新生儿无创神经辅助通气支持的临床应用

Non-invasive ventilation with neurally adjusted ventilatory assist in newborns

神经辅助通气(neurally adjusted ventilatory assist,NAVA)是呼吸的时间和程度都由患者控制的一种呼吸模式,持续监测患儿的呼吸节律,以膈肌电活动信号(electrical activity of diaphragm,Edi)作为辅助通气的信号,使得不考虑漏气时无创辅助通气的同步得以实现.无创NAVA的优势在于改善人机同步,可靠的呼吸监测,自主调节呼吸.理论上,这些优点使无创NAVA成为呼吸衰竭新生儿有效理想的呼吸支持方式.无创NAVA作为一种新兴的呼吸支持模式用于降低新生儿气管插管率,实现早期拔管,可作为一种新型的持续正压通气模式.

Neurally adjusted ventilatory assist(NAVA)is a mode of ventilation in which both the timing and degree of ventilatory assist are controlled by the patient.Since NAVA uses the diaphram electrical activity (Edi)as the controller signal,it is possible to deliver synchronized non-invasive NAVA(NIV-NAVA)regardless of leaks and to monitor continuously patient respiratory pattern.Advantages of NIV-NAVA over conventional modes include improved patient-ventilator interaction,reliable respiratory monitoring and self-regulation of re-spiratory support.In theory,these characteristics make NIV-NAVA an ideal mode to provide effective,appropri-ate non-invasive support to newborns with respiratory insufficiency.NIV-NAVA has been successfully used clini-cally in neonates as a mode of ventilation to prevent intubation,to allow early extubation,and as a novel way to deliver nasal continuous positive airway pressure.