NIV-PSV和NIV-NAVA对 AECOPD伴呼吸衰竭ICU病人脱机率及肺功能的影响比较

doi:10.3969/j.issn.1003-9198.2021.08.008

摘要/Abstract

摘要： 目的分析比较无创人机协调通气(NIV-PSV)和无创神经调节辅助通气(NIV-NAVA)对ICU急性加重期慢性阻塞性肺疾病(AECOPD)伴呼吸衰竭(呼衰)病人脱机率及肺功能的影响。方法回顾性分析我院ICU 86例行无创机械通气干预的AECOPD伴呼衰病人临床资料,分为NIV-NAVA组(32例)和NIV-PSV组(54例)。记录2组通气1 h后呼吸力学[气道峰值压力(Ppeak)、气道平台压(Pplat)、病人呼吸功(WOBp)]、人机同步性(触发延迟时间、切换延迟时间、无效触发率、人机不同步指数)及通气效率[死腔通气率(VD/VT)、功能残气量(FRC)],比较通气前及通气1 h后血气分析(PaO₂、PaCO₂)、通气前及通气7 d后肺功能[FVC、最大呼气流速(PEFR)]差异,并分析2组脱机成功情况及ICU住院时间。结果通气1 h后,NIV-NAVA组Ppeak、Pplat、WOBp及触发延迟时间、切换延迟时间、无效触发率、人机不同步指数、VD/VT、FRC均低于NIV-PSV组(P＜0.01);2组PaO₂均较通气前升高,PaCO₂较通气前降低(P＜0.05),且NIV-NAVA组较NIV-PSV组改变更明显(P＜0.05)。通气7 d后,2组FVC、PEFR均较通气前升高(P＜0.05),且NIV-NAVA组高于NIV-PSV组(P＜0.05)。NIV-NAVA组脱机成功率高于NIV-PSV组,且48 h内插管率及ICU住院时间低于NIV-PSV组(P＜0.05)。结论 NIV-NAVA通气模式在人机同步性、通气效率、肺保护方面均优于NIV-PSV,能使AECOPD伴呼衰病人成功脱机,并改善病人肺功能。

关键词: 急性加重期慢性阻塞性肺疾病, 呼吸衰竭, 无创人机协调通气, 无创神经调节辅助通气, 死腔通气率

Abstract: Objective To analyze and compare the effects of non-invasive patient-ventilator synchrony ventilation (NIV-PSV) and non-invasive neurally adjusted ventilatory assist (NIV-NAVA) on weaning rate and lung function in the patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) complicated with respiratory failure in the intensive care unit (ICU). Methods A retrospective analysis was performed on the clinical data of 86 patients with AECOPD and respiratory failure who underwent non-invasive mechanical ventilation intervention in the ICU of our hospital. Among them, 32 patients underwent NIV-NAVA ventilation (NIV-NAVA group), and 54 patients underwent NIV-PSV ventilation (NIV-PSV group). Respiratory mechanics [peak airway pressure (Ppeak), airway platform pressure (Pplat), patient work of breathing (WOBp)], patient-ventilator synchrony (trigger delay time, switching delay time, invalid trigger rate, patient-ventilator asynchrony index) and ventilation efficiency [dead space ventilation rate (VD/VT), functional residual capacity (FRC)] were recorded in the two groups after 1 h of ventilation. The blood gas analysis [arterial partial pressure of blood oxygen (PaO₂), partial pressure of carbon dioxide (PaCO₂)] before ventilation and 1 h after the ventilation,the lung function [forced vital capacity (FVC), peak expiratory flow rate (PEFR)] before ventilation and 7 d after the ventilation were observed and compared, and the success rate of weaning and ICU stay were analyzed in the two groups. Results After 1 h of ventilation, the Ppeak, Pplat, WOBp and trigger delay time, switching delay time, invalid trigger rate, patient-ventilator asynchrony index, VD/VT, and FRC in the NIV-NAVA group were significantly lower than those in the NIV-PSV group (P<0.01). The level of PaO₂was higher and the level of PaCO₂ was lower in the two groups than those before the ventilation (P<0.05), especially in the NIV-NAVA group (P<0.05). After 7 d of ventilation, the levels of FVC and PEFR in the two groups were significantly higher than those before the ventilation (P<0.05),especially in the NIV-NAVA group (P<0.05). The success rate of weaning in NIV-NAVA group was higher and the intubation rate within 48 h and ICU stay were lower than those in the NIV-PSV group (P<0.05). Conclusions NIV-NAVA ventilation model is superior to NIV-PSV in patient-ventilator synchrony, ventilation efficiency and lung protection. It can successfully wean in the AECOPD patients with respiratory failure and improve the lung function, with significant application value.

Key words: acute exacerbation of chronic obstructive pulmonary disease, respiratory failure, non-invasive patient-ventilator synchrony ventilation, non-invasive neurally adjusted ventilatory assist, dead space ventilation rate

中图分类号:

R 563.8

黄飞. NIV-PSV和NIV-NAVA对 AECOPD伴呼吸衰竭ICU病人脱机率及肺功能的影响比较[J]. 实用老年医学, 2021, 35(8): 820-824.

HUANG Fei. Comparison of NIV-PSV and NIV-NAVA on weaning rate and lung function in ICU patients with AECOPD complicated with respiratory failure[J]. Practical Geriatrics, 2021, 35(8): 820-824.

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