| Objective In this study,by comparison with conventional mechanical ventilation PSV, further study NAVA guide AECOPD patients weaning strategies and its mechanism, in order to new ideas for improve the human-machine coordination and the success rate of weaning of patients with respiratory failure. patients.Content To compare the effects of PSV and NAVA on respiratory mechanics, hemodynamics,gas exchange and synchronization index in patients with AECOPD Ⅲ-level; observing the correlation of NAVA model to improve AECOPD patients with inflammation and oxidative, and the combined application of weaning strategies and EAdi to guide patients weaning.Methods A total of 40 patients with mechanical ventilation treatment of AECOPD Ⅲ-level a comprehensive hospital intensive care unit(ICU) were enrolled for this study. Self-control method had given and each patient was randomly applied PSV and NAVA ventilation.The synchronization index and respiratory mechanics were compared between two ventilation modes.40 patients were randomly divided into PSV(n=20) or NAVA(n=20) mode according to “gender, age, APACHEⅡscore, medical history, PaCO2”five factors level adopt “the distribution of the imbalance index of minimum principle”, compared two groups of the successful rate of weaning, 48 h re-intubation rate and ICU length of stay. The level of C-reactive protein(CRP), serum amyloid A(SAA), human cartilage glycoprotein 39(YKL-40),triggering receptors expressed on myeloid cells-1(TREM-1), Tumor necrosis factor-alpha(TNF-α)in serum were measured by enayme-linked immunosorbent assay(ELSIA) at began ventilation 1 day, 3 day, 5 day, 7 day, and monitoring the concentration of procalcitonin(PCT) after ICU,and compared with the healthy control group. And compare two group of corresponding points the level of YKL-40, TREM-1 in broncho-alveolar lavage fluid(BALF) collected with Gibot method in unemployment of bronchoscope.Results 1.The inspiratory / expiratory off cycle delay and the trigger delay were significantly shorter in NAVA mode than that of PSV(P<0.001). The plateaupressure(P<0.05), the magnitude of EAdi(P<0.05), WOBp / WOBt(P<0.01) and the peak airway pressure were significantly lower in NAVA than in PSV mode.The ventilator frequency was significantly lower than the central respiratory frequency in PSV mode,(t=2.315,P=0.012). 2.There were no significant difference of leukocyte count, neutrophils percentage and PCT between NAVA group and PSV group(P>0.05), the fall concentration of blood CRP,SAA and TNF-α in NAVA group were significantly higher than PSV group(P<0.01),but the concentration of blood YKL-40 and TREM-1were no significant difference between NAVA group and PSV group(P>0.05). The fall concentration of BALF YKL-40 in NAVA group was significantly higher than PSV group(P<0.01), but the concentration of BALF TREM-1were no significant difference between NAVA group and PSV group(P>0.05); 3. NAVA group and PSV group the rate of final weaning showed no significant difference, but the rate of direct weaning was higher in NAVA group than in PSV group(P<0.05), and the rate of 48 h re-intubation was lower than PSV group(P<0.05). ICU length of stay was less than PSV group(P=0.031). The peak of EAdi in patients failed of direct weaning before first attempt off was significantly higher than other patients(P=0.002).Conclusions 1. Compared with the conventional mechanical ventilation PSV, NAVA can improve patient-ventilator synchrony with AECOPD,and reduce the patient work of breathing; 2. Compared with the conventional mechanical ventilation PSV, NAVA can relieve inflammation and oxidative stress of patients with AECOPD; 3. The EAdi monitoring of clinicians choose the weaning timing and assessment of the state of the respiratory muscles has a positive meaning. If NAVA could improve the ultimate rate of weaning in AECOPD patients needs further study. |
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