作者：牟志芳，张趁英，康秀文，李勇，沈叶菊，董跃福

单位：

1.222000江苏省连云港市第一人民医院重症医学科 2.222000江苏省连云港市第一人民医院呼吸与危重症医学科 3.222000江苏省连云港市第一人民医院关节外科 通信作者：张趁英，E-mail：sijienanjing@163.com

单位（英文）：

1.Department of Critical Medicine, Lianyungang First People's Hospital, Lianyungang 222000, China 2.Department of Respiratory and Critical Care Medicine, Lianyungang First People's Hospital, Lianyungang 222000, China 3.Department of Joint Surgery, Lianyungang First People's Hospital, Lianyungang 222000, China Corresponding author: ZHANG Chenying, E-mail: sijienanjing@163.com

关键词：

慢性阻塞性肺疾病; 急性加重; 神经调节辅助通气; 压力支持通气; 肺顺应性; 机械通气触发;

关键词（英文）：

Chronic obstructive pulmonary disease; Acute exacerbation; Neuromodulation assisted ventilation;Pressure support ventilation; Lung compliance; Mechanical ventilation trigger

中图分类号：

DOI：

10.12114/j.issn.1008-5971.2022.00.143

基金项目：

连云港市卫生计生科技项目（201812）

摘要：

目的 探讨神经调节辅助通气（NAVA）对慢性阻塞性肺疾病急性加重期（AECOPD）患者肺通气、肺顺应性及机械通气触发延迟时间的影响。方法 选取2016年5月至2021年2月连云港市第一人民医院收治的72例AECOPD患者作为研究对象，采用随机数字表法将其分为对照组和观察组，各36例。所有患者经口气管插管，连接呼吸机，对照组患者予以传统压力支持通气（PSV）模式，观察组患者予以NAVA模式，待患者自主呼吸试验通过后尝试撤机，撤机后转为无创辅助通气，若失败则继续有创机械通气。比较两组患者通气前及通气24 h后呼吸力学指标（吸气压力、气道峰压、平台压）及通气过程中呼吸力学指标[分钟通气量（VE）、吸入潮气量（VTi）、呼吸频率、膈肌电活动（EAdi）峰值]，通气前及通气24 h后肺顺应性，机械通气时间及机械通气触发延迟时间（包括吸气触发延迟时间和吸呼气切换延迟时间），并发症发生率。结果 通气24 h后，两组患者吸气压力、气道峰压、平台压分别低于本组通气前，且观察组低于对照组（P<0.05）；观察组患者通气过程中VE、VTi及EAdi峰值均低于对照组（P<0.05）。通气24 h后，两组患者肺顺应性分别低于本组通气前，且观察组低于对照组（P<0.05）。观察组患者机械通气时间、吸气触发延迟时间及吸呼气切换延迟时间均短于对照组（P<0.05）。对照组患者并发症发生率为11.1%（4/36），与观察组患者的8.3%（3/36）比较，差异无统计学意义（χ2=0.158,P=0.691）。结论 相较于PSV模式，NAVA模式能更有效地改善AECOPD患者呼吸力学指标，提高肺顺应性，缩短机械通气触发延迟时间，且安全性良好，临床应用前景较好。

英文摘要：

【Abstract】 Objective To explore the effects of neuromodulation assisted ventilation (NAVA) on respiratory mechanicsindexes, lung impedance compliance and delay time of mechanical ventilation trigger in patients with acute exacerbation of chronicobstructive pulmonary disease (AECOPD) . Methods A total of 72 patients with AECOPD who were admitted to LianyungangFirst People's Hospital from May 2016 to February 2021 were screened as the research subjects, they were divided into controlgroup and observation group using random number table method, with 36 cases in each group. All patients were intubated throughthe mouth and connected to the ventilator. The patients in the control group were given the traditional pressure support ventilation(PSV) mode, and the patients in the observation group were given the NAVA mode. After the patients passed the spontaneousbreathing test, they tried to withdraw the ventilator, and then switched to non-invasive auxiliary ventilation. If they failed, theycontinued to have invasive mechanical ventilation. The respiratory mechanical indexes (inspiratory pressure, peak airway pressureand plateau pressure) before ventilation and 24 hours after ventilation and respiratory mechanical indexes [minute ventilation (VE) ,inhalation tidal volume (VTi) , respiratory rate, electrical activity of the diaphragm (EAdi) peak value] during ventilation, lungimpedance compliance before ventilation and 24 hours after ventilation, mechanical ventilation time and delay time of mechanicalventilation trigger (including inspiratory trigger delay time and inspiratory expiratory switching delay time) , and the incidenceof complications were compared between the two groups. Results At 24 hours after ventilation, the inspiratory pressure, peakairway pressure and plateau pressure in the two groups were lower than those before ventilation, respectively, and those in theobservation group were lower than those in the control group (P < 0.05) . The VE, VTi and EAdi peak value in the observationgroup were lower than those in the control group (P < 0.05) . At 24 hours after ventilation, the lung impedance compliance in thetwo groups was lower than that before ventilation, respectively, and that in the observation group was lower than that in the controlgroup (P < 0.05) . The mechanical ventilation time, inspiratory trigger delay time and inspiratory expiratory switching delay time inthe observation group were shorter than those in the control group (P < 0.05) . There was no significant difference in the incidenceof complications between the control group and the observation group [11.1% (4/36) vs 8.3% (3/36) ;χ2 =0.158, P=0.691] .Conclusion Compared with PSV model, NAVA model can more effectively improve the respiratory mechanical indexes ofAECOPD patients, improve lung compliance, and shorten the delay time of mechanical ventilation trigger. It has good safety andgood clinical application prospect.

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