[俯卧位或脊柱位对心脏手术后合并急性肺损伤的机械通气新生儿的影响]

[Effect of prone or spine position on mechanically ventilated neonates after cardiac surgery with acute lung injury].

作者信息

Zhu Li-min, Xu Zhuo-ming, Ji Gang, Cai Xiao-man, Liu Xin-rong, Zheng Jing-hao, Zhang Hai-bo, Shi Zhen-ying, 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

Zhonghua Yi Xue Za Zhi. 2010 May 11;90(18):1260-3.

PMID:20646599

Abstract

OBJECTIVE

To compare the efficacy and safety ventilated with pressure support ventilation (PSV) or neurally adjusted ventilatory assist (NAVA) in neonates undergoing open-heart surgery with acute lung injury (ALI) in spine and prone positions.

METHODS

Fifteen neonates with a mean age of (15 +/- 9) days and a mean weight of (3.5 +/- 0.6) kg underwent open-heart surgery with ALI from July to December in 2009 were enrolled in this study. After hemodynamic stabilization ventilated with pressure regulated volume control (PRVC-base), all cases were ventilated with PSV and NAVA both in spine (SP) and prone (PP) positions for 60 minutes in a randomized crossover trial respectively. The hemodynamics, blood gas analysis, airway pressure, electrical activity of diaphragm (EAdi) and asynchrony index (AI) during every mode were recorded.

RESULTS

The heart rate, systolic blood pressure and central venous pressure were stable in every mode. The peak inspiratory pressure and mean airway pressure in every mode had no significant difference but were significantly lower than in PRVC-base either in spine or prone position. The respiratory rate in PSV and NAVA with prone position was more rapid than in spine position and in PRVC-base (P < 0.05). But there was no significant difference in minute ventilation (MV) for each mode. The oxygenation index was higher in NAVA or PSV in both positions versus PRVC-base [(200 +/- 60) mm Hg in PRVC-base, (272 +/- 76) mm Hg in PSV-SP, (308 +/- 90) mm Hg in PSV-PP, (347 +/- 84) mm Hg in NAVA-SP and (365 +/- 87) mm Hg in NAVA-PP respectively, P < 0.01]. The oxygenation index was significantly higher in NAVA-PP than in PSV-SP (P < 0.05) while PaCO(2) was in normal range and had no significant difference for any mode. The minimal EAdi in NAVA-PP was significant lower than that in PSV-SP [(0.2 +/- 0.1) microV vs (0.5 +/- 0.2) microV, P < 0.05]. The AI of NAVA either in spine or in prone position was 0. It was significantly lower than that in PSV-SP [(21.5 +/- 4.8)%, P < 0.01] and PSV-PP [(22.4 +/- 3.4)%, P < 0.01].

CONCLUSION

Especially in a prone position, NAVA demonstrates a better synchrony in ALI neonates after cardiac surgery. It helps to provide a better oxygenation for the patients.

摘要

目的

比较压力支持通气（PSV）或神经调节通气辅助（NAVA）在脊柱位和俯卧位接受心脏直视手术并伴有急性肺损伤（ALI）的新生儿中的疗效和安全性。

方法

选取2009年7月至12月间15例平均年龄为（15±9）天、平均体重为（3.5±0.6）kg且伴有ALI的新生儿接受心脏直视手术。在血流动力学稳定后采用压力调节容量控制（PRVC模式）通气，之后所有病例在随机交叉试验中分别于脊柱位（SP）和俯卧位（PP）接受PSV和NAVA通气各60分钟。记录每种模式下的血流动力学、血气分析、气道压力、膈肌电活动（EAdi）和不同步指数（AI）。

结果

每种模式下心率、收缩压和中心静脉压均稳定。每种模式下的吸气峰压和平均气道压无显著差异，但在脊柱位或俯卧位均显著低于PRVC模式。PSV和NAVA在俯卧位时的呼吸频率比脊柱位及PRVC模式时更快（P<0.05）。但每种模式下的分钟通气量（MV）无显著差异。NAVA或PSV在两个体位时的氧合指数均高于PRVC模式[PRVC模式时为（200±60）mmHg，PSV-SP时为（272±76）mmHg，PSV-PP时为（308±90）mmHg，NAVA-SP时为（347±84）mmHg，NAVA-PP时为（365±87）mmHg，P<0.01]。NAVA-PP时的氧合指数显著高于PSV-SP（P<0.05），而PaCO₂在正常范围内，且各模式间无显著差异。NAVA-PP时的最小EAdi显著低于PSV-SP[（0.2±0.1）μV对（0.5±0.2）μV，P<0.05]。NAVA在脊柱位或俯卧位时的AI均为0，显著低于PSV-SP[（21.5±4.8）%，P<0.01]和PSV-PP[（22.4±3.4）%，P<0.01]。