CAJ | 학술논문

目的观察神经调节辅助通气(NAVA)对改善慢性阻塞性肺疾病急性加重期(AECOPD)患者炎症及氧化应激状态的相关性,探讨NAVA模式相对于压力支持通气(PSV)模式在提高脱机成功率方面的影响.方法前瞻性观察研究,收集天津市第一中心医院重症监护病房(ICU) 2012年11月至2014年1月期间收治的40例进行机械通气治疗的AECOPDⅢ级患者,排除严重呼吸抑制或需要深度镇静、高位截瘫、神经肌肉病变等的患者,并根据“性别、年龄、APACHEⅡ评分、病史、PaCO2”五个因素水平按“不平衡指数最小的分配原则”随机分为PSV组和NAVA组,每组20例,比较两组脱机成功率、48 h再插管率及ICU住院天数,分别于开始通气第1天、第3天、第5天以及第7天时通过纤维支气管肺泡灌洗技术获取其支气管肺泡灌洗液(BALF)并抽取静脉血,采用酶联免疫吸附试验(ELISA)方法检测血清中C-反应蛋白(CRP)、血清淀粉样蛋白A (SAA)、人软骨糖蛋白-39 (YKL-40),并与纳入的25例健康体检者作为对照组比较;再比较两组相应时点BALF中YKL-40水平.计数资料采用x2检验,计量资料采用成组￡检验或重复测量方差分析,以P ＜0.05为差异具有统计学意义.结果 (1) NAVA组和PSV组中白细胞数、中性粒细胞比例变化均差异无统计学意义(P＞0.05),NAVA组血CRP和SAA质量浓度下降的幅度明显高于PSV组(P＜0.01),但两组间血YKL-40的质量浓度差异无统计学意义(P＞0.05); NAVA组BALF中YKL-40的质量浓度下降幅度明显高于PSV组(P＜0.01); (2) NAVA组与PSV组最终脱机成功率差异无统计学意义,但NAVA组直接脱机成功率高于PSV组(P=0.046),48 h内再插管率低于PSV组(P =0.032).NAVA组患者ICU住院天数低于PSV组(P=0.031),直接脱机失败患者首次试脱机前EAdi峰值显著高于其他患者(P =0.002).结论 NAVA能缓解AECOPD患者的炎症及氧化应激反应,最终提高患者的直接脱机成功率,减少ICU住院时间,但具体能否提高最终脱机成功率还需深入研究. 目的觀察神經調節輔助通氣(NAVA)對改善慢性阻塞性肺疾病急性加重期(AECOPD)患者炎癥及氧化應激狀態的相關性,探討NAVA模式相對于壓力支持通氣(PSV)模式在提高脫機成功率方麵的影響.方法前瞻性觀察研究,收集天津市第一中心醫院重癥鑑護病房(ICU) 2012年11月至2014年1月期間收治的40例進行機械通氣治療的AECOPDⅢ級患者,排除嚴重呼吸抑製或需要深度鎮靜、高位截癱、神經肌肉病變等的患者,併根據“性彆、年齡、APACHEⅡ評分、病史、PaCO2”五箇因素水平按“不平衡指數最小的分配原則”隨機分為PSV組和NAVA組,每組20例,比較兩組脫機成功率、48 h再插管率及ICU住院天數,分彆于開始通氣第1天、第3天、第5天以及第7天時通過纖維支氣管肺泡灌洗技術穫取其支氣管肺泡灌洗液(BALF)併抽取靜脈血,採用酶聯免疫吸附試驗(ELISA)方法檢測血清中C-反應蛋白(CRP)、血清澱粉樣蛋白A (SAA)、人軟骨糖蛋白-39 (YKL-40),併與納入的25例健康體檢者作為對照組比較;再比較兩組相應時點BALF中YKL-40水平.計數資料採用x2檢驗,計量資料採用成組￡檢驗或重複測量方差分析,以P ＜0.05為差異具有統計學意義.結果 (1) NAVA組和PSV組中白細胞數、中性粒細胞比例變化均差異無統計學意義(P＞0.05),NAVA組血CRP和SAA質量濃度下降的幅度明顯高于PSV組(P＜0.01),但兩組間血YKL-40的質量濃度差異無統計學意義(P＞0.05); NAVA組BALF中YKL-40的質量濃度下降幅度明顯高于PSV組(P＜0.01); (2) NAVA組與PSV組最終脫機成功率差異無統計學意義,但NAVA組直接脫機成功率高于PSV組(P=0.046),48 h內再插管率低于PSV組(P =0.032).NAVA組患者ICU住院天數低于PSV組(P=0.031),直接脫機失敗患者首次試脫機前EAdi峰值顯著高于其他患者(P =0.002).結論 NAVA能緩解AECOPD患者的炎癥及氧化應激反應,最終提高患者的直接脫機成功率,減少ICU住院時間,但具體能否提高最終脫機成功率還需深入研究.
