徐芳芳 郑丽芳 王亚萍 张伟文

[摘要] 目的 分析神經调节辅助通气在慢性阻塞性肺疾病急性加重期（AECOPD）患者呼吸机撤离中的应用。方法 选取我院于2016年6月～2017年6月期间收治的164例AECOPD患者作为本次研究对象，随机将其平均分为研究组82例和对照组82例。其中，研究组予神经调节辅助通气模式治疗，对照组予压力支持通气模式治疗，通过人机同步性指标比较患者对人机同步性及呼吸负荷的影响，观察比较两组AECOPD患者治疗后脱机成功率以及呼吸力学指标的不同。 结果 研究组AECOPD患者的触发延迟时间、呼/吸气切换延迟时间明显短于对照组，且呼吸机通气频率显著低于中枢呼吸频率（P<0.05）；研究组AECOPD患者的呼吸力学指标Ppeak、Pplat、Eadi以及WOBp/WOBt显著低于对照组（P<0.05）；两组AECOPD患者治疗后最终脱机成功率相比无明显区别（P>0.05），但研究组患者的直接脱机成功率明显高于对照组（P<0.05）。 结论 NAVA能显著改善AECOPD患者人机协调性，应用NAVA的治疗效果较好，利于患者预后，在AECOPD患者呼吸机撤离中具有积极应用价值。

[关键词] 神经调节辅助通气；AECOPD患者；呼吸机撤离；价值与应用；压力支持通气

[中图分类号] R563.9 [文献标识码] B [文章编号] 1673-9701（2018）30-0097-04

[Abstract] Objective To analyze the use of neuromodulation assisted ventilation in ventilator evacuation in patients with acute exacerbation of chronic obstructive pulmonary disease（AECOPD）. Methods A total of 164 AECOPD patients who were admitted to our hospital from June 2016 to June 2017 were selected as the study subjects. They were randomly divided into study group and control group， with 82 cases in each group. The study group was treated with neuromodulation assisted ventilation mode， and the control group was treated with pressure support ventilation mode. The effects of patients on man-machine synchronism and respiratory load were compared by using man-machine synchronization index， and the difference of off-line success rate and respiratory mechanics between AECOPD patients in the two groups was observed and compared. Results The trigger delay time and call/inhalation switching delay time of AECOPD patients in the study group were significantly shorter than those of the control group， and the ventilator ventilation frequency was significantly lower than central respiratory frequency（P<0.05）. The respiratory mechanical indexes Ppeak， Pplat， Eadi and WOBp/WOBt of the AECOPD patients in the study group were significantly lower than those of the control group（P<0.05）. There was no significant difference in the final off-line success rate of AECOPD patients in the two groups（P>0.05）， but the success rate of the study group was significantly higher than that of the control group（P<0.05）. Conclusion NAVA can significantly improve the coordination of AECOPD patients. The therapeutic effect of NAVA was better， which was beneficial to the prognosis of patients， and hadpositive application value in the withdrawal of ventilators in AECOPD patients.

[Key words] Neuromodulation-assisted ventilation； AECOPD patients； Ventilator evacuation； Value and application； Pressure support ventilation

慢性阻塞性肺疾病是一种具有气流阻塞特征的慢性支气管炎和（或）肺气肿，可进一步发展为肺心病和呼吸衰竭的常见慢性疾病[1]。AECOPD为慢性阻塞性肺病的急性加重阶段，致残率和病死率很高，临床主要表现为发热、全身疲乏、心情压抑、呼吸不畅等，短期内患者病情会持续恶化，胸闷气短、咳嗽的症状会越来越严重，医生需要改变对AECOPD患者的常规用药，除了影响患者肺功能之外，还会引起全身性的炎症反应，使病情加重，造成恶性循环[2]。机械通气治疗是治疗AECOPD患者呼吸衰竭的主要手段，及早的成功撤机更有利于改善……