ABSTRACT
OBJECTIVE@#To observe the effect of ultrasound-guided acupoint electrical stimulation on the patients with diaphragmatic dysfunction associated with mechanical ventilation in ICU.@*METHODS@#Fifty-two patients were randomly divided into an observation group (26 cases, 3 cases dropping) and a control group (26 cases). Conventional treatment was given to all patients. On the basis of conventional treatment, acupoint electrical stimulation therapy was applied at Zhangmen (LR 3), Dabao (SP 21), Pishu (BL 20), Shenshu (BL 23), etc. In the observation group, the treatment was given for 30 min each time, 3 times a day for 7 days. Diaphragm thickening fraction (TFdi) was used as an index to guide the individualized setting of stimulation intensity and judge the effect, and the difference of mechanical ventilation time, ICU time, total hospitalization time, hospital mortality and reintubation rate between the two groups were observed.@*RESULTS@#The mechanical ventilation time in the observation group was shorter than that in the control group (0.05). During hospitalization, 2 patients died in the observation group and 3 patients died in the control group, there was no significant difference in hospital mortality (>0.05). One patient in the observation group was reintubated and 8 patients in the control group (<0.05). The use of acupoint electrical stimulation was a factor in shortening the mechanical ventilation time and reducing the reintubation events (<0.05).@*CONCLUSION@#Ultrasound-guided acupoint electrical stimulation can relieve ventilator-induced diaphragmatic dysfunction, reduce ventilator support time and reintubation events.
Subject(s)
Humans , Acupuncture Points , Diaphragm , Electric Stimulation , Electric Stimulation Therapy , Respiration, ArtificialABSTRACT
Objective To investigate the correlation between blood flow velocity and respiratory variability in different parts of left heart of patients with sepsis via measuring the flow velocity of the E-wave of mitral valve (MV), peak flow velocity of left ventricular outflow tract (LVOT), and respiratory variability (ΔVpeak) by ultrasonography. Methods Totally 81 patients with sepsis hospitalized in ICU were chosen consecutively from March 2017 to October 2017. Each patient's flow velocity of the E-wave of mitral valve and peak flow velocity of LVOT was inspected, by apical four-chamber view and apical five-chamber view respectively, to calculate the respiratory variability. Results (1) Of the 81 patients with sepsis, 33 patients (40.7％) had complete control of mechanical ventilation (no spontaneous breathing trigger), and 48 patients (59.3％) had spontaneous breathing and incomplete control of mechanical ventilation (partial spontaneous breathing trigger). (2) There was no significant difference in the mean values of flow velocity of the E-wave of mitral valve and peak flow velocity of LVOT in patients with sepsis. Whereas the flow velocity of the E-wave of mitral valve (0.15±0.05) was greater than the peak flow velocity of LVOT (0.12±0.04) with statistical significance (P<0.01). In sepsis patients with complete control of mechanical ventilation (no spontaneous breathing trigger), respiratory variability in the flow velocity of the E-wave of mitral valve (0.17±0.06) was significantly greater than the peak flow velocity of LVOT (0.11±0.03), P<0.01, whereas in sepsis patients with incomplete control of mechanical ventila tion (partial spontaneous breathing trigger), there was no statistically significant difference between the respiratory variability in flow velocity of the E-wave of mitral valve (0.14±0.04) and in the peak flow velocity of LVOT (0.13±0.03), P=0.102. (3) The respiratory variability in flow velocity of the E-wave of mitral valve was correlated with the peak flow velocity of LVOT (r=0.670, P<0.01). The flow velocity of the E-wave of mitral valve was all correlated with the peak flow velocity of LVOT in both sepsis patients with complete control of mechanical ventilation (no spontaneous breathing trigger) (r=0.894, P<0.01), and sepsis patients with incomplete control of mechanical ventilation (partial spontaneous breathing trigger) (r=0.774, P<0.01), respectively. Conclusions The respiratory variability in flow velocity of the E-wave of mitral valve was correlated with that in the peak flow velocity of LVOT, which may provide a new indicator in evaluating the fluid responsiveness of patients with sepsis.