[神经调节通气辅助在先天性心脏病心脏手术患儿中的应用]

[Application of neurally adjusted ventilatory assist in infants who underwent cardiac surgery for congenital heart disease].

作者信息

Zhu Li-Min, Shi Zhen-Ying, Ji Gang, Xu Zhuo-Ming, Zheng Jin-Hao, Zhang Hai-Bo, Xu Zhi-Wei, Liu Jin-Fen

机构信息

Department of Cardiothoracic Vascular Surgery, Shanghai Children's Medical Center, Medical College of Shanghai Jiaotong University, Shanghai 200127, China.

出版信息

Zhongguo Dang Dai Er Ke Za Zhi. 2009 Jun;11(6):433-6.

PMID:19558804

Abstract

OBJECTIVE

Neurally adjusted ventilatory assist (NAVA) is a new mode of mechanical ventilation that delivers ventilatory assist in proportion to neural effort. This study aimed to compare the hemodynamic safety, oxygenation and gas exchange effects ventilated with NAVA and with pressure support ventilation (PSV) in infants who underwent open-heart surgery.

METHODS

Twenty-one infants who underwent open-heart surgery for congenital heart disease (mean age 2.9+/- 2.1 months and mean weight 4.2+/- 1.4 kg) were enrolled. They were ventilated with PSV and NAVA for 60 minutes respectively in a randomized order. The hemodynamic, oxygenation and gas exchange effects produced by the two ventilation modes were compared.

RESULTS

Three cases failed to shift to NAVA because of the bilateral diaphragmatic paralysis after operation. In the other 18 cases, there were no significant differences in the heart rate (HR), systolic blood pressure (BPs) and central venous pressure (CVP) in the two ventilation modes. The PaO2/FiO2 (P/F) ratio in NAVA was slightly higher than in PSV, but there was no statistical difference. PaCO2 did not show significant differences in the two modes. The peak inspiratory pressure (PIP) and electrical activity of the diaphragm (EAdi) in NAVA were significantly lower than in PSV. The EAdi signal after extubation was higher in infants who needed reintubation or intervention of noninvasive mechanical ventilation than in those who were extubated successfully (30.0+/- 8.4 microV vs 11.1+/- 3.6 microV; P<0.01).

CONCLUSIONS

As the first study of application of NAVA in infants in China, this study shows that NAVA has the same homodynamic effects as PSV. However the PIP for maintaining the same level of PaCO2 in NAVA is significantly lower than that in the traditional PSV. Monitoring the EAdi signal after extubation may show the risks of reintubation or intervention of noninvasive mechanical ventilation.

摘要

目的

神经调节通气辅助（NAVA）是一种新型机械通气模式，可根据神经驱动按比例提供通气辅助。本研究旨在比较接受心脏直视手术的婴儿采用NAVA和压力支持通气（PSV）通气时的血流动力学安全性、氧合及气体交换效果。

方法

纳入21例因先天性心脏病接受心脏直视手术的婴儿（平均年龄2.9±2.1个月，平均体重4.2±1.4 kg）。他们以随机顺序分别接受PSV和NAVA通气60分钟。比较两种通气模式产生的血流动力学、氧合及气体交换效果。

结果

3例术后因双侧膈神经麻痹未能转换为NAVA通气。在其余18例中，两种通气模式下的心率（HR）、收缩压（BPs）和中心静脉压（CVP）无显著差异。NAVA模式下的动脉血氧分压/吸入氧分数值（PaO2/FiO2，P/F）略高于PSV模式，但无统计学差异。两种模式下的动脉血二氧化碳分压（PaCO2）无显著差异。NAVA模式下的吸气峰压（PIP）和膈肌电活动（EAdi）显著低于PSV模式。需要再次插管或接受无创机械通气干预的婴儿拔管后的EAdi信号高于成功拔管的婴儿（30.0±8.4 μV对11.1±3.6 μV；P<0.01）。