목적 관찰신경조절보조통기(NAVA)대개선만성조새성폐질병급성가중기(AECOPD)환자염증급양화응격상태적상관성,탐토NAVA모식상대우압력지지통기(PSV)모식재제고탈궤성공솔방면적영향.방법 전첨성관찰연구,수집천진시제일중심의원중증감호병방(ICU) 2012년11월지2014년1월기간수치적40례진행궤계통기치료적AECOPDⅢ급환자,배제엄중호흡억제혹수요심도진정、고위절탄、신경기육병변등적환자,병근거“성별、년령、APACHEⅡ평분、병사、PaCO2”오개인소수평안“불평형지수최소적분배원칙”수궤분위PSV조화NAVA조,매조20례,비교량조탈궤성공솔、48 h재삽관솔급ICU주원천수,분별우개시통기제1천、제3천、제5천이급제7천시통과섬유지기관폐포관세기술획취기지기관폐포관세액(BALF)병추취정맥혈,채용매련면역흡부시험(ELISA)방법검측혈청중C-반응단백(CRP)、혈청정분양단백A (SAA)、인연골당단백-39 (YKL-40),병여납입적25례건강체검자작위대조조비교;재비교량조상응시점BALF중YKL-40수평.계수자료채용x2검험,계량자료채용성조￡검험혹중복측량방차분석,이P ＜0.05위차이구유통계학의의.결과 (1) NAVA조화PSV조중백세포수、중성립세포비례변화균차이무통계학의의(P＞0.05),NAVA조혈CRP화SAA질량농도하강적폭도명현고우PSV조(P＜0.01),단량조간혈YKL-40적질량농도차이무통계학의의(P＞0.05); NAVA조BALF중YKL-40적질량농도하강폭도명현고우PSV조(P＜0.01); (2) NAVA조여PSV조최종탈궤성공솔차이무통계학의의,단NAVA조직접탈궤성공솔고우PSV조(P=0.046),48 h내재삽관솔저우PSV조(P =0.032).NAVA조환자ICU주원천수저우PSV조(P=0.031),직접탈궤실패환자수차시탈궤전EAdi봉치현저고우기타환자(P =0.002).결론 NAVA능완해AECOPD환자적염증급양화응격반응,최종제고환자적직접탈궤성공솔,감소ICU주원시간,단구체능부제고최종탈궤성공솔환수심입연구.
Objective To observe the correlation between neutrally adjusted ventilatory assist (NAVA) mode and improvement of inflammation and oxidative stress in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD),and as well as to investigate the effects of NAVA mode versus pressure support ventilation (PSV) mode on improving the success rate of weaning advantages.Methods A total of 40 patients with AECOPD-Ⅲ supported by mechanical ventilation treatment admitted from November 2012 to January 2014 into intensive care unit (ICU) were enrolled for prospective study.The patients were randomly divided into PSV mode (n =20) and NAVA mode (n =20) according to "gender,age,APACHE Ⅱ score,medical history,PaCO2" of five factors and adopting "the principle of minimum distribution of the imbalance index".The comparisons of the successful rate of weaning,48 h re-intubation rate and length of ICU stay were made between two groups.The level of C-reactive protein (CRP),serum amyloid A (SAA),human cartilage glycoprotein 39 (YKL-40) in serum were measured by enzyme-linked immunosorbent assay (ELSIA) on the 1st day,3rd day,5th day and 7th day after initiation of mechanical ventilation,and results of these laboratory tests in patients were compared with those in healthy subjects of control group.And simultaneously,the broncho-alveolar lavage fluid (BALF) was collected with Gibot method by employment of optic fiber bronchoscope on the given days for detection of YKL-40,and levels of YKL-40 were compared between NAVA mode and PSV mode.Enumeration data were analyzed with x2 test,measurement data were analyzed with t test or repeated measures analysis of variance,and P ＜ 0.05 was considered to be significant.Results (1) There were no significant differences in leukocyte count and neutrophils percentage between NAVA mode and PSV mode (P ＞ 0.05).The magnitudes of decrease in concentrations of blood CRP and SAA in NAVA mode were significantly greater than those in PSV mode (P ＜ 0.01),but there was no significant difference in blood YKL-40 between NAVA mode and PSV mode (P ＞ 0.05).The magnitude of reduction in concentration of BALF YKL-40 in NAVA mode was significantly greater than that in PSV mode (P ＜0.01).(2) There was on significant difference in rate of final weaning between NAVA mode and PSV mode,but the rate of direct weaning was higher in NAVA mode than that in PSV mode (P =0.046),and the 48 h re-intubation rate was lower in NAVA mode than that in PSV mode (P =0.032).The length of ICU stay was shorter in NAVA mode than that in PSV mode (P =0.031).The peak of EAdi (electric activated diaphragma trigger) in 8 patients failing in direct weaning before first attempt was significantly higher than that in other patients with successful weaning patients (P =0.002).Conclusions NAVA mode can attenuate inflammation and oxidative stress in patients with AECOPD,and ultimately improve the rate of direct weaning and shorten the length of ICU stay.Further research is necessary to confirm the capability of NAVA mode for improving the ultimate rate of weaning in AECOPD patients.