不同腹腔压对神经调节辅助通气中膈肌电活动和潮气量的影响

发布时间：2018-04-30 10:12

本文选题：肺通气 + 腹腔压　；参考：《温州医科大学学报》2017年03期

【摘要】：目的:探究神经调节辅助通气(NAVA)中的膈肌电活动(EAdi)及潮气量于不同腹腔压(IAP)时的变化情况,为临床通气参数设置提供参考。方法:选取2015年1月至10月在衢州市人民医院ICU病房机械通气患者44例,入选标准为年龄18岁,呼吸末正压(PEEP)通气在3~5 cmH_2O(1 cmH_2O=0.098 kPa)并且预测通气时间≥72 h的患者。通过膀胱注入0.9%氯化钠溶液的方法间接测量出IAP,每次间隔6 h,依据国际腹腔间隙综合征学会(WSACS)对高IAP的定义将12 mmHg(1 mmHg=0.133 kPa)设定为分界线,区分高腹内压和非高腹内压。经鼻放置EAdi导管于每小时测定EAdi值,同时记录潮气量。结果:高腹内压组EAdi值[(5.8±0.7)μV]显著低于非高腹内压组[(6.8±0.6)μV],差异有统计学意义(P0.05),高腹内压组潮气量[(9.6±1.3)mL/kg]显著高于非高腹内压组[(8.8±1.0)mL/kg],差异有统计学意义(P0.05)。结论:NAVA中,高IAP时,EAdi数值降低,潮气量增多;非高IAP时,EAdi数值升高,潮气量减少。
[Abstract]:Objective: to investigate the changes of diaphragm electromyoelectric activity (EADI) and tidal volume during different abdominal pressure (IAPs) in NAVA, and to provide a reference for the setting of clinical ventilation parameters. Methods: Forty-four patients with mechanical ventilation in ICU ward of Quzhou people's Hospital from January to October 2015 were selected. The age of patients was 18 years old with positive end-respiratory pressure (Pep) ventilation at 3 ~ 5 cmH_2O(1 cmH_2O=0.098 KPA) and the predicted ventilation time was more than 72 h. IAPs were indirectly measured by intravesical injection of 0.9% sodium chloride solution at intervals of 6 hours. According to the definition of high IAP by the International Society of abdominal Space Syndrome (IAPs), 12 mmHg(1 mmHg=0.133 KPA was set as the dividing line to distinguish high intra-abdominal pressure from non-high intraabdominal pressure. EAdi catheter was placed through the nose to determine the EAdi value per hour and the moisture volume was recorded at the same time. Results: the EAdi value of high intra-abdominal pressure group [5.8 卤0.7 渭 V] was significantly lower than that of non-high intraabdominal pressure group [6.8 卤0.6 渭 V], the difference was statistically significant (P 0.05). The tidal volume of high intraabdominal pressure group [9.6 卤1.3)mL/kg] was significantly higher than that of non-high intraabdominal pressure group [8.8 卤1.0)mL/kg] (P 0.05). Conclusion in the case of high IAP, the EAdi value decreases and the tidal volume increases, while the EAdi value increases and the tidal volume decreases at non-high IAP.
【作者单位】：衢州市人民医院重症医学科;
【基金】：浙江省医药卫生一般研究计划项目(2014KYB302)
【分类号】：R459.7

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