神经调节辅助通气在慢性阻塞性肺疾病急性加重患者中的应用研究
发布时间：2019-07-04 17:40
【摘要】：研究目的:通过比较慢性阻塞性肺疾病急性加重期(AECOPD)并发呼吸衰竭的患者需行有创机械通气治疗时的人机交互性、患者做功、血清炎症因子水平、直接脱机成功率以及机械通气治疗总时间等指标,探讨神经调节辅助通气(NAVA)与传统的同步间歇指令通气+压力支持通气(SIMV+PSV)模式的差异,总结NAVA模式在AECOPD并发呼吸衰竭的患者在临床治疗中的应用。研究方法:应用前瞻、对照的研究方法,实验共纳入60例AECOPD并发Ⅱ型呼吸衰竭需要有创机械通气的患者随机分为NAVA组(n=30)和SIMV+PSV组(n=30)。分别检测两组患者在机械通气开始(0h)以及6h后的动脉血气情况,使用NAVA-Tracker软件检测机械通气1h、24h、48h、72h的人机交互性指标(触发延迟时间、无效触发次数、无效触发指数、吸呼气转换延迟时间等)和呼吸力学指标(气道峰压值、膈肌电位峰值、患者呼吸功负荷及其在总呼吸做功的占比等),并记录患者的直接脱机成功率以及有创机械通气的总时间;酶联免疫吸附测定法检测机械通气0h、24h、48h、72h患者血清炎症因子白介素-6和白介素-8水平。结果:1.机械通气时,NAVA模式和SIMV+PSV模式对AECOPD并发Ⅱ型呼吸衰竭的气体交换治疗效果差异无统计学意义(P0.05)。2.在机械通气1h、24h、48h、72h时,NAVA模式下患者的吸气触发延迟时间、吸呼气转换延迟时间和呼吸做功均低于SIMV+PSV模式(P0.05);NAVA组未出现无效触发,其无效触发次数和无效触发指数与SIMV+PSV组差异有统计学意义(P0.05)。通气支持程度:神经调节辅助通气组气道支持压力与膈肌电位峰值呈显著正相关(r=0.95,P0.05),SIMV+PSV组的气道支持压力与膈肌电位峰值之间未见显著相关性(P0.05)。3.NAVA组呼吸机相关性肺损伤相关的部分炎症因子水平低于SIMV+PSV组:在有创机械通气开始时,两组患者血清中的IL-6和IL-8基础水平差异无统计学意义(P0.05);行机械通气治疗72h后,NAVA组的患者血清IL-6和IL-8水平均呈现总体下降趋势;SIMV+PSV组患者的血清IL-6水平总体呈升高趋势,IL-8水平则在机械通气48h内逐渐降低,而后升高。4.将直接脱机成功率相比较,NAVA组和SIMV+PSV组之间未见明显差异(P0.05),而有创机械通气治疗总时间方面,NAVA组则比SIMV+PSV组明显缩短(P0.05)。结论:在AECOPD并发呼吸衰竭患者行有创机械通气治疗过程中,相比于SIMV+PSV模式,NAVA模式可以更好地改善人机交互性,有效避免呼吸肌疲劳的出现,降低发生VALI相关的炎症反应,缩短机械通气时间,从而改善患者的预后。
文内图片：
图片说明：NAVA模式的工作机制
[Abstract]:Objective: to compare the human-mechanical interaction, patient work, serum inflammatory factor level, direct offline success rate and total time of mechanical ventilation treatment in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) complicated with respiratory failure, and to explore the difference between neuroregulated assisted ventilation (NAVA) and traditional synchronous intermittent ventilation pressure-supported ventilation (SIMV PSV). To summarize the clinical application of NAVA model in the clinical treatment of patients with AECOPD complicated with respiratory failure. Methods: a total of 60 patients with AECOPD complicated with type II respiratory failure who needed invasive mechanical ventilation were randomly divided into NAVA group (n 鈮，
本文编号：2510092
文内图片：
图片说明：NAVA模式的工作机制
[Abstract]:Objective: to compare the human-mechanical interaction, patient work, serum inflammatory factor level, direct offline success rate and total time of mechanical ventilation treatment in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) complicated with respiratory failure, and to explore the difference between neuroregulated assisted ventilation (NAVA) and traditional synchronous intermittent ventilation pressure-supported ventilation (SIMV PSV). To summarize the clinical application of NAVA model in the clinical treatment of patients with AECOPD complicated with respiratory failure. Methods: a total of 60 patients with AECOPD complicated with type II respiratory failure who needed invasive mechanical ventilation were randomly divided into NAVA group (n 鈮，
本文编号：2510092
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