神经调节辅助通气对慢性阻塞性肺疾病患者炎性反应及脱机的影响  

Effects of neurally adjusted ventilatory assist on inflammatory reaction and weaning in patients with AECOPD

作　　者：金秋[1] 王宏飞[1] 王勇强[1] 王兵[1] 

机构地区：[1]天津医科大学一中心临床学院天津市第一中心医院重症医学科天津市急救医学研究所,天津300070

出　　处：《中华急诊医学杂志》2015年第5期530-535,共6页Chinese Journal of Emergency Medicine

基　　金：天津市卫生局科技基金（2010KY07）;国家临床重点专科（2011873）

摘　　要：目的 观察神经调节辅助通气（NAVA）对改善慢性阻塞性肺疾病急性加重期（AECOPD）患者炎症及氧化应激状态的相关性,探讨NAVA模式相对于压力支持通气（PSV）模式在提高脱机成功率方面的影响.方法 前瞻性观察研究,收集天津市第一中心医院重症监护病房（ICU） 2012年11月至2014年1月期间收治的40例进行机械通气治疗的AECOPDⅢ级患者,排除严重呼吸抑制或需要深度镇静、高位截瘫、神经肌肉病变等的患者,并根据“性别、年龄、APACHEⅡ评分、病史、PaCO2”五个因素水平按“不平衡指数最小的分配原则”随机分为PSV组和NAVA组,每组20例,比较两组脱机成功率、48 h再插管率及ICU住院天数,分别于开始通气第1天、第3天、第5天以及第7天时通过纤维支气管肺泡灌洗技术获取其支气管肺泡灌洗液（BALF）并抽取静脉血,采用酶联免疫吸附试验（ELISA）方法检测血清中C-反应蛋白（CRP）、血清淀粉样蛋白A （SAA）、人软骨糖蛋白-39 （YKL-40）,并与纳入的25例健康体检者作为对照组比较;再比较两组相应时点BALF中YKL-40水平.计数资料采用x2检验,计量资料采用成组￡检验或重复测量方差分析,以P ＜0.05为差异具有统计学意义.结果 （1） NAVA组和PSV组中白细胞数、中性粒细胞比例变化均差异无统计学意义（P＞0.05）,NAVA组血CRP和SAA质量浓度下降的幅度明显高于PSV组（P＜0.01）,但两组间血YKL-40的质量浓度差异无统计学意义（P＞0.05）; NAVA组BALF中YKL-40的质量浓度下降幅度明显高于PSV组（P＜0.01）; （2） NAVA组与PSV组最终脱机成功率差异无统计学意义,但NAVA组直接脱机成功率高于PSV组（P=0.046）,48 h内再插管率低于PSV组（P =0.032）.NAVA组患者ICU住院天数低于PSV组（P=0.031）,直接脱机失败患者首次试脱机前EAdi峰值显著高于其他患者（P =0.002）.结论 NAVA能缓解AECOPD患者的炎症及氧化应激�Objective To observe the correlation between neutrally adjusted ventilatory assist （NAVA） mode and improvement of inflammation and oxidative stress in patients with acute exacerbation of chronic obstructive pulmonary disease （AECOPD）,and as well as to investigate the effects of NAVA mode versus pressure support ventilation （PSV） mode on improving the success rate of weaning advantages.Methods A total of 40 patients with AECOPD-Ⅲ supported by mechanical ventilation treatment admitted from November 2012 to January 2014 into intensive care unit （ICU） were enrolled for prospective study.The patients were randomly divided into PSV mode （n =20） and NAVA mode （n =20） according to ＂gender,age,APACHE Ⅱ score,medical history,PaCO2＂ of five factors and adopting ＂the principle of minimum distribution of the imbalance index＂.The comparisons of the successful rate of weaning,48 h re-intubation rate and length of ICU stay were made between two groups.The level of C-reactive protein （CRP）,serum amyloid A （SAA）,human cartilage glycoprotein 39 （YKL-40） in serum were measured by enzyme-linked immunosorbent assay （ELSIA） on the 1st day,3rd day,5th day and 7th day after initiation of mechanical ventilation,and results of these laboratory tests in patients were compared with those in healthy subjects of control group.And simultaneously,the broncho-alveolar lavage fluid （BALF） was collected with Gibot method by employment of optic fiber bronchoscope on the given days for detection of YKL-40,and levels of YKL-40 were compared between NAVA mode and PSV mode.Enumeration data were analyzed with x2 test,measurement data were analyzed with t test or repeated measures analysis of variance,and P ＜ 0.05 was considered to be significant.Results （1） There were no significant differences in leukocyte count and neutrophils percentage between NAVA mode and PSV mode （P ＞ 0.05）.The magnitudes of decrease in concentrations of blood CRP and SAA in NAVA mode were significantly greater th

关 键 词：神经调节辅助通气 慢性阻塞性肺疾病急性加重期 压力支持通气 生物标记物 

分 类 号：R563.9[医药卫生—呼吸系统]