摘要
目的:探讨机械通气的脑损伤患者在压力支持通气（PSV）模式下支持过度的发生率及相关影响因素。方法:回顾性分析2017年6月至2019年7月期间北京天坛医院ICU收治的以PSV模式进行有创机械通气且进行食管压监测的成年脑损伤患者，运用软件（ICU-Lab 2.5软件包，KleisTEK，Bari，意大利）收集流量、气道压和食管压-时间波形数据，计算呼吸力学参数如吸气做功（WOB）、压力-时间乘积（PTP）等判定患者是否存在支持过度，统计支持过度发生率，分析支持过度和患者病情、呼吸机参数之间的相关性。其中，支持过度的定义1：食管PTP（PTPes）<50 cmH2O·s/min（1 cmH2O=0.098 kPa）或无效触发（IE）≥10%；定义2：WOB<0.3 J/L或IE≥10%，满足以上任意一项即认为存在支持过度。结果:在71例接受PSV模式进行有创机械通气的成年脑损伤患者中，共收集173条数据；按照支持过度的定义1和定义2，其发生率分别为53.5%（38/71）和76.1%（54/71）。伤及脑干与非伤及脑干的脑损伤患者支持过度的发生率比较，差异无统计学意义（P>0.05）。根据定义1，支持过度与压力支持水平（PS）相关；根据定义2，支持过度与PS、镇痛镇静药物的使用相关，差异均有统计学意义（均P<0.05）。支持过度患者与非支持过度患者的ICU住院时间、机械通气时间、气管切开率比较，差异均无统计学意义（P>0.05）。结论:接受PSV模式的脑损伤患者支持过度的发生率较高，与PS、镇痛镇静药物应用相关，需要针对这一特定人群进行监测与治疗。
Abstract
Objective:To investigate the prevalence and influence factors of over-assistance in brain-injured patients undergoing pressure support ventilation (PSV).Methods:Brain-injured patients with mechanical ventilation under PSV were retrospectively analyzed from June 2017 to July 2019 in the Intensive Care Unit of Beijing Tiantan Hospital. The data such as the flow, airway pressure, and esophageal pressure-time wave form were collected using the software (ICU-Lab 2.5 software package, KleisTek, Bari, Italy). The respiratory parameters such as WOB, PTP were calculated to determine whether the patient had over-assistance. Prevalence of over-assistance was counted, the relationship between over-assistance and patients’ conditions and ventilator settings. The clinical criteria for over-assistance were: PTPes<50 cmH2O·s/min (definition 1) or ineffective trigger ≥10%; or WOB<0.3 J/L or ineffective trigger ≥10% (definition 2).Results:A total of 173 data sets were collected from 71 patients receiving mechanical ventilation in PSV. According to the two definitions, the incidence of over-assistance was 53.5%(38/71) and 76.1%(54/71), respectively. There was no significant difference in the incidence of over-assistance among patients with different types of brain injury (P>0.05). According to the definition 1, over-assistance was correlated with pressure support (PS) (P<0.05). According to the definition 2, over-assistance was associated with PS, the use of analgesic and sedative drugs (all P<0.05). There were no significant difference in ICU stay, mechanical ventilation time and tracheotomy rate between over-assistance and without over-assistance patients (P>0.05).Conclusion:Brain-injured patients receiving PSV have a high incidence of over-assistance. The level of pressure support and analgesic and sedative strategies are associated with insufficient inspiratory effort indicating targeted monitoring and treatment for this specific population.
基金项目
首都临床诊疗技术研究及转化应用项目(Z201100005520050)
万方数据