神经调节辅助通气在轻中度急性呼吸窘迫综合征患者保护性肺通气中的作用  

Role of neurally adjusted ventilatory assist in lung-protective ventilation in patients with acute respiratory distress syndrome

作　　者：忽新刚 韩蕾 蒋亚芬 张杰 刘智达 田翠杰 王学林 程剑剑 HU Xingang;HAN Lei;JIANG Yafen;ZHANG Jie;LIU Zhida;TIAN Cuijie;WANG Xuelin;CHENG Jianjian(Department of Respiratory and Critical Care Medicine,Henan Provincial People's Hospital,Zhengzhou University People's Hospital,Zhengzhou,Henan 450000,China;Department of General Practice,Henan Provincial People's Hospital,Zhengzhou University People's Hospital,Zhengzhou,Henan 45o000,China)

机构地区：[1]河南省人民医院郑州大学人民医院呼吸与危重症医学科,河南郑州450000 [2]河南省人民医院郑州大学人民医院全科医学科,河南郑州450000

出　　处：《中华实用诊断与治疗杂志》2024年第5期488-492,共5页Journal of Chinese Practical Diagnosis and Therapy

摘　　要：目的 观察神经调节辅助通气(NAVA)模式对轻中度急性呼吸窘迫综合征(ARDS)患者不同肺区机械能的影响,探讨其改善人机不同步的作用。方法 2016年1月—2019年1月河南省人民医院诊治轻中度ARDS患者60例,机械通气采用NAVA模式者30例为观察组,采用同步间歇指令通气+压力支持通气模式者30例为对照组。2组入院后均给予抗感染、治疗原发病、气道管理等常规治疗,保证血流动力学和内环境稳定,应用肺部电阻抗断层成像监测仪监测机械通气12、24 h时总机械能及非重力依赖区、重力依赖区机械能。比较2组病因、ARDS程度、入院时急性生理学及慢性健康状况Ⅱ(APACHEⅡ)评分等临床资料;记录机械通气12、24 h时pa(O_(2))、pa(CO_(2))、氧合指数、吸气触发延迟时间、吸呼气转换延迟时间、最大呼气压、最大吸气压、浅快呼吸指数。结果 (1)2组男性、中度ARDS比率及年龄、病因、入院时APACHEⅡ评分比较差异均无统计学意义(P>0.05)。(2)机械通气12、24 h时,观察组pa(CO_(2))[(44.38±3.00)、(42.10±2.88)mmHg]、浅快呼吸指数[(89.55±5.56)、(78.05±5.42)次/(min·L)]、总机械能[(10.43±1.12)、(11.28±1.26)mJ]、非重力依赖区机械能[(7.21±0.57)、(7.90±0.58)mJ]均低于对照组[(49.55±2.57)、(48.43±2.53)mmHg;(92.23±3.83)、(91.20±3.51)次/(min·L);(11.22±1.11)、(13.88±1.69)mJ;(7.98±0.75)、(9.17±1.03)mJ](P<0.05),最大呼气压[(88.14±5.98)、(95.64±2.71)mmH_(2)O]、最大吸气压[(44.79±7.59)、(61.19±4.57)mmH_(2)O]均高于对照组[(84.66±6.13)、(86.67±2.70)mmH_(2)O;(41.73±2.48)、(41.80±2.99)mmH_(2)O](P<0.05),吸气触发延迟时间[(90.77±2.48)、(70.65±1.33)ms]、吸呼气转换延迟时间[(85.98±0.97)、(80.64±1.35)ms]均短于对照组[(92.61±4.12)、(74.51±1.85)ms;(96.74±1.06)、(84.33±1.42)ms](P<0.05),pa(O_(2))、氧合指数、重力依赖区机械能与对照组比较差异均无统计学意义(P>0.05)。2组机械通气24 h时上述Objective To observe the influence of neurally adjusted ventilatory assist(NAVA)on mechanical power in different lung regions of patients with acute respiratory distress syndrome(ARDS),and to explore its role in improving patient-ventilator synchrony.Methods Sixty patients with mild to moderate ARDS were treated in Henan Provincial People's Hospital from January 2016 to January 2019,among whom 30 patients received NAVA ventilation(observation group),and the other 30 patients received synchronized intermittent mandatory ventilation(SIMV)+pressure support ventilation(control group).Both two groups received conventional treatment including anti-infection,treatment of primary diseases,and airway management to ensure the hemodynamic and internal environmental stability.Lung electrical impedance tomography was used to monitor the total mechanical power and mechanical power in non-gravitational dependent and gravitational dependent lung regions 12 and 24 h after mechanical ventilation in both groups,The clinical data such as the etiology,degree of ADRS,and Acute Physiology and Chronic Health Evaluation Ⅱ(APACHE Ⅱ)score on admission were compared between two groups.The pa(O_(2)),pa(CO_(2)),oxygenation index,inspiratory trigger delay time,inspiratory-expiratory phase transition delay time,maximal expiratory pressure,maximal inspiratory pressure,and rapid shallow breathing index were recorded 12 and 24 h after mechanical ventilation.Results(1)There were no significant differences in the gender ratio,proportion of moderate ARDS,age,etiology,and admission APACHEI score between two groups(P>0.05).(2)After mechanical ventilation for 12 and 24 h,the values of pa(CO_(2)),rapid shallow breathing indexes,total mechanical power values,and mechanical power values in non-gravitational dependent lung region werelower inobservationgroup[(44.38±3.00),(42.10±2.88)mmHg;(89.55±5.56),(78.05±5.42)breaths/(minL);(10.43±1.12),(11.28±1.26)mJ;(7.21±0.57),(7.90±0.58)mJ]than those in control group[(49.55±2.57),(48.43±2.53)mmHg;(92.23

关 键 词：急性呼吸窘迫综合征 神经调节辅助通气 电阻抗成像技术 机械能 

分 类 号：R563.8[医药卫生—呼吸系统]