[Application of external diaphragm pacemaker combination with high-flow nasal cannula in offline patients with postoperative severe cerebral hemorrhage].

Objective: To investigate the offline clinical effect of external diaphragm pacemaker (EDP) combination with High-flow nasal cannula oxygen therapy in postoperative severe cerebral hemorrhage patients. Methods: A total of 123 severe postoperative severe cerebral hemorrhage patients with tracheotomy and mechanical ventilation (MV) were selected, who were admitted in NICU of PLA Rocket Force Characteristic Medical Center from October 2016 to December 2019. These patients were randomly divided into the High-flow nasal cannula (HFNC) group (n=63) and HFNC+EDP group (n=60). In the HFNC group, the HFNC was given to the patients who were off ventilator. The HFNC+EDP group was added on the basis of treatment in the HFNC group, once a day and 30 minutes each time. Results: Compared to the HFNC group, the oxygenation index (OI) of the HFNC+EDP group was higher in the next 1, 12, 24 and 48 hour [(209±15) mmHg vs (218±18) mmHg, (215±14) mmHg vs (222±17) mmHg, (223±13) mmHg vs (235±15) mmHg, (236±7) mmHg vs (257±12) mmHg,P<0.05]. The offline time was shorter [(13±3) d vs (12±3) d,P<0.05]. The excursion of diaphragm was higher [(1.94±0.08) cm vs (2.91±0.11) cm,P<0.05]. The length of stay in NICU was shorter [(33±14) d vs (28±9) d,P<0.05]. The Glasgow Coma Scale (GCS) was higher when being discharged from the NICU (5.9±2.1 vs 7.8±0.4, P<0.05) and the hospital (9.9±2.1 vs 11.0±2.0, P<0.05). Conclusions: EDP combination with HFNC can increase the excursion of diaphragm, shorten the offline time and length of stay in the NICU, thereby enhancing the early recovery and improving the prognosis.目的： 探讨体外膈肌起搏器（EDP）联合经鼻高流量氧疗（HFNC）对辅助重症脑出血术后机械通气（MV）患者脱机的临床疗效。 方法： 选择火箭军特色医学中心神经重症监护病房（NICU）2016年10月至2019年12月收治的需行MV的神外重症脑出血术后气管切开患者123例，将其按随机数字表法分为HFNC组（n=63）和HFNC+EDP组（n=60）。HFNC组在患者脱离呼吸机后序贯经鼻高流量吸氧；HFNC+EDP组：在HFNC组基础上加用EDP治疗，1次/d，每次30 min。 结果： 与HFNC组相比，HFNC+EDP组患者脱机后1、12、24及48 h的氧合指数较高[（209±15）mmHg比（218±18）mmHg，（215±14）mmHg比（222±17）mmHg，（223±13）mmHg比（235±15）mmHg，（236±7）mmHg比（257±12）mmHg；均P<0.05]、脱机时间较短[（13±3）d比（12±3）d，P<0.05]、膈肌移动度增加[（1.94±0.08）cm比（2.91±0.11）cm，P<0.05]、住NICU时间较短[（33±14）d比（28±9）d，P<0.05]、出NICU时格拉斯哥评分（GCS）（5.9±2.1比7.8±0.4，P<0.05）及出院GCS较高（9.9±2.1比11.0±2.0，P<0.05）。 结论： EDP联合HFNC能增加神外重症脑出血术后气管切开患者的膈肌移动度，缩短脱机时间和入住NICU的时间，从而早日康复，改善预后。.