神经调节辅助通气在重症创伤性湿肺合并ARDS患者中的应用  

The Application of NAVA in the Patients of Severe Traumatic Wet Lung

作　　者：林竹[1] 王兵[1] 王勇强[1] 曹书华[1] 

机构地区：[1]天津医科大学一中心临床学院ICU,天津300192

出　　处：《中国中西医结合外科杂志》2011年第5期479-481,共3页Chinese Journal of Surgery of Integrated Traditional and Western Medicine

基　　金：天津市卫生局科技基金(2010KY07)

摘　　要：目的:探索在重症创伤性湿肺(STWL)患者中应用神经电活动辅助通气(NAVA)模式与传统压力支持通气(如PSV)模式相比较时,其人机同步性、呼吸力学、气体交换能力、血流动力学上的差异。方法:以18例需机械通气的重症创伤性湿肺患者为研究对象,每例患者随机先任选NAVA或PSV模式进行机械通气120min,再换用另一种通气模式。比较同一患者在两种通气模式下,其人机同步性、呼吸力学、气体交换能力、血流动力学等方面的不同。结果:18例患者的血流动力学(HR、CVP)及气体交换能力(动脉血pH值、PaO2、PaCO2、SaO2)在两种模式间无明显差异(P>0.05),在人机同步性(Trigger delay、Off cycle delay)及呼吸力学(PIP、Pmean)方面NAVA优于PSV,差异具有显著性(P<0.05)。结论:对于重症创伤性湿肺机械通气患者,NAVA模式比PSV模式,具有人机协调性高、呼吸力学稳定等优势,而在血流动力学及气体交换能力上具有相似的安全性。0bjective To compare the differences of patient-ventilator synchrony,respiratory mechanics,gas exchange capacity and hemodynamic in patients of severe traumatic wet lung （STWL）,with use of neurally adjusted ventilatory assist （NAVA） or traditional press support ventilation （like PSV）.Methods The study was based on 18 patients of STWL.They were ventilated with PSV or NAVA randomized at the beginning for 120 minutes,and then they were ventilated with the other mode.To compare the patient-ventilator synchrony,respiratory mechanics,gas exchange effects and hemodynamic,produced by the two ventilation modes.Results In the 18 cases,there were no significant differences in the hemodynaic（HR,CVP） and gas exchange effects（pH,PaO2,PaCO2,SaO2）under the two ventilation modes （P 0.05）.NAVA was superior to PSV in patient-ventilator synchrony（Trigger delay,Off cycle delay）and respiratory mechanics（PIP,Pmean）,and the difference was significant （P 0.05）.Conclusions Contrasted with PSV,NAVA had advantage in higher patient-ventilator synchrony and stability of respiratory mechanics in patients with STWL.However,NAVA and PSV had similar security in hemodynamic,oxygenation and gas exchange effects.

关 键 词：创伤性湿肺 神经调节辅助通气 膈肌电 人机同步性 

分 类 号：R655.3[医药卫生—外科学]