神经调节辅助通气与压力支持通气时吸气努力中膈肌贡献的增加：一项肌电图研究。

Increased diaphragmatic contribution to inspiratory effort during neurally adjusted ventilatory assistance versus pressure support: an electromyographic study.

机构信息

From the Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMR_S 1158 "Neurophysiologie Respiratoire Expérimentale et Clinique," Paris, France (J.C., M.S., T.S.); INSERM, UMR_S 1158 "Neurophysiologie Respiratoire Expérimentale et Clinique," Paris, France (J.C., M.S., T.S.); AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie et Réanimation Médicale (Département "R3S"), Paris, France (M.S., A.D., T.S.); and UMR_S 974, Inserm-Université Paris 6, Paris, France (A.D.).

出版信息

Anesthesiology. 2014 Nov;121(5):1028-36. doi: 10.1097/ALN.0000000000000432.

DOI:10.1097/ALN.0000000000000432

PMID:25208082

Abstract

BACKGROUND

Neurally adjusted ventilatory assist (NAVA), regulated exclusively by the electromyographic activity (EA) of the diaphragm (EAdi), could affect the distribution of neural drive to the various inspiratory muscles. The objective of this study was to compare EAdi, EA of the scalene (EAscal), and EA of the alae nasi (EAan), according to the ventilatory mode and assist level in 12 mechanically ventilated patients.

METHODS

Seven assist levels of pressure support ventilation (PSV) and NAVA were sequentially applied. EAdi, EAscal, and EAan were quantified and expressed as a percentage of their maximum values. The relative contributions of extradiaphragmatic muscles to inspiratory efforts were assessed by calculating EAscal/EAdi and EAan/EAdi ratios. Three assist levels for each of the two ventilatory modes that resulted in EAdi values of 80 to 100%, 60 to 80%, and 40 to 60% were assigned to three groups (N1, N2, and N3). Results are expressed as median and interquartile range.

RESULTS

EA of inspiratory muscles decreased during PSV and NAVA (P < 0.0001). Although EAdi remained constant within groups (P = 0.9), EAscal was reduced during NAVA compared with PSV in N1 and N3 (65% [62 to 64] and 27% [18 to 34] in NAVA vs. 90% [81 to 100] and 49% [40 to 55] in PSV, P = 0.007). Altogether, EAscal/EAdi and EAan/EAdi ratios were lower in NAVA than PSV (0.7 [0.6 to 0.7] and 0.7 [0.6 to 0.8] in NAVA vs. 0.9 [0.8 to 1.1] and 0.9 [0.7 to 1.1] in PSV, P < 0.05).

CONCLUSIONS

NAVA and PSV both reduced extradiaphragmatic inspiratory muscle activity, in proportion to the level of assistance. Compared with PSV, NAVA resulted in a predominant contribution of the diaphragm to inspiratory effort.

摘要

背景

神经调节辅助通气（NAVA）仅由膈肌肌电图（EAdi）调节，可能会影响到向各个吸气肌传递神经冲动的分布。本研究的目的是比较在 12 名机械通气患者中，根据通气模式和辅助水平，EAdi、斜角肌肌电图（EAscal）和鼻翼肌电图（EAan）的变化。

方法

依次施加七种压力支持通气（PSV）和 NAVA 的辅助水平。量化并以其最大数值的百分比表示 EAdi、EAscal 和 EAan。通过计算 EAscal/EAdi 和 EAan/EAdi 比值来评估膈外肌肉对吸气努力的相对贡献。两种通气模式下的三个辅助水平，EAdi 值分别为 80%至 100%、60%至 80%和 40%至 60%，分配给三组（N1、N2 和 N3）。结果以中位数和四分位间距表示。

结果

PSV 和 NAVA 期间吸气肌的 EA 降低（P<0.0001）。尽管 EAdi 在组内保持不变（P=0.9），但在 N1 和 N3 中，NAVA 期间的 EAscal 较 PSV 降低（65%[62 至 64]和 27%[18 至 34]在 NAVA 中，90%[81 至 100]和 49%[40 至 55]在 PSV 中，P=0.007）。总的来说，NAVA 中的 EAscal/EAdi 和 EAan/EAdi 比值低于 PSV（0.7[0.6 至 0.7]和 0.7[0.6 至 0.8]在 NAVA 中，0.9[0.8 至 1.1]和 0.9[0.7 至 1.1]在 PSV 中，P<0.05）。