摘要目的:探讨体外膈肌起搏器(EDP)联合神经调节辅助通气(NAVA)对肺部感染行有创机械通气患者膈肌功能的影响。方法:本研究为病例对照研究。采用单纯随机抽样法，收集2022年1月至2023年1月在连云港市第一人民医院重症医学科收治的80例行有创机械通气治疗的肺部感染患者，采用随机数字表法分为NAVA组、NAVA＋EDP组，每组40例，NAVA组给予常规治疗，NAVA＋EDP组在常规治疗的基础上增加EDP治疗，记录每组入组时和撤机时的膈肌活动度(DE)、膈肌增厚分数(DTF)、膈肌电活动峰值(EAdipeak)、静态肺顺应性(Cst)、气道平台压(Pplat)、气道阻力(Raw)、动脉血二氧化碳分压(PaCO 2)、氧合指数(P/F)以及患者机械通气时间、ICU住院时间。组间计量资料比较采用 t检验；计数资料的比较采用 χ2检验。 结果:2组患者入组时DE、DTF、EAdipeak、Cst、Pplat、Raw、PaCO 2、P/F比较，差异均无统计学意义( t值分别为1.14、0.81、0.40、0.78、0.45、0.95、0.83、0.41，均 P>0.05)。撤机时，与NAVA组比较，NAVA＋EDP组DE[(13.80±1.84) mm比(12.71±1.66) mm]、DTF [(32.81±2.77)%比(31.32±2.84) %]、Cst[(42.13±2.35) ml/cmH 2O比(40.55±2.09) ml/cmH 2O] (1 cmH 2O＝0.098 kPa)均增高，差异均有统计学意义( t值分别为2.65、2.36、2.41，均 P<0.05)，EAdipeak[(9.41±1.54) μm比(10.54±1.76) μm]、Pplat [(10.95±1.95) cmH 2O比(12.08±1.82) cmH 2O]、Raw[(16.07±2.87) cmH 2O·L -1·s -1比(17.63±2.60) cmH 2O·L -1·s -1]均降低，差异均有统计学意义( t值分别为3.05、2.67、2.16，均 P<0.05)；与NAVA组比较，NAVA＋EDP组PaCO 2、P/F差异均无统计学意义( t值分别为1.93、1.32，均 P>0.05)。与NAVA组比较，NAVA＋EDP组患者机械通气时间[ (139.98±13.65) h比(172.18±16.44) h]和ICU住院时间[ (7.68±1.14) d比(8.93±13.5) d]均减少，差异均有统计学意义( t值分别为9.53、4.48，均 P<0.001)。 结论:NAVA联合EDP可改善肺部感染行有创机械通气患者的膈肌功能，减少机械通气时间和ICU住院时间。

abstractsObjective:To investigate the effect of external diaphragm pacemaker (EDP) combined with neurally adjusted ventilatory assist (NAVA) on diaphragmatic function in patients with pulmonary infection requiring mechanical ventilation.Methods:This was a case-control study.A total of 80 patients with pulmonary infection requiring mechanical ventilation admitted to the First People′s Hospital of Lianyungang from January 2022 to January 2023 were selected as the subjects by simple random sampling method, and they were divided into NAVA+ EDP group (40 cases) and NAVA group (40 cases). Patients in NAVA group were treated with conventional therapy, and patients in NAVA+ EDP group were given EDP on the basis of conventional treatment.The diaphragmatic excursion (DE), diaphragmatic thickening fraction (DTF), the peak of diaphragm′s electrical activity (EAdipeak), static lung compliance (Cst), plateau pressure (Pplat), airway resistance (Raw), partial pressure of carbon dioxide in artery (PaCO 2), the arterial oxygen tension/inspired oxygen tension ratio (P/F), mechanical ventilation time, and the length of ICU stay were observed and compared between the two groups.T test was used to compare the measurement data between the groups, and χ2 test was used to compare the enumeration data. Results:At the beginning, there was no significant difference in DE, DTF, EAdipeak, Cst, Pplat, Raw, PaCO 2, and P/F between the two groups ( t values were 1.14, 0.81, 0.40, 0.78, 0.45, 0.95, 0.83 and 0.41, respectively, all P>0.05). When evacuating the ventilator, compared with the NAVA group, DE ([13.80±1.84] mm vs [12.71±1.66] mm), DTF ([32.81±2.77]% vs [31.32±2.84]%) and Cst ([42.13±2.35] ml/cmH 2O vs [40.55±2.09] ml/cmH 2O)(1 cmH 2O=0.098 kPa)in the NAVA+ EDP group were significantly increased ( t values were 2.65, 2.36, and 2.41, respectively, all P<0.05), the EAdipeak ([9.41±1.54] μm vs [10.54±1.76] μm), Pplat ([10.95±1.95] cmH 2O vs [12.08±1.82] cmH 2O) and Raw ([16.07±2.87] cmH 2O·L -1·s -1vs [17.63±2.60] cmH 2O·L -1·s -1) in the NAVA+ EDP group were decreased ( t values were 3.05, 2.67, and 2.16, respectively, all P<0.05). However, there was no difference in PaCO 2 and P/F between the two groups ( t values were 1.93 and 1.32, respectively, both P>0.05). The mechanical ventilation time ([139.98±13.65] h vs [172.18±16.44] h) and the length of ICU stay ([7.68±1.14] d vs [8.93±13.5] d) in the NAVA+ EDP group was significantly shorter than that in the NAVA group, with statistically significant differences ( t values were 9.53 and 4.48, respectively, both P<0.001). Conclusions:For pulmonary infection patients requiring mechanical ventilation, EDP combined with NAVA can improve diaphragmatic function, reduce the duration of mechanical ventilation, and shorten the length of ICU stay.