在患者中使用自发通风模式,为右心室外流通道阻塞性先天性心脏病接受了正手术:一个交叉研究
Xiaolei Gong1, Limin Zhu1, Mingjie Zhang1
1Cardiac Intensive Care Unit, Department of Thoracic and Cardiovascular Surgery, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, 200127 Shanghai, China.
Reviews in cardiovascular medicine
|July 30, 2024
概括
在右心室外流通道阻塞性先天性心脏病 (RVOTO-CHD) 的手术后切换到像NAVA这样的自发通风模式可以改善心脏功能和呼吸机制. 需要进一步的试验来确认这些好处.
科学领域:
- 心血管外科心血管外科
- 儿童心脏病学 儿童心脏病学
- 呼吸系统生理学 呼吸系统生理学
背景情况:
- 患有右心室外流管阻塞性先天性心脏病 (RVOTO-CHD) 的患者通常需要进行正手术.
- 手术后的血液动力学管理对于改善这些患者的结果至关重要.
- 呼吸机设置可以显著影响危急病患者的心血管功能.
研究的目的:
- 为了评估改变通风模式对RVOTO-CHD手术后患者血液动力学的影响.
- 为了比较压力调节体积控制 (PRVC) 与压力支通风 (PSV) 和神经调节呼吸辅助 (NAVA) 等自发模式的疗效.
主要方法:
- 一项涉及31名RVOTO-CHD患者的研究,这些患者接受了正手术.
- 使用脉冲指示器连续心脏输出 (PiCCO) 技术进行血液动力学监测.
- 患者从PRVC模式转换为PSV和NAVA模式,按随机顺序进行心声回声检查.
主要成果:
- 与PRVC相比,自发通风模式 (PSV和NAVA) 改善了右心室心脏指数和收缩性.
- 在NAVA模式下,心脏指数,中风体积指数和全球终端透气指数显著改善.
- NAVA模式还降低了血管外肺水指数,改善了呼吸机制,包括降低了峰值吸气压和驱动压力.
结论:
- 自发通风模式,特别是NAVA,可以增强手术后RVOTO-CHD患者的右心血管动力学和呼吸机制.
- 需要进一步的随机对照试验来验证自发通风模式在这个患者群体中的好处.
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