无创神经调节辅助通气在慢性阻塞性肺疾病伴呼吸衰竭患者治疗中的应用
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摘要
目的探究无创神经调节辅助通气(NIV-NAVA)在慢性阻塞性肺疾病(COPD)伴呼吸衰竭患者治疗中的应用效果。方法 80例COPD伴呼吸衰竭患者按随机数字表分为试验组和对照组各40例,入院后均给予基础支持治疗,试验组、对照组分别予NIV-NAVA、NIV-人机协调通气。记录脱机成功率、人机不同步事件发生情况及通气治疗前后血气分析结果。结果与对照组相比,试验组直接脱机成功率、最终脱机成功率明显高,ICU住院时间明显缩短(P<0.05)。与对照组相比,试验组无效触发、自动触发、双触发次数明显低,触发延迟时间明显短,人机对抗发生率明显低(P<0.05)。治疗后血气指标中pH值、动脉血氧分压(PaO2)明显升高,动脉血二氧化碳分压(PaCO2)明显降低,但试验组PaO2升高幅度及PaCO2降低幅度明显大于对照组(P<0.05)。结论在NIV-NAVA治疗COPD伴呼吸衰竭过程中,人机协调性好,脱机成功率高,有助于改善气体交换效果。
Objective To investigate the efficacy of non-invasive ventilation with neurally adjusted ventilatory assist(NIV-NAVA) in the treatment of patients with chronic obstructive pulmonary disease(COPD) and respiratory failure. Methods Eighty COPD patients with respiratory failure were randomly divided into the study group and the control group(n=40 each). Basic supportive care and non-invasive ventilation(NIV) were given after admission. The study group and the control group were given NIV-NAVA and NIV with pressure support ventilation. The rate of successful weaning, occurrence of asynchrony and blood gas before and after ventilation were recorded. Results Compared with the control group, the study group showed significantly higher direct and totalrates of successful weaning,and shorter length of ICU stay(P<0.05). Compared with the control group, the study group showed significantly less ineffective triggers, autotriggers, and double triggers, with shorter trigger delay time and less patient-ventilator asynchrony(P<0.05). After treatment, the p H value and arterial oxygen partial pressure(PaO2) increased and the arterial carbon dioxide partial pressure(PaCO2) decreased significantly in the both groups. However, the increasesin PaO2 and the reductions in PaCO2 were significantly greater in the study group compared with the control group(P <0.05).Conclusion For treatment of COPD with respiratory failure, NIV-NAVA yields better patient-ventilator synchrony and higher success rate of weaning, and helps to improve the gas exchange.
Objective To investigate the efficacy of non-invasive ventilation with neurally adjusted ventilatory assist(NIV-NAVA) in the treatment of patients with chronic obstructive pulmonary disease(COPD) and respiratory failure. Methods Eighty COPD patients with respiratory failure were randomly divided into the study group and the control group(n=40 each). Basic supportive care and non-invasive ventilation(NIV) were given after admission. The study group and the control group were given NIV-NAVA and NIV with pressure support ventilation. The rate of successful weaning, occurrence of asynchrony and blood gas before and after ventilation were recorded. Results Compared with the control group, the study group showed significantly higher direct and totalrates of successful weaning,and shorter length of ICU stay(P<0.05). Compared with the control group, the study group showed significantly less ineffective triggers, autotriggers, and double triggers, with shorter trigger delay time and less patient-ventilator asynchrony(P<0.05). After treatment, the p H value and arterial oxygen partial pressure(PaO2) increased and the arterial carbon dioxide partial pressure(PaCO2) decreased significantly in the both groups. However, the increasesin PaO2 and the reductions in PaCO2 were significantly greater in the study group compared with the control group(P <0.05).Conclusion For treatment of COPD with respiratory failure, NIV-NAVA yields better patient-ventilator synchrony and higher success rate of weaning, and helps to improve the gas exchange.
引文
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[2]陆静,王艳梅,张美兰,等.延续护理对COPD伴呼吸衰竭患者BiPAP通气的影响[J].中华现代护理杂志,2017,23(29):3693-3698.
[3]蔡柏蔷.中华医学会呼吸病学分会慢性阻塞性肺疾病学组工作会议纪要[J].中华结核和呼吸杂志,2010,33(9):715-717.
[4]张军,赵锐,徐杰,等.长期应用无创呼吸机联合吸氧对COPD伴慢性Ⅱ型呼吸衰竭患者的临床疗效分析[J].贵州医药,2016,40(11):1152-1153.
[5]贾建超,张文平,汪铮,等.神经调节辅助通气在人机同步性方面的应用进展[J].中华实用诊断与治疗杂志,2017,31(9):934-936.
[6] Demoule A,Clavel M,Rolland-Debord C,et al. Neurally adjusted ventilatory assist as an alternative to pressure support ventilation in adults:a French multicentre randomized trial[J]. Inten Care Med,2016,42(11):1-10.
[7]金秋,王宏飞,王勇强,等.神经调节辅助通气对慢性阻塞性肺疾病患者炎性反应及脱机的影响[J].中华急诊医学杂志,2015,24(5):530-535.
[8]王丹琼,罗建,熊晓华,等.无创神经调节辅助通气在AECOPD患者中的应用[J].中华医学杂志,2016,96(42):3375-3378.