膈神經是維持呼吸功能的主要神經, 由頸3 ～5 神經組成, 在維持正常通氣功能中占有重要的地位。膈肌位于胸腔和腹腔之間, 為向上膨隆呈穹窿形的扁薄闊肌, 是主要的呼吸肌, 在呼吸運動中起著非常重要的作用。膈肌起搏即通過電刺激膈神經或膈肌使膈肌收縮, 維持患有膈肌功能障礙患者的自然負壓呼吸。自發現電刺激能引起膈肌收縮至今已有200 多年歷史, 該技術應用于臨床也已有60 余年歷史[1] 。
ObjectiveTo investigate the clinical efficacy of AIRVO2 respiratory humidification apparatus in patients with tracheotomy after successful weaning from mechanical ventilation in intensive care unit (ICU).MethodsOne hundred subjects were randomly divided into a control group (treated with the tracheotomy mask joint oxygen inhalation by heating humidifier, n=50) and an observation group (treated with AIRVO2 model, n=50) on the basis of conventional therapy. Blood gas indexes (pH, PaO2, PaCO2, PaO2/FiO2) and clinical data (heart rate, respiratory rate, SpO2, sputum viscosity) were recorded at 0 h, 6 h, 12 h, 24 h, 48 h, 72 h after weaning. Besides, the incidence of postoperative pulmonary infection, rapid shallow breathing index (RSBI), successful weaning rate from mechanical ventilation and daily cost of weaning between the two groups were compared at 72 h after weaning.ResultsAfter treatment, all observed data of the patients were obviously improved compared with those before treatment. The differences of humidification effects between the observation group and the control group at the same time point were statistically significant (P<0.05). The differences of heart rate, respiratory rate, and SpO2 between the observation group and the control group at the same time point were statistically significant (P<0.05). The improvement of PaO2 and PaCO2 at the same time point were statistically different between the observation group and the control group (P<0.05). Seventy-two hours after weaning, the incidence of postoperative pulmonary infection and RSBI in the observation group were significantly lower than those in the control group (P<0.05), successful weaning rate from mechanical ventilation in the observation group was significantly higher than that in the control group (P<0.05), and the average daily cost of weaning from mechanical ventilation in the observation group was lower than that in the control group (P<0.05). Nine patients in the control group and 1 patient in the observation group needed secondary mechanical ventilation due to hypoxemia.ConclusionThe therapy of AIRVO2 respiratory humidification apparatus combined with conventional treatment may achieve satisfactory effect for patients of successful weaning from mechanical ventilation with tracheotomy, and it is worthy of promotion in clinical use.