不同通气模式对AECOPD并发肺性脑病撤机困难患者人机同步程度的影响  

Effects of different ventilation modes on the degree of man⁃machine synchronization in AECOPD patients complicated with pulmonary encephalopathy and difficulty in weaning

作　　者：贾航 翟书鹏 JIA Hang;ZHAI Shupeng(Dept.of Emergency Medicine,Nanyang Central Hospital,Nanyang 473000,China)

机构地区：[1]南阳市中心医院急诊内科,河南南阳473000

出　　处：《华夏医学》2023年第5期94-98,共5页Acta Medicinae Sinica

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20191583)。

摘　　要：目的:探讨不同通气模式对慢性阻塞性肺疾病急性加重期(AECOPD)并发肺性脑病撤机困难患者人机同步程度的影响。方法:将63例AECOPD并发肺性脑病撤机困难患者按照随机数字表法分为试验组32例及对照组31例。试验组给予无创神经调节辅助通气(NAVA),对照组给予压力支持通气(PSV),对比两组患者人机同步性指标、总呼吸功、应激因子水平及脱机情况。结果:试验组呼吸通气频率低于对照组,吸气触发延迟时间、吸气呼气切换延迟时间均短于对照组,差异有统计学意义(P<0.05)。两组总呼吸功比较,差异无统计学意义(P>0.05)。治疗后,两组丙二醛(MDA)水平均降低,且试验组低于对照组,而两组超氧化物歧化酶(SOD)、谷胱甘肽过氧化物酶(GSH⁃Px)水平均升高,且试验组高于对照组(P<0.05)。试验组24 h脱机成功率大于对照组,48 h内再插管率低于对照组(P<0.05)。结论:尽管PSV及NAVA均可改善AECOPD并发肺性脑病撤机困难患者脱机情况,但NAVA的应用效果及人机同步程度优于PSV,更值得临床推广。Objective:To investigate the effects of different ventilation modes on the degree of man⁃machine synchronization in acute exacerbation of chronic obstructive pulmonary disease(AECOPD)patients complicated with pulmonary encephalopathy and difficulty in removing the ventilation.Methods:63 AECOPD patients complicated with pulmonary encephalopathy and difficulty in weaning were randomized into the test group(32 cases)and the control group(31 cases)using a random number table method.The test group were given non⁃invasive neuro⁃modulation assisted ventilation(NAVA),while the control group were given pressure support ventilation(PSV).The man⁃machine synchronization indexes,the total respiratory functions,stress factor level and off⁃ventilator were compared between the patients in both groups.Results:The respiratory ventilation frequency of the test group was lower than that of the control group,and aspiratory trigger delay time and inhale and exhale switch delay time in the test group was shorter than that in the control group,the differences were statistically significant(P<0.05).There was no significant difference in total respiratory functions between two groups(P>0.05).After treatment,the levels of malondialdehyde(MDA)were decreased in both groups,and the experimental group had lower levels than the control group.But the levels of superoxide dismutase(SOD)and glutathione peroxidase(GSH⁃Px)increased in both groups,and the experimental group had higher levels than the control group(P<0.05).The 24 hours off⁃ventilator success rate of the experimental group was greater than that of the control group,while the reintubation rate within 48 hours was lower than that of the control group(P<0.05).Conclusion:Although both PSV and NAVA can improve the weaning of ventilator in AECOPD patients complicated with pulmonary encephalopathy,which can be proved that the application effects and man⁃machine synchronization degree of NAVA might be superior to PSV.Therefore,NAVA will be more worthy of clinical promotion.

关 键 词：通气模式 慢性阻塞性肺疾病急性加重期 肺性脑病 

分 类 号：R825.93[医药卫生—急诊医学]