神经调节辅助通气对ARDS机械通气同步性影响的实验研究  

Effects of neurally adjusted ventilatory assist on subject-ventilator synchrony in rabbits with acute respiratory distress syndrome

作　　者：黄东亚[1] 黄英姿[1] 吴晓燕[1] 刘火根[1] 杨毅[1] 邱海波[1] 

机构地区：[1]东南大学附属中大医院重症医学科东南大学急诊与危重病医学研究所,南京210009

出　　处：《中华医学杂志》2011年第19期1348-1352,共5页National Medical Journal of China

基　　金：江苏省自然科学基金（BK2008298）;江苏省医学领军人才基金（2006）;江苏省135重点人才基金（2007）;江苏省科技发展计划（BS2007045）

摘　　要：目的 探讨神经调节辅助通气（NAVA）对急性呼吸窘迫综合征（ARDS）机械通气同步性的影响.方法 盐酸吸入法复制兔ARDS模型,充分肺复张后,随机分为压力支持通气组（PSV组）和NAVA通气组（NAVA组）.观察两组在机械通气0、1、2、3 h时的吸气触发、吸呼气转换以及通气支持程度指标.结果 NAVA组的吸气触发延迟时间低于PSV组（P＜0.05）;在通气0、1、2、3 h时,NAVA组的吸气触发延迟时问均低于PSV组（P＜0.05）;通气过程中不同时间点的吸气触发延迟时间差异无统计学意义（P＞0.05）.PSV组的无效触发指数为（17.7.4±13.7）%,而在NAVA组未见无效触发.PSV绀吸呼气转换延迟时间明显低于NAVA组（P＜0.05）;在通气0、1、2、3 h时,PSV组的吸呼气转换延迟时间均低于NAVA组（P＜0.05）.通气过程中不同时间点的吸呼气转换延迟时间差异无统计学意义（P＞0.05）.通气支持程度：NAVA组气道峰压（Ppeak）与膈肌电位峰值（peak EAdi）呈显著上E相关（r=0.86±0.07,P＜0.05）;PSV组Ppoak与peak EAdi之间无相关性（P＞0.05）.结论 与PSV相比,NAVA更能改善ARDS机械通气同步性.Objective To observe the effects of neurally adjusted ventilatory assist（NAVA）on subject-ventilator synchrony in rabbits with acute respiratory distress syndrome（ARDS）.Methods The rabbit model of ARDS was induced by intratracheal infusion of hydrochloric acid.After sufficient recruitment,the rabbits were randomly divided into 2 groups：pressure support ventilation（PSV）group and NAVA group.The parameters of subject-ventilator synchrony such as ventilation trigger,ventilation switching and delay：tIle trigger delay in the NAVA group were markedly lower than the PsV group at 0,1,2,3 h（P＜0.05）;as ventilation time elapsed.the trigger delay changed neither in NAVA nor in PSV group While all neural efforts were trigger,there was no ineffective trigger observed in the NAVA group.（2）Offcycle delay：the off-cycle delay were significantly lower in the PSV group than that in the NAVA group at 0,1,2,3 h（P＜0.05）;as the ventiIation time elapsed,the off-cycle delay changed neither in the NAVA group nor in the PSV group（P＞0.05）.（3）Magnitude of assist：in the NAVA group.peak EAdi and peak pressure were markedly correlated（determination coefficient 0.86±0.07,P＜0.05）.But pressure dellvery during the PSV group was not correlated with EAdi（P＞0.05）.Conclusion As compared with PSV,NAVA can improve subject-ventilator synchrony in rabbits with ARDS.

关 键 词：肺通气 通气机 机械 呼吸窘迫综合征 

分 类 号：R563.8[医药卫生—呼吸系统]