无创神经调节辅助通气在AECOPD患者中的应用

Effect of non-invasive NAVA on the patients with acute exacerbation of chronic obstructive pulmonary disease

目的探讨无创的神经调节辅助通气模式（NIV-NAVA）对慢性阻塞性肺疾病急性发作（AECOPD）患者气体交换效果和人机协调性的影响。方法采用随机、前瞻研究40例ICU的AECOPD患者，达到无创通气指征后按照随机数字法分为无创人机协调通气（NIV．PSV）组（n=20）与NIV—NAVA组（n=20），分别记录无创通气前后30min的呼吸相关参数，血气，人机不同步事件，人机不同步指数。结果入组患者均完成无创通气。NIV-NAVA组相对于NIV—PSV组，能够获得相同的气体交换效果。NIV-NAVA组无效触发，自动触发以及双触发的发生均明显少于NIV-PSV组（P〈0．05），NIV—NAVA组触发延迟（112．7±15．1）与（62．2±8．9）ms、吸呼转换时间明显优于NIV—PSV组（188．0±39．2）与（73．0±18．3）ms（P〈0．001）。NIV—NAVA组发生AI〉10％明显少于NIV—PSV组（P〈0．05）。结论相比NIV-PSV，NIV-NAVA模式能够达到相同的气体交换效果，同时NIV—NAVA能够减少人机不同步事件的发生，降低人机不同步指数，从而改善人机协调性。

Objective To observe the effect of non-invasive neurally adjusted ventilatory assist （NIV-NAVA） on patient-ventilator synchrony and effect of gas exchange in patients with acute exacerbation of chronic obstructive pulmonary disease compared with NIV-pressure support ventilation （PSV）. Methods This was a prospective study of 40 patients with AECOPD given 30-min trials of NIV with NIV-PSV group （n = 20 ） and NAVA group （n = 20 ） in random order. Arterial blood gas analysis （ABGs）, main asynchrony events and asynchrony index were quantified. Results There were no significant difference between the two groups on effect of gas exchange （ P 〉 0. 05 ）. Main asynchrony events during NIV-NAVA including autotriggering, ineffective efforts and double triggering were less frequent than NIV-PSV （P 〈 0. 05 ）. The trigger delay in the NIV-NAVA group was markedly shorter than the NIV-PSV （62. 20 ±8. 91 vs 112. 65 ± 15.10） ms （ P 〈 0. 001 ）. The inspiratory/expiratory off-cycle delay was significantly shorter in the NIV-PSV group than that in the NIV-NAVA group （73. 00 ± 18.27 vs 187.95 ± 39. 24） ms （ P 〈 0. 001 ）. The occurrence of severe asynchrony （ AI 〉 10% ） was also less under NAVA （ P 〈 0.05 ）. Conclusions Both NIV-NAVA and NIV-PSV can improve gas exchange. As compared with NIV-PSV, NIV-NAVA can reduce main asynchrony events, improve patient-ventilator synchrony in patients with AECOPD.