摘要
目的对比不同通气模式对呼吸机相关性膈肌功能障碍(VIDD)的影响。方法选择2022年1月至2024年1月贵州中医药大学第二附属医院90例行机械通气的患者为研究对象,按照随机数表法分为3组,每组30例。分别采用神经调节辅助通气(NAVA)、同步间歇指令通气(SIMV)、压力支持通气(PSV)机械通气模式,作为NAVA组、SIMV组、PSV组。对比3组人机同步性指标、氧化应激指标、膈肌功能、机械通气指标、撤机成功率及并发症发生情况。结果3组吸气触发延迟时间、吸/呼气切换延迟时间比较,NAVA组短于SIMV组和PSV组(P<0.05),SIMV组短于PSV组(P<0.05);3组无效触发率比较,NAVA组低于SIMV组和PSV组(P<0.05),SIMV组低于PSV组(P<0.05)。治疗后,3组丙二醛(MDA)水平均降低(P<0.05),超氧化物歧化酶(SOD)、谷胱甘肽(GSH)水平均升高(P<0.05)。治疗后,NAVA组MDA水平低于SIMV组和PSV组(P<0.05),SIMV组低于PSV组(P<0.05);NAVA组SOD、GSH水平高于SIMV组和PSV组(P<0.05),SIMV组高于PSV组(P<0.05)。治疗后,3组右侧膈肌增厚分数(DTF)、膈肌移动度(DE)均升高(P<0.05),且NAVA组高于SIMV组和PSV组(P<0.05),SIMV组高于PSV组(P<0.05)。NAVA组ICU入住时间、机械通气时间短于SIMV组和PSV组(P<0.05),SIMV组短于PSV组(P<0.05)。NAVA组和SIMV组脱机成功率高于PSV组(P<0.05),并发症总发生率低于PSV组(P<0.05)。结论NAVA机械通气模式能够减轻氧化应激损伤,缩短患者机械通气时间,撤机成功率高、并发症少,对膈肌功能影响小,优于SIMV、PSV模式。
Objective To compare the effects of different ventilation modes on ventilator-induced diaphragm dysfunction(VIDD).Methods Ninety patients undergoing mechanical ventilation at the Second Affiliated Hospital of Guizhou University of Chinese Medicine from January 2022 to January 2024 were enrolled and randomly divided into three groups(n=30 each)using a random number table.The groups received respectively:neurally adjusted ventilatory assist(NAVA),synchronized intermittent mandatory ventilation(SIMV),and pressure support ventilation(PSV),designated as NAVA,SIMV,and PSV groups.Comparisons included patient-ventilator synchronization,oxidative stress markers,diaphragm function,mechanical ventilation parameters,weaning success rate,and complications.Results The inspiratory trigger delay and inspiratory/expiratory switching delay in the NAVA group were significantly shorter than those in both the SIMV and PSV groups(P<0.05),and shorter in the SIMV group than in the PSV group(P<0.05).The ineffective triggering rate was significantly lower in the NAVA group than in both the SIMV and PSV groups(P<0.05),and lower in the SIMV group than in the PSV group(P<0.05).After treatment,malondialdehyde(MDA)levels significantly decreased(P<0.05)while superoxide dismutase(SOD)and glutathione(GSH)levels significantly increased(P<0.05)in all three groups.Post-treatment intergroup comparisons showed MDA levels in the NAVA group were significantly lower than in both the SIMV and PSV groups(P<0.05),and lower in the SIMV group than in the PSV group(P<0.05);SOD and GSH levels in the NAVA group were significantly higher than in both the SIMV and PSV groups(P<0.05),and higher in the SIMV group than in the PSV group(P<0.05).Diaphragmatic thickening fraction(DTF)and excursion(DE)significantly increased in all groups after treatment(P<0.05),with the NAVA group showing significantly higher values than both the SIMV and PSV groups(P<0.05),and the SIMV group significantly higher than the PSV group(P<0.05).ICU stay duration and mechanical ventilation time were significantly shorter in the NAVA group than in both the SIMV and PSV groups(P<0.05),and shorter in the SIMV group than in the PSV group(P<0.05).The weaning success rate was significantly higher in the NAVA and SIMV groups than in the PSV group(P<0.05),while the total complication incidence was significantly lower in the NAVA and SIMV groups than in the PSV group(P<0.05).Conclusion The NAVA mode reduces oxidative stress injury,shortens mechanical ventilation duration,achieves higher weaning success with fewer complications,and minimizes diaphragm dysfunction,outperforming SIMV and PSV modes.
作者
杜伟
张程
王晓松
DU Wei;ZHANG Cheng;WANG Xiaosong(Graduate School,Guizhou Medical University,Guiyang,Guizhou 550000,China;Emergency Department,Hongyan Campus,The Second Affiliated Hospital of Guizhou University of Traditional Chinese Medicine,Guiyang,Guizhou 550000,China)
出处
《转化医学杂志》
2025年第7期79-83,共5页
Translational Medicine Journal
基金
中国医学科学院(2019国家卫健委重点实验室)(2019PT320003)。
关键词
通气机
机械
膈肌功能障碍
通气模式
撤机成功率
并发症
Mechanical ventilator
Ventilator-induced diaphragm dysfunction
Ventilation modes
Weaning success rate
Complications
