The Effect Of Pulmonary Rehabilitation Combined With Diaphragm Pacing Therapy On Diaphragm Weakness In Patients With Mechanical Ventilation

Objective: To explore the effect of pulmonary rehabilitation combined with diaphragm pacemaker therapy on diaphragm in severely ventilated patients with mechanical ventilation.Methods:From August 2018 to December 2019,40 patients with ICU severe coma with cerebral hemorrhage or traumatic brain injury who met the inclusion criteria in the Second Hospital of Hebei Medical University were randomly divided into the control group(20 cases)and the experimental group(20 cases).The control group was given conventional ICU nursing and drug treatment and conventional rehabilitation treatment(transcranial direct current stimulation,cerebellar nucleus stimulation,hyperbaric oxygen therapy,comprehensive sensory stimulation therapy,low-frequency electrical stimulation and joint loosening training,etc.);the experimental group was based on the control group.Increased diaphragm pacemaker therapy and pulmonary rehabilitation techniques(abdominal resistance training,airway clearance techniques,etc.),10 days of treatment is a course of treatment,and the observation indicators are compared after 3 courses of treatment(30 days).The Glasgow Coma Scale(GCS)score,APACHEII score,ultrasound assessment of diaphragm activity(cm)and thickness(cm),and mechanical ventilation time(days)of the patients were measured before and 30 days after treatment / d),ICU hospital stay(d)and total hospital stay(d).Results:1.There was no difference in GCS scores between the two groups of patients before treatment(P>0.05),and they improved after 30 days of treatment,and the score of the test group(12.75±1.59)was better than the control group(10.35±1.93).Significance(P<0.05);2.There was no difference in APACHEII score between the two groups of patients before treatment(P>0.05),but the APACHEII score decreased significantly after 30 days of treatment,and the experimental group(11.20± 1.47)score was better than the control group(12.90±1.52).The difference was(P<0.05);3.Pre-treatment diaphragm muscle activity control group(1.562±0.236),experimental group(1.442±0.222),diaphragm thickness control group(0.104±0.042),and experimental group(0.154±0.042).There was no significant difference in activity(1.582±0.271)and thickness(0.191±0.036)measured by normal people(P>0.05);After 30 days of treatment,the control group had diaphragm activity(0.939±0.159)and diaphragm thickness(0.104±0.042);the experimental group had diaphragm activity(1.442±0.222)and diaphragm thickness(0.154±0.042).The measured values of diaphragm muscle activity and thickness of the two groups were lower than before treatment(P<0.05),but compared with the control group,the degree of diaphragm muscle activity and thickness decreased less in the experimental group,and the differences between the two groups were statistically significant(P<0.05).4.The comparison of offline time,ICU hospitalization time,and total hospitalization time between the two groups of patients showed that the above-mentioned time in the experimental group was(13.90±3.86d)(19.00 ±7.25d)、(36.40±13.55d),and all were small.In the control group(17.00±2.13d)(23.05±3.76d)(44.45±10.69d),the difference was(P<0.05)。5.During the course of treatment,no adverse events such as accidental extubation and fall were found in the two groups of patients,and the incidence of adverse events was 0.Conclusion:Pulmonary rehabilitation combined with diaphragm pacemaker therapy can promote diaphragm function in critically ill patients,which can prevent diaphragm atrophy and thinning,improve patient respiratory function,shorten mechanical ventilation time,ICU hospitalization time and total hospitalization time in ICU patients.Observed cases are few,treatment is affected by bed turnover,and long-term prognosis needs to be further studied.Through randomized control trials,early rehabilitation in ICU can improve the consciousness of patients and improve the functional status without increasing adverse events.Early rehabilitation of ICU patients is safe,feasible and effective.Due to the small number of cases observed in this study and the effect of bed turnover,long-term prognosis still need further study.