神經調節輔助通氣在AECOPD患者序貫治療中的應用

王丹瓊 張偉文 羅建 熊曉華 祝利華 方紅龍 胡建華 吳華勇

神經調節輔助通氣在AECOPD患者序貫治療中的應用

王丹瓊 張偉文 羅建 熊曉華 祝利華 方紅龍 胡建華 吳華勇

目的 觀察神經調節輔助通氣在慢性阻塞性肺疾病急性加重（AECOPD）患者序貫治療中的療效。 方法 將28例AECOPD需要機械通氣的患者按照隨機數字表法分為壓力支持通氣（PSV）組15例和神經調節輔助通氣（NAVA）組13例，達到肺部感染控制（PIC）窗后拔管，PSV組予無創通氣（NIV）-PSV模式，NAVA組予NIV-NAVA模式進行無創序貫治療，監測兩組患者達到PIC窗時間、血氣分析、無創序貫時間、48h再插管率、ICU入住時間。結果 經過機械通氣治療后兩組患者呼吸頻率，心率以及血氣等指標明顯改善。NAVA組達到PIC窗的時間較PSV組更短（P＜0.05）。NIV-NAVA組與NIV-PSV組比較，無創序貫時間縮短（P＜0.05），ICU入住時間減少（P＜0.05）。NIV-NAVA組48h再插管率低于NIV-PSV組，但差異無統計學意義。結論 相比PSV，NAVA能夠更早到達PIC窗，減少有創機械通氣時間，NAVA序貫治療較PSV能夠縮短無創序貫時間以及ICU入住時間。

慢性阻塞性肺疾病急性加重 序貫機械通氣 肺部感染控制窗 神經調節輔助通氣

【 Abstract】 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)-PSVand 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 PSVfor AECOPD patients.

【 Key words】 Acute exacerbation of chronic obstructive pulmonary disease Sequential mechanical ventilation Pulmonary infection control window Neurally adjusted ventilatory assist

慢性阻塞性肺疾病急性加重（AECOPD）合并呼吸衰竭常需要機械通氣治療，在國內80%~90%的AECOPD是由支氣管-肺部感染引起，以肺部感染控制（pulmonary infection control，PIC）窗為切換點實施序貫通氣能比較準確地判斷早期拔管時機，改善治療效果[1]。神經調節輔助通氣（neurally adjusted ventilatory assist，NAVA）是一種全新的通氣模式，具有改善人機協調，減少呼吸肌做功，縮短機械通氣時間等優勢[2-4]。筆者旨在觀察NAVA在AECOPD患者序貫治療中的療效。

1 對象和方法

1.1 對象 選取我院ICU 2015年1月至2016年6月的AECOPD患者共28例，男19例，女9例，年齡58~80（69.00±6.28）歲。……