神经调节辅助通气在AECOPD患者序贯治疗中的应用

摘要

目的 观察神经调节辅助通气在慢性阻塞性肺疾病急性加重(AECOPD)患者序贯治疗中的疗效.方法 将28例AECOPD需要机械通气的患者按照随机数字表法分为压力支持通气(PSV)组15例和神经调节辅助通气(NAVA)组13例,达到肺部感染控制(PIC)窗后拔管,PSV组予无创通气(NIV)-PSV模式,NAVA组予NIV-NAVA模式进行无创序贯治疗,监测两组患者达到PIC窗时间、血气分析、无创序贯时间、48h再插管率、ICU入住时间.结果 经过机械通气治疗后两组患者呼吸频率,心率以及血气等指标明显改善.NAVA组达到PIC窗的时间较PSV组更短(P＜0.05).NIV-NAVA组与NIV-PSV组比较,无创序贯时间缩短(P＜0.05),ICU入住时间减少(P＜0.05).NIV-NAVA组48h再插管率低于NIV-PSV组,但差异无统计学意义.结论 相比PSV,NAVA能够更早到达PIC窗,减少有创机械通气时间,NAVA序贯治疗较PSV能够缩短无创序贯时间以及ICU入住时间.%Objective To assess the application of neurally adjusted ventilatory assist (NAVA) in sequential mechanical ventilation for patients with acute exacerbation chronic obstructive pulmonary disease (AECOPD).Methods Twenty-eight AECOPD patients receiving mechanical ventilation in ICU were randomly divided into pressure support ventilation (PSV) group (n=15) and NAVA group (n=13).When pulmonary infection control (PIC) window appeared,the PSV converted to non-invasive ventilation(NIV)-PSV and the NAVA converted to NIV-NAVA with noninvasive sequential mechanical ventilation.The arterial blood gas,the time of noninvasive sequential mechanical ventilation,reintubation rate in 48 h and the length of ICU stay were documented and compared between two groups.Results The breathing rate,heart rate and effect of gas exchange were improved after mechanical ventilation in both groups.Compared with PSV,NAVA had shorter time for reaching PIC window (92.62 ± 7.61 h vs.101.40 ± 12.88 h,P＜0.05).The time of noninvasive sequential mechanical ventilation on NIV-NAVA were shorter (72.46 ± 11.95h vs.81.87h ± 11.10,P＜0.05),and the length of ICU stay was shorter than NIV-PSV (7.57 ± 2.66d vs 10.30 ± 4.03d,P＜0.05)in noninvasive sequential mechanical ventilation.Compared with NIV-PSV,reintubation rate within 48h in NIV-NAVA had a lower trend,but there was no significant difference between two groups (P ＞0.05).Conclusion NAVA has a short time of PIC window appearing and invasive ventilation,and also a shorter duration of noninvasive sequential mechanical ventilation and shorter length of ICU stay than PSV for AECOPD patients.