摘要
机械通气自引入临床实践以来,经历了从完全控制通气到各种辅助通气的重大演变,传统的呼吸机依靠气动压力、传感器和控制器来完成呼吸周期;而神经调节辅助通气(NAVA)作为一种近年来新兴起的辅助通气形式,通过监测膈肌电信号(EAdi)向患者提供适当比例的辅助支持水平。EAdi是感知呼吸中枢驱动进而触发呼吸机辅助送气的最佳可用信号。与其他通气模式不同,NAVA呼吸指令来源于中枢,因此NAVA具有良好的人机同步性和患者自主调节性。与传统通气模式相比,NAVA可以降低呼吸负荷,减轻呼吸肌相关性肺损伤(VILI),改善人机协调性,改善气体交换,提高脱机成功率等。本文就NAVA的研究进展进行综述,以期为临床应用提供理论指导。
Mechanical ventilation has,since its introduction into clinical practice,undergone a major evolution from controlled ventilation to diverse modes of assisted ventilation.Conventional mechanical ventilators depend on flow sensors and pneumatic pressure and controllers to complete the respiratory cycle.Neurally adjusted ventilatory assist(NAVA)is a new form of assisted ventilation in recent years,which monitors the electrical activity of the diaphragm(EAdi)to provide an appropriately level of pressure support.And EAdi is the best available signal to sense central respiratory drive and trigger ventilatory assist.Unlike other ventilation modes,NAVA breathing instructions come from the center.Therefore,NAVA have the synchronous nature of the breaths and the patient-adjusted nature of the support.Compared with traditional ventilation mode,NAVA can efficiently unload respiratory muscles,relieve the risk of ventilator-induced lung injury(VILI),improve patient-ventilator coordination,enhance gas exchange,increase the success rate of weaning,etc.This article reviews the research progress of NAVA in order to provide theoretical guidance for clinical applications.
作者
圣玉良
邵蔚
王雨豪
康秀文
胡蓉
Sheng Yuliang;Shao Wei;Wang Yuhao;Kang Xiuwen;Hu Rong(Department of Respiratory and Critical Care Medicine,the Affiliated Lianyungang Hospital of Xuzhou Medical University,Lianyungang 222000,Jiangsu,China;Jinzhou Medical University,Jinzhou 121000,Liaoning,China;Department of Critical Care Medicine,the Affiliated Lianyungang Hospital of Xuzhou Medical University,Lianyungang 222000,Jiangsu,China)
出处
《中华危重病急救医学》
CAS
CSCD
北大核心
2023年第11期1229-1232,共4页
Chinese Critical Care Medicine
基金
江苏省连云港市卫生计生科技项目(201812)。
关键词
神经调节辅助通气
膈肌电信号
研究进展
Neurally adjusted ventilatory assist
Electrical activity of the diaphragm
Research advance
