不同腹腔压对神经调节辅助通气中膈肌电活动和潮气量的影响

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摘要目的：探究神经调节辅助通气（NAVA）中的膈肌电活动（EAdi）及潮气量于不同腹腔压（IAP）时的变化情况，为临床通气参数设置提供参考。方法：选取2015年1月至10月在衢州市人民医院ICU病房机械通气患者44例，入选标准为年龄＞18岁，呼吸末正压（PEEP）通气在3～5 cmH2O（1 cmH2O=0.098 kPa）并且预
测通气时间≥72 h的患者。通过膀胱注入0.9%氯化钠溶液的方法间接测量出IAP，每次间隔6 h，依据国际腹腔间隙综合征学会（WSACS）对高IAP的定义将12 mmHg（1 mmHg=0.133 kPa）设定为分界线，区分高腹内压和非高腹内压。经鼻放置EAdi导管于每小时测定EAdi值，同时记录潮气量。结果：高腹内压组EAdi值[（5.8±0.7）μV]显著低于非高腹内压组[（6.8±0.6）μV]，差异有统计学意义（P＜0.05），高腹内压组潮气量[（9.6±1.3）mL/kg]显著高于非高腹内压组[（8.8±1.0）mL/kg]，差异有统计学意义（P＜0.05）。结论：NAVA中，高IAP时，EAdi数值降低，潮气量增多；非高IAP时，EAdi数值升高，潮气量减少。

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关键词 ：肺通气, 腹腔压, 潮气量, 膈肌电活动

Abstract：Objective: To evaluate how IAP affects the EAdi and the tidal volume (VT) during NAVA was meaningful to set parameters of clinical ventilation. Methods: Forty-four patients in ICU were enrolled in this study. Inclusion criteria: over 18 years old adult who was going to use mechanical ventilation for over 72 hours at positive end-expiratory pressure (PEEP) 3-5 cmH2O (1 cmH2O=0.098 kPa). IAP was indirectly measured by injecting saline to bladder with 6 hours interval. The dividing line of high IAP and non-high IAP was set as 12 mmHg (1 mmHg=0.133 kPa) according to WSACS. By a EAdi catheter via nose EAdi was recorded with VT hourly. Results: EAdi was significant lower when IAP was over than 12 mmHg; and VT was significant higher when IAP was less than 12 mmHg. Conclusion: The changes of EAdi and VT under different IAP during NAVA: when IAP was high, EAdi decreases while VT increases and vice-versa.

Key words： pulmonary ventilation intra-abdominal pressure tidal volume electrical activity of the diaphragm

收稿日期: 2016-07-23

基金资助:浙江省医药卫生一般研究计划项目（2014KYB302）。

作者简介: 吴华勇（1978-），男，浙江衢州人，主治医师，硕士。

链接本文:

https://xb.wmu.edu.cn/CN/ 或 https://xb.wmu.edu.cn/CN/Y2017/V47/I3/225

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