肺复张联合早期体外膈肌起搏对中重度ARDS患者的影响OACSTPCD

Objective To investigate the effect of recruitment maneuver combined with early external diaphragm pacing on patients with moderate to severe ARDS.Methods Total 57 patients with moderate to severe ARDS who were treated in the e-mergency intensive care unit of our hospital from January 2022 to September 2023 were selected.According to the random number table method,they were divided into control group(14 cases),RM group(14 cases),EDP group(14 cases)and RM+EDP group(15 cases).Patients in control group received routine treatment,patients in RM group were treated with recruitment maneuver on the basis of routine treatment(PEEP increasing method).Patients in EDP group were treated with external diaphragm pacing on the basis of conventional treatment,from 48 hours after mechanical ventilation until weaning.Patients in RM+EDP group were treated with the same recruitment maneuver and external diaphragm pacing on the basis of routine treatment.The oxygenation index,lung ultrasound score(LUS),diaphragm excursion(DE),diaphragm thickening fraction(DTF),mechanical ventilation time,length of ICU stay and 28-day mortality were compared among groups.Results ①Compared with control group,oxygenation index of RM group and RM+EDP group increased significantly on the 3rd and 7th day(all P＜0.05).Compared with RM+EDP group,oxy-genation index of EDP group was significantly decreased on the 3rd and 7th day(all P＜0.05),and oxygenation index of RM group was significantly decreased on the 7th day(P＜0.05).②Compared with control group,the mechanical ventilation time and length of ICU stay of RM group,EDP group and RM+EDP group were significantly shorter(all P＜0.05).Compared with RM+EDP group,the mechanical ventilation time and length of ICU stay in RM group and EDP group were significantly prolonged(all P＜0.05).③There was no significant difference in 28-day mortality among four groups(P＞0.05).④Compared with control group,lung ultrasound scores of RM group and RM+EDP group were significantly lower on the 3rd day,the 7th day and the weaning time(all P＜0.05),and the lung ultrasound scores of EDP group were significantly lower on the weaning time(P＜0.05).Com-pared with RM+EDP group,lung ultrasound score of EDP group was significantly higher on the 3rd,7th day and at the weaning time(all P＜0.05),and RM group was significantly higher at the weaning time(P＜0.01).⑤Compared with control group,dia-phragm excursion(DE)and diaphragmatic thickening fraction(DTF)of EDP group and RM+EDP group were significantly in-creased on the 3rd day,the 7th day and the weaning time(P＜0.05).Compared with RM group,the diaphragm excursion(DE)and diaphragm thickening fraction(DTF)of the EDP group and RM+EDP group were significantly increased on the 3rd,7th and wea-ning time(all P＜0.05).Conclusion Recruitment maneuver or early external diaphragm pacing could improve oxygenation,shorten mechanical ventilation time and length of ICU stay in patients with moderate to severe ARDS.The combination of the two would be more effective.The mechanism would be at least partly related to improving lung ventilation and protecting diaphragm function.