (PMV) and is associated with increased rate of weaning failure and days of hospitalization. Electrical stimulation (ES) has been shown to be beneficial in patients with severe chronic heart failure and chronic obstructive pulmonary disease. The purpose of this study is to examine the effects of ES on pulmonary mechanics and hospitalization outcomes in patients with PMV. METHODS: Patients who have been on mechanical ventilator for more than 21 days were randomly assigned into electrical stimulation group (ES, n=8), and sham group (sham, n=8). The ES groups received abdominal muscle electrical stimulation for 30 min/session, 2 sessions/day for 10 days. Before and after intervention, subjects were assessed pulmonary function: tidal volume (Vt) , respiratory rate (RR) and maximal inspiratory pressure (Pimax). The hospitalization outcome which included weaning rate, length of RCC stay were followed up until patients were discharged from RCC. RESULTS: Significant increase in Vt (208.6±39.7 ml vs 497.4±118.2 ml, p＜0.05) and RR ((24.7±10.5 bpm vs15.4±8.0bpm, p＜0.05) were found in ES group. There is no significant improvement in pulmonary function in sham group. There is no significant difference in weaning rates and length of RCC stay between ES and sham group. CONCLUSION: PMV patients may benefits from muscular electrical stimulation in the improvement of pulmonary function. Whether this improvement result to promotion of hospitalization outcome may require further study.

並列關鍵字

electrical stimulation ； diff icult weaning ； muscle training