麻醉期间神经调节通气辅助的可行性：大型动物模型中两种麻醉剂的随机交叉研究。
Neurally adjusted ventilatory assist feasibility during anaesthesia: A randomised crossover study of two anaesthetics in a large animal model.
作者信息
Jalde Francesca Campoccia, Jalde Fredrik, Sackey Peter V, Radell Peter J, Eksborg Staffan, Wallin Mats K E B
机构信息
From the Department of Anesthesiology, Surgical Services and Intensive Care Medicine, Karolinska University Hospital, Solna; Department of Physiology and Pharmacology, Karolinska Institute, Stockholm (FCJ); Maquet Critical Care (FJ); Department of Anesthesiology, Surgical Services and Intensive Care Medicine, Karolinska University Hospital, Solna; Department of Physiology and Pharmacology, Karolinska Institute (PVS); Department of Physiology and Pharmacology, Section for Anesthesiology and Intensive Care Medicine (PJR); Department of Women's and Children's Health (SE); Department of Physiology and Pharmacology, Section for Anesthesiology and Intensive Care Medicine, Karolinska Institute, Stockholm; Maquet Critical Care, Solna, Sweden (MKEBW).
出版信息
Eur J Anaesthesiol. 2016 Apr;33(4):283-91. doi: 10.1097/EJA.0000000000000399.
BACKGROUND
Spontaneous breathing during mechanical ventilation improves gas exchange by redistribution of ventilation to dependent lung regions. Neurally adjusted ventilatory assist (NAVA) supports spontaneous breathing in proportion to the electrical activity of the diaphragm (EAdi). NAVA has never been used in the operating room and no studies have systematically addressed the influence of different anaesthetic drugs on EAdi.
OBJECTIVES
The aim of this study was to test the feasibility of NAVA under sedation and anaesthesia with two commonly used anaesthetics, sevoflurane and propofol, with and without remifentanil, and to study their effects on EAdi and breathing mechanics.
DESIGN
A crossover study with factorial design of NAVA during sedation and anaesthesia in pigs.
SETTING
University basic science laboratory in Uppsala, Sweden, from March 2009 to February 2011.
ANIMALS
Nine juvenile pigs were used for the experiment.
INTERVENTIONS
The lungs were ventilated using NAVA while the animals were sedated and anaesthetised with continuous low-dose ketamine combined with sevoflurane and propofol, with and without remifentanil.
MAIN OUTCOME MEASURES
During the last 5 min of each study period (total eight steps) EAdi, breathing pattern, blood gas analysis, neuromechanical efficiency (NME) and neuroventilatory efficiency (NVE) during NAVA were determined.
RESULTS
EAdi was preserved and normoventilation was reached with both sevoflurane and propofol during sedation as well as anaesthesia. Tidal volume (Vt) was significantly lower with sevoflurane anaesthesia than with propofol. NME was significantly higher with sevoflurane than with propofol during anaesthesia with and without remifentanil. NVE was significantly higher with sevoflurane than with propofol during sedation and anaesthesia.
CONCLUSION
NAVA is feasible during ketamine-propofol and ketamine-sevoflurane anaesthesia in pigs. Sevoflurane promotes lower Vt, and affects NME and NVE less than propofol. Our data warrant studies of NAVA in humans undergoing anaesthesia.
背景
机械通气期间自主呼吸通过将通气重新分布至下垂肺区来改善气体交换。神经调节通气辅助（NAVA）根据膈肌电活动（EAdi）按比例支持自主呼吸。NAVA从未在手术室中使用过，且尚无研究系统地探讨不同麻醉药物对EAdi的影响。
目的
本研究旨在测试在使用两种常用麻醉药七氟醚和丙泊酚进行镇静和麻醉的情况下，联合或不联合瑞芬太尼时NAVA的可行性，并研究它们对EAdi和呼吸力学的影响。
设计
一项在猪镇静和麻醉期间对NAVA进行析因设计的交叉研究。
地点
2009年3月至2011年2月期间，瑞典乌普萨拉的大学基础科学实验室。
动物
九只幼猪用于实验。
干预措施
在动物使用持续低剂量氯胺酮联合七氟醚和丙泊酚进行镇静和麻醉时，使用NAVA进行肺通气，联合或不联合瑞芬太尼。
主要观察指标
在每个研究期的最后5分钟（共八个步骤），测定NAVA期间的EAdi、呼吸模式、血气分析、神经机械效率（NME）和神经通气效率（NVE）。
结果
在镇静和麻醉期间，七氟醚和丙泊酚均可使EAdi得以保留并实现正常通气。七氟醚麻醉时的潮气量（Vt）显著低于丙泊酚麻醉时。在联合或不联合瑞芬太尼麻醉期间，七氟醚麻醉时的NME显著高于丙泊酚麻醉时。在镇静和麻醉期间，七氟醚麻醉时的NVE显著高于丙泊酚麻醉时。
结论
在猪中，NAVA在氯胺酮-丙泊酚和氯胺酮-七氟醚麻醉期间是可行的。七氟醚可使Vt降低，且与丙泊酚相比，对NME和NVE的影响较小。我们的数据为在接受麻醉的人类中研究NAVA提供了依据。
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