无创神经调节辅助通气对慢性阻塞性肺疾病急性加重并肺性脑病撤机困难的机械通气患者的影响  

Effect of noninvasive neuromodulation assisted ventilation on mechanically ventilated patients with acute exacerbation of chronic obstructive pulmonary disease and pulmonary encephalopathy

作　　者：王文杰[1] 樊清波[1] 李敏[1] 隗强[1] 刘卫青[1] 秦秉玉[1] 赵丽敏[1] WANG Wenjie;FAN Qingbo;LI Min;WEI Qiang;LIU Weiqing;QIN Bingyu;ZHAO Limin(Henan Provincial People’s Hospital,Zhengzhou 450003,China)

机构地区：[1]河南省人民医院,河南郑州450003

出　　处：《中国实用神经疾病杂志》2021年第2期125-130,共6页Chinese Journal of Practical Nervous Diseases

基　　金：中国宋庆龄基金项目(编号:2018MZFZY-004)。

摘　　要：目的探讨无创神经调节辅助通气对慢性阻塞性肺疾病急性加重(AECOPD)并肺性脑病撤机困难的机械通气(MV)患者人机同步程度、氧化应激水平及脱机情况的影响。方法选取2017-10—2020-07就诊于河南省人民医院的93例AECOPD并肺性脑病撤机困难的MV患者为研究对象,对照组46例采用压力支持通气模式,观察组47例给予无创神经调节辅助通气。观察2组患者的预后情况,通过吸气触发延迟时间、吸气呼气切换延迟时间、呼吸通气频率评定2组患者的人机同步程度;通过治疗前后血清谷胱甘肽(GSH)、超氧化物歧化酶(SOD)、丙二醛(MDA)水平评定2组患者的氧化应激水平;通过直接脱机、间接脱机、最终脱机及2 d内再插管情况评定2组患者的脱机情况。结果观察组AECOPD患者吸气触发延迟时间(115.69±18.34)ms、吸气呼气切换延迟时间(148.90±45.69)ms、呼吸通气频率(21.82±8.15)次/min均小于对照组(P<0.05)。观察组AECOPD患者SOD(976.35±98.28)U/mL、MDA(3.56±0.46)μmol/L、GSH(82.77±7.46)U/L水平与对照组比较无明显变化(P>0.05)。观察组AECOPD患者最终脱机率明显大于对照组(95.74%vs 80.43%,P<0.05)。2组患者治疗有效率比较差异无统计学意义(93.62%vs 91.30%,P>0.05)。结论对于AECOPD并肺性脑病撤机困难的MV患者,无创神经调节辅助通气能够通过膈肌电触发模式,增强AECOPD患者人机同步程度、改善氧化应激指标效果及脱机情况。Objective To investigate the effect of non-invasive neuromodulation-assisted ventilation on man-machine synchronization,oxidative stress and weaning-off in patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD) combined with pulmonary encephalopathy(MV) in patients with mechanical ventilation(MV).Methods A total of 93 MV patients with AECOPD and pulmonary encephalopathy who were admitted to Henan Provincial People’ s Hospital from October2017 to July 2020 were selected as the research objects and grouped according to different treatment plans.Forty-six patients in the control group were given pressure-supported ventilation mode,while 47 patients in the observation group were given non-invasive neuromodulation assisted ventilation.The prognosis of patients in the two groups was observed,and the man-machine synchronization degree of patients in the two groups was evaluated by the delay time of inspiratory trigger,delay time of inspiratory and expiratory switch,and respiratory and ventilation frequency.The levels of serum glutathione(GSH),superoxide dismutase(SOD) and malondialdehyde(MDA) were evaluated before and after treatment.Weaning of patients in the two groups was assessed by direct weaning,indirect weaning,final weaning and 2 d retracheal intubation.Results The delay time of inspiratory trigger(115.69±18.43)ms,delay time of inspiratory and expiratory switch(148.90±45.69)ms and respiratory and ventilation frequency(21.82±8.15)times/min of AECOPD patients in the observation group were all lower than those in the control group(P<0.05).The SOD(976.35±98.28)U/mL,MDA(3.56±0.46) μmol/L and GSH(82.77±7.46)U/mL levels of AECOPD patients in the observation group showed no significant changes compared with the control group,and the difference was not statistically significant(P>0.05).The weaning of the observation group was better than that of the control group(P<0.05).There was no significant difference in the effective rate between the two groups(P>0.05).Conclusion For MV patients

关 键 词：肺性脑病 慢性阻塞性肺疾病 无创神经调节 机械通气 人机同步程度 氧化应激 脱机情况 

分 类 号：R747.9[医药卫生—神经病学与精神病学]