神经调节辅助通气对急性呼吸窘迫综合征患者呼吸机相关膈肌功能障碍的影响

Effect of neuromodulatory assisted ventilation on ventilator-associated diaphragmatic dysfunction in patients with acute respiratory distress syndrome

目的探讨神经调节辅助通气对急性呼吸窘迫综合征(ARDS)患者呼吸机相关膈肌功能障碍的影响。方法选择驻马店市中心医院2013年6月至2017年6月收治的126例ARDS患者为研究对象,根据机械通气方式将患者分为定压控制通气组(n=40)、压力支持通气组(n=41)及神经调节辅助通气组(n=45);比较3组患者吸气触发延迟时间、吸/呼气切换延迟时间、无效触发率、机械通气时间、脱机成功率及治疗前后血清谷胱甘肽(GSH)、超氧化物歧化酶(SOD)、丙二醛(MDA)水平,并观察临床治疗效果。结果定压控制通气组和神经调节辅助通气组患者吸气触发延迟时间、吸/呼气切换延迟时间及无效触发率均显著低于压力支持通气组(P<0.05);神经调节辅助通气组患者无效触发率显著低于定压控制通气组(P<0.05),定压控制通气组与神经调节辅助通气组患者吸气触发延迟时间、吸/呼气切换延迟时间比较差异无统计学意义(P>0.05)。压力支持通气组、神经调节辅助通气组患者机械通气时间短于定压控制通气组(P<0.05)。压力支持通气组、定压控制通气组、神经调节辅助通气组患者脱机成功率分别为85.4%(35/41)、57.5%(23/40)、95.6%(43/45),压力支持通气组、神经调节辅助通气组患者脱机成功率高于定压控制通气组(P<0.05)。治疗前3组患者血清GSH、MDA、SOD水平比较差异无统计学意义(P>0.05)。治疗后3组患者血清GSH、MDA水平显著低于治疗前(P<0.05),SOD水平显著高于治疗前(P<0.05)。压力支持通气组、神经调节辅助通气组患者治疗后血清GSH、SOD水平显著高于定压控制通气组(P<0.05),MDA水平显著低于定压控制通气组(P<0.05)。压力支持通气组患者血清GSH、SOD、MDA水平与神经调节辅助通气组比较差异无统计学意义(P>0.05)。结论神经调节辅助通气较压力支持通气能明显提高人机同步程度,降低机体氧化应激水平,提高脱机成功率和临床治疗有效率。

Objective To investigate the effect of neuromodulatory assisted ventilation on ventilator-related diaphragmatic dysfunction in patients with acute respiratory distress syndrome(ARDS).Methods One hundred and twentysix cases of ARDS patients in the Central Hospital of Zhumadian City from June 2013 to June 2017 were selected as the research objects.According to the mechanical ventilation method,the patients were divided into the fixed-pressure control ventilation group(n=40),the pressure support ventilation group(n=41)and the neuromodulatory assisted ventilation group(n=45).The inspiratory trigger delay time,inhalation/exhalation switch delay time,ineffective trigger rate,mechanical ventilation time,successful rate of weaning from medical ventilator,and glutathione(GSH),superoxide dismutase(SOD)and malondialdehyde(MDA)levels before and after treatment were compared among the three groups,and the clinical effect was observed.Results The inspiration trigger delay time,suction/breath switch delay time and ineffective trigger rate of patients in the fixed-pressure control ventilation group and the neuromodulatory assisted ventilation group were significantly lower than those in the fixed-pressure control ventilation group(P<0.05).The ineffective triggering rate of patients in the neuromodulatory assisted ventilation group was significantly lower than that in the fixed-pressure control ventilation group(P<0.05),and there was no statistically significant difference in inspiration trigger delay time and suction/breath switch delay time between the fixed-pressure control ventilation group and the neuromodulatory assisted ventilation group(P>0.05).The mechanical ventilation time of patients in the pressure support ventilation group and the neuromodulatory assisted ventilation group was shorter than that in the fixed-pressure control ventilation group(P<0.05).The success rate of weaning from medical ventilator in the pressure support ventilation group,the fixed-pressure control ventilation group and the neuromodulatory assisted ventilation group was 85.4%(35/41),57.5%(23/40),and 95.6%(43/45),respectively.The success rate of weaning from medical ventilator in the pressure support ventilation group and the neuromodulatory assisted ventilation group was higher than that in the fixed-pressure control ventilation group(P<0.05).There was no significant difference in the level of GSH,SOD and MDA in the three groups before treatment(P>0.05).After treatment,the GSH and MDA levels in the three groups were significantly lower than those before treatment(P<0.05),and SOD level was significantly higher than that before treatment(P<0.05).The GSH and SOD levels after treatment in the pressure support ventilation group and the neuromodulatory assisted ventilation group were significantly higher than those in the fixed-pressure control ventilation group,(P<0.05),while MDA level was significantly lower than that in the fixed-pressure control ventilation group(P<0.05).There was no significant difference in the level of GSH,SOD and MDA between the pressure support ventilation group and the neuromodulatory assisted ventilation group(P>0.05).Conclusion The neuromodulatory auxiliary ventilation can significantly improve the degree of man-machine synchronization,decrease the oxidative stress,improve the success rate of weaning from medical ventilator and clinical treatment efficiency.