| Objective:This research focused on exploring the clinical effectiveness of electro-acupuncture on VIDD,and we hypothesized that it could reduce the extent of diaphragm dysfunction of ventilated patients and help with weaning,which would provide a new method to treat VIDD.Method:This research was conducted during Jun 1 2018 to Jan 31 2019 in the ICU Dept.of Guang'anmen Hospital,China Academy of Chinese Medical Sciences,with 30 recruited under diagnosis standard,recruitment and exclusion criterions.It's a self-control study with small sample size.Baihui(DU20),double Zhongfu(LU1),Zhongwan(RN12),Qihai(RN6),Guanyuan(RN4),double Zusanli(ST36),double Taixi(KI3)were selected in the 7-day treatment course,with electro-needles between left Zhongfu(LU1)and Zhongwan(RN12),and right Zhongfu(LU1)and Guanyuan(RN4),whose frequency was 20Hz,and current intensity 12mA.We hypothesized that the primary outcome(diaphragmatic thickness fraction,diaphragm excursion)observed by ICU portable ultrasound machine,and secondary outcome(PaO2,PaCO2,IO,self-triggered times under 5L/min trigger sensitivity within 30 seconds in PS ventilation mode,ventilation mode and its parameters)would get better after intervene.Besides,basic information(name,age,APACHE II,15-day death/survival,15-day weaned/still ventilated)was also recorded.SPSS 20.0 was used for data analysis while P<0.05 is considered statistically significant.Results:30 subjects were recruited in the ICU of Guang'anmen Hospital between Jun 2018 and Jan 2019.(1)Diaphragmatic thickness fraction:before intervene(0.29±0.18)and after intervene(0.3010.12),without statistical significance(P=0.854).(2)Diaphragm excursion:before intervene(10.49±7.31)mm and after intervene(13.83±9.33)mm,with statistical significance(P=0.001).(3)PaO2:before intervene(123.13±48.56)mmHg and after intervene(116.56±26.98)mmHg,without statistical significance(P=0.535).(4)PaCO2:before intervene(36.47±8.68)mmHg and after intervene(33.62±7.54)mmHg,with statistical significance(P=0.025).(5)IO:before intervene(335.13±202.67)and after intervene(342.23±131.08),without statistical significance(P=0.874).(6)Self-triggered times under 5L/min trigger sensitivity within 30 seconds in PS ventilation mode:before intervene(5.13±7.32)and after intervene(7.13±8.25),with statistical significance(P=0.015).(7)Ventilation mode:we counted the subjects before and after intervene in different ventilation modes and discovered there was statistical significance(P=0.015)in number differences of the four ventilation modes before and after the intervene(weaning 0,PS mode 7,SIMV mode 11,PC mode 12;weaning 8,PS mode 6,SIMV mode 9,PC mode 7,respectively).It also shows more subjects resorted to low level ventilation mode after the intervene.(8)Correlative factors to 15-day mortality:the only correlative factor discovered was APACHE ? with moderate correlativity and statistical significance(correlative index=0.439,P=0.015).It was also proved statistically significantly(P=0.018)that the death had higher APACHE ?(31.3819.23)than the survival(21.18±7.59).(9)Correlative factors to 15-day successful weaning:we discovered only diaphragm excursion was moderately and statistically significantly correlative to 15-day successful weaning(correlative index=0.492,P=0.006).And the weaned had higher diaphragm excursion(15.44±10.42)mm than the un-weaned(8.02±3.29)mm with statistical significance(P=0.006).(10)The first diagnosis is correlative to diaphragmatic thickness fraction with statistical significance(correlative index=0.439,P=0.015).Meanwhile in this study we discovered lung diseases may cause more damage to the function of diaphragm than others.Conclusion:Acupuncture can alleviate ventilation induced diaphragm dysfunction.It also reduces the liability on ventilation.Besides,diaphragm excursion under ultrasound and APACHE ? can effectively and practically assess the ventilated prognosis on mortality and weaning.At last,this study can show that lung diseases may conduct more impairment on diaphragm than other diseases. |
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