神经调节辅助通气在AECOPD患者呼吸机撤离中的应用  

Effect of neurally adjusted ventilatory assist on weaning of mechanical ventilation in the patients with acute exacerbation of chronic obstructive pulmonary disease

作　　者：王兵[1] 王勇强[1] 曹书华[1] 张会云[1] 米颖[1] 吴琼[1] 

机构地区：[1]天津市第一中心医院重症医学科,300192

出　　处：《中国急救医学》2011年第9期772-776,共5页Chinese Journal of Critical Care Medicine

基　　金：基金项目：天津市卫生局科技基金项目（No.2010KY07）

摘　　要：目的比较神经调节辅助通气（NAVA）与压力支持通气（PSV）模式对AECOPD呼吸衰竭患者呼吸机撤离期间人机同步性、呼吸肌做功及脱机成功率等方面的影响。方法30例进行机械通气治疗的AECOPDⅢ级患者采用自身对照方法每例随机先后应用PSV和NAVA，比较两种通气模式气道峰值压（Ppeak）、气道平台压（Pplat）、EAdi峰值信号、患者呼吸功占总呼吸功的百分比（WOBp／WOBt）等呼吸力学指标及触发延迟时间、无效触发、吸／呼气切换延迟时间等人机同步性指标。再将30例患者随机分为PSV组和NAVA组，每组15例，比较两组脱机成功率、48h冉插管率及ICU住院时间。结果NAVA模式时患者吸气触发延迟时间及吸／呼气切换延迟时间较PSV模式明显缩短（P〈0．001），EAdi幅度低于PsV模式（P〈0．05），Pplat和Ppeak低于PSV模式（P〈0．05和P〈0．01），WOBp／WOBt显著低于PSV模式（P〈0．01），PSV模式时呼吸机通气频率湿著低于中枢呼吸频率（t=2．509，P=0．017）。NAVA组最终脱机成功率与PSV组比较差异无统计学意义，但直接脱机成功率高于PSV组（P〈0．05），48h内再插管率低于PSV组（P〈0．05），ICU住院时间低于PSV组（P=0．038）。直接脱机失败患者首次试脱机前EAdi峰值娃著高于其他患者（P=0．002）．结论与传统机械通气模式PSV比较，NAVA能改善AECOPD机械通气患者人机协调性，减少患者呼吸做功；EAdi监测有助于临床脱机时机的选择及对呼吸肌状态的评估；NAVA是否能提高患者最终脱机成功率需深入研究。Objective To compare the effect of neurally adjusted ventilatory assist （NAVA） and proportional assist ventilation （PSV） on mechanical synchronism, respiratory work, weaning guide and rate of weaning in the respiratory failure patients with acute exacerbation of chronic obstruetive pulmonary disease （AECOPD）. Methods 30 patients with AECOPD III- level were treated with mechanical ventilation . Self - control method was used and each patient accepted randomly PSV and NAVA ventilation. The respiratory mechanics and synchronization index such as peak airway pressure （Ppeak） , airway plateau pressure （Pplat） , EAdi peak signal, WOBp / WOBt ,the trigger delay time, inwdid trigger, the inspiratory/expiratory off cycle delay were compared between two ventilation modes. Then 30 patients were randomly divided into NAVA group and PSV group （each n = 15） , the sueeesstul rate of weaning, 48 h re - intubation rate and ICU length of stay were evaluated. Results The trigger delay and the inspiratory/expiratory off cycle delay were significantly shorter in NAVA mode than in 19SV （P 〈 0. 001 ）. The ventilator frequency was significantly lower than the central respiratory frequeney in PSV mode （t =2.509,P：0.017）. The magnitude of EAdi（P〈0.05）, the plateau pressure（P〈O. 05）, the peak airway pressure and WOBp/WOBt（P 〈0. O1 ） were significantly lower in NAVA than in PSV mode. The rate of direct weaning was higher in NAVA group than in PSV group（P 〈0.05）, and the 48 h re - intubation rate was lower in NAVA group than in PSV group（P 〈0.05）. ICU length of stay was less in NAVA group than in PSV group（ P = 0. 038 ）. The peak of EAdi in 8 patients failed of direct weaning before first attempt off was significantly higher than other successful weaning patients （P = 0. 002）. Conclusion Compared with the conventional mechanical ventilation PSV, NAVA can improve patientventilator synchrony of in AECOPD patients, and reduce the patient work of breathing. The EAdi monito

关 键 词：慢性阻塞性肺疾病急性加重期 神经调节辅助通气 撤离呼吸机 

分 类 号：R511.6[医药卫生—内科学]