神经电活动辅助通气模式和压力支持通气模式对急性呼吸窘迫综合征患者肺内气体分布影响的比较

发布时间：2018-03-02 23:06

本文选题：神经电活动辅助通气　切入点：ARDS　出处：《临床麻醉学杂志》2016年11期 　论文类型：期刊论文

【摘要】：目的比较神经电活动辅助通气(NAVA)模式和压力支持通气(PSV)模式对急性呼吸窘迫综合征(ARDS)患者肺内气体分布的影响。方法本研究纳入18例符合标准的ARDS机械通气患者,男11例,女7例,采用单盲随机自对照的研究方法,同一患者以随机先后顺序应用NAVA和PSV模式分别通气30min,在通气0、30min时观察气体交换、血流动力学指标,对呼吸参数、人机同步性以及电阻抗断层摄影监测的肺气体分布均进行持续监测分析。结果与PSV比较,两种模式下HR、MAP、PIP及PEEP差异无统计学意义;NAVA模式改善ARDS患者氧合指数(P0.05),减少人机不同步事件的发生(P0.05),增加重力依赖区ROI 3、4区通气,减少非重力依赖区ROI 1、2区通气(P0.05)。结论与PSV比较,NAVA可以改善ARDS患者气体交换和人机同步性,改善肺内气体分布不均一性。
[Abstract]:Objective to compare the neural activity of assisted ventilation (NAVA) and pressure support ventilation (PSV) on acute respiratory distress syndrome (ARDS) patients with pulmonary gas distribution. Methods this study included 18 cases of ARDS patients with mechanical ventilation standard, male 11 cases, female 7 cases, single blind randomized study method adopted by self control, the same patient in a random sequence of application of NAVA and PSV model respectively ventilation 30min, observation of gas exchange in the ventilation 0,30min, hemodynamics, on respiratory parameters, pulmonary gas synchronism and electrical impedance tomography monitoring for continuous monitoring of distribution was analyzed. Results compared with PSV, the two modes HR, MAP, PIP and PEEP had no significant difference; NAVA mode to improve oxygenation in patients with ARDS index (P0.05), to reduce human occurred not synchronous event (P0.05), ROI 3,4 increased the dependent region area ventilation, reduce non dependent region R OI 1,2 area ventilation (P0.05). Conclusion compared with PSV, NAVA can improve the gas exchange and man-machine synchronization of ARDS patients, and improve the inhomogeneity of gas distribution in the lungs.

【作者单位】：江苏大学附属金坛医院ICU;江苏大学附属医院神经内科;东南大学附属中大医院ICU;
【基金】：江苏省常州市金坛区科技计划项目(JT2014058)
【分类号】：R563.8

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