摘要
目的 比较神经调节辅助通气 （NAVA）和同步间歇指令通 气＋压力支持通气（SIMV＋PSV）在慢性阻塞性肺疾病急性加重 （AECOPD）呼吸衰竭患者治疗中的差异。方法 60例AECOPD行有创机械通气的患者随机分为 NAVA组 （n =30）和 SIMV＋PSV组 （n =30）。观察2组患者的人机同步性指标（吸气触发延迟时间、吸呼气转换延迟时间、无效触发次数、无效触发指数）、呼吸力学指标 （患者呼吸做功及其在总呼吸做功的占比）。酶联免疫吸附测定法检测血清炎症因子IL-6和IL-8水平。观察患者的直接脱机成功率及有创机械通气时间。结果 NAVA模式下患者的吸气触发延迟时间、吸呼气转换延迟时间和呼吸 做功均低于SIMV＋PSV模式（吸气触发延迟时间：1h、24h、48h、72ht值分别-13.69、-12.55、-11.87、-14.34;吸呼气转换延迟时间：1h、24h、48h、72ht值分别为8.22、14.60、12.89、11.66、呼吸做功：1h、24h、48h、72ht值分别为-12.99、-13.70、-10.41、-19.66;P 值均〈0.05）;NAVA组未出现无效触发,其无效触发次数和无效触发指数与SIMV＋PSV组差异有统计学意义 （无效触发次数1h、24h、48h、72ht值分别为-6.27、-8.11、-12.08、-11.22;无 效 触 发 指 数 1h、24h、48h、72ht 值 分 别 为 -5.90、-7.71、-11.25、-9.39;P 值均〈0.05）。NAVA组呼吸机相关性肺损伤相关的部分炎症因子水平低于 SIMV＋PSV组 （IL-6水平1ht=0.94,P 〉0.05,72ht=-6.50,P 〈0.05;IL-8水平1ht=-0.52,P 〉0.05,72ht=-6.23,P 〈0.05）。与SIMV＋PSV组比较,NAVA组的直接脱机成功率差异无统计学意义 （χ2=1.18,P 〉0.05）,而有创机械通气治疗总时间则明显缩短 （t=3.22,P 〈0.05）。结论 在 AECOPD并发呼吸衰竭患者行有创机械通气治疗过程中,相比于 SIMV＋PSV模式,NAVA模式可以更好地改善人机交互性,有效避免呼吸肌疲劳的出现,降低呼吸机相关性肺损伤的发生风险,缩短机械通气时间,从而改善患者的预后。
Objective To compare the difference between neurally adjusted ventilation assist （NAVA） and synchronized intermittent mandatory ventilation with pressure support ventilation （SIMV＋ PSV） on the treatment of patients with respiratory failure in the acute exacerbation of chronic obstructive pulmonary diseases（AECOPD）. Methods Sixty mechanically ventilated patients with respiratory failure in AECOPD were randomly allocated to NAVA group （ n =30） and SIMV＋ PSV group （ n = 30）. Observe the parameters of patient-ventilator interaction such as trigger delay time, cycling-off delay time, ineffective trigger number and ineffective trigger index, and the parameters of respiratory mechanics such as patient＇s work of breathing and it＇s proportion in total work of breathing were measured. The levels of interleukin-6 and interleukin-8 in serum were detected by enzyme-linked immunosorbent assay. The rate of direct weaning from mechanical ventilation and total mechanical ventilation time were also observed. Results The trigger delay time, cycling-off delay time and patientrs work of breathing in the NAVA group were statistically lower than those in the SIMV＋PSV group （Trigger delay time： 1 h, 24 h, 48 h, 72 h t = - 13. 69, - 12.55, - 11.87, - 14.34. cycling-off delay time： 1 h, 24 h, 48 h, 72 h t = 8.22,14.60, 12.89,11.66.Patient＇s work of breathing：1 h,24 h,48 h, 72 h t =-12.99, -13.70, -10.41, -19.66. All P G0.05）. No ineffective trigger was observed in NAVA group, and ineffective trigger count and ineffective trigger index were statistically different between NAVA group and SIMV ＋ PSV group （Ineffective trigger count ： 1 h, 24 h, 48 h, 72 h t = - 6.27, - 8.11, - 12.08, - 11.22. Ineffective trigger index：l h,24 h,48 h,72 h t =-5.90,-7.71, -11.25, -9.39.All P G0.05）.The serum inflammatory factor levels related to ventilation-associated lung injury in NAVA group were lower than those in the SIMV＋ PSV group （IL-6 level：l ht =0.94, P 〉0.05.72 ht =-6.50, P 〈0.05.IL-8 level：1 ht =-0.52, P〉 0.05.72 h t = -6.23, P G0.05）. There was no significant difference in the rates of direct weaning from mechanical ventilation between the two groups （ χ2 = 1.18, P 〉0.05）. But in NAVA group, the total mechanical ventilation time was statistically lower than that in SIMV＋PSV group （ t =3.22, P G0.05）. Conclusions Compared with SIMV＋PSV, NAVA could significantly improve the patient-ventilation interaction in mechanically ventilated patients with AECOPD complicated with respiratory failure, reducing respiratory load and the risk of ventilator-associated lung injury, and shortening the duration of mechanical ventilation, therefore it may improve the prognosis of patients.
出处
《国际呼吸杂志》
2018年第2期101-108,共8页
International Journal of Respiration
基金
军队后勤科研计划重点项目（BHJ16J011）
海军总医院归国人员创新技术项目启动基金（GGCX201208）
国家自然科学基金（81300050）
海军总医院创新培养基金（CXPY201417）
关键词
慢性阻塞性肺疾病急性加重
神经调节辅助通气
同步间歇指令通气
压力支持通气
人机同步性
呼吸机相关性肺损伤
Acute excerbation of chronic obstructive pulmonary disease
Neurally adjusted ventilation assist
Synchronized intermittent mandatory ventilation
Pressure support ventilation
Patientventilation interaction
Ventilation-associated lung injury
