The Effect Of Early External Diaphragm Pacing On Diaphragm Thickening Score And Weaning In Patients With Diaphragmatic Dysfunction And Mechanical Ventilation

Objective:To observe the effect of early external diaphragm pacemaker（EDP）on mechanically ventilated patients with diaphragmatic dysfunction,and the predictive value of diaphragm thickening fraction（DTF）for the success of spontaneous breathing experiment（SBT）.Methods:A prospective randomized controlled study was used to enroll 72 patients with diaphragm dysfunction who met the inclusion criteria in the Critical Care Medicine Department of the First Affiliated Hospital of Nanchang University from December2019 to December 2020.They were divided into the control group and the EDP group by a random number table,36 cases each.Both groups were given conventional treatment,and the EDP group was given EDP treatment.Ultrasound was used to measure the patient’s right diaphragmatic thickening score at the time of enrollment,the first day,the third day,and the seventh day after treatment,before weaning,and before transferring to the ICU.（DTF）to evaluate the efficacy of external diaphragmatic pacing,and to compare the two groups of patients in terms of mechanical ventilation time,ICU admission time,28-day weaning rate,and hospital mortality.At the same time,DTF was observed to predict the successful cut-off of the spontaneous breathing experiment.Reasults:1.Treatment group and control group gender,age,APACHII score,hemoglobin,albumin,procalcitonin,creatinine,blood gas analysis(PH,Pa O₂,Pa CO_2,oxygenation index Pa O₂/Fi O₂),DTF（d0）,P both>0.05,The difference was not statistically significant.2.There were significant differences in DTF between the treatment group and the control group at different times（P<0.05）.Compared with different time and different time*groups,P<0.05;treatment time also has an impact.DTF gradually increases with treatment time,and there is an interaction effect between treatment and time.As time goes by,the increase of DTF in the treatment group and the control group is different.The increase in the treatment group was even greater.On the first day after enrollment,the third day after enrollment,and the seventh day after enrollment,there was no statistical difference in DTF between the treatment group and the control group（all P>0.05）.At the time of weaning and transfer from the ICU,the DTF of the treatment group and the control group were statistically different（P<0.05）.For the pairwise comparison of DTF at each time point in the group,P<0.05,and the difference in DTF was statistically significant.3.The mechanical ventilation time,ICU hospital stay,28-day weaning rate,and in-hospital mortality rate of the two groups of patients were all>0.05,and there was no statistical difference.4.DTF predicts that the best critical index for successful extubation in mechanically ventilated patients is 30.24%,sensitivity is 86%,specificity is 73.3%,and area under the curve is 0.83.Conclusions:1.Early external diaphragm pacing can improve diaphragm function in mechanically ventilated patients with diaphragm dysfunction.2.Bedside diaphragm ultrasound DTF can predict the outcome of weaning in mechanically ventilated patients.