在神经刺激辅助通风过程中监测隔膜力度
Andrea Castellvi-Font1,2,3, Idunn S Morris4,5,6,7, Francisco José Parrilla-Gómez1,2
1Critical Care Department, Critical Illness Research Group (GREPAC), Hospital del Mar, Hospital del Mar Research Institute (HMRI), Barcelona, Spain.
Critical care (London, England)
|December 24, 2025
概括
隔膜神经刺激辅助通风 (DNAV) 需要监测隔膜负荷. 减少气道压力-时间产物 (ΔPTPaw) 准确地量化了DNAV期间的呼吸肌力劳动,指导神经刺激定位.
科学领域:
- 机械通风机械通风机械通风
- 呼吸系统生理学 呼吸系统生理学
- 神经肌肉刺激是一种神经肌肉刺激.
背景情况:
- 隔膜神经刺激辅助通风 (DNAV) 在机械通风过程中增强心肺功能.
- 精确监测隔膜负荷对于有效的DNAV至关重要,以防止过度刺激或过度刺激.
研究的目的:
- 为了确定在隔膜神经刺激过程中气道压力-时间产物 (ΔPTPaw) 的减少是否可靠地反映了呼吸肌肉努力的强度.
- 为了验证 ΔPTPaw 作为对隔膜神经刺激定位的定量度量.
主要方法:
- STIMULUS试验的二次分析,涉及四个级别的隔膜神经刺激定位.
- 测量气道,食道和胃压力,以计算跨隔膜压力-时间乘积 (PTPdi) 和呼吸肌压力-时间乘积 (PTPmus).
- 计算 ΔPTPaw 作为非刺激和刺激呼吸之间的气道压力-时间乘积的差异;使用混合效应模型,布兰德-阿尔特曼和 ROC 曲线进行统计分析.
主要成果:
- ΔPTPaw与PTPdi (R2 = 0.82) 和PTPmus (R2 = 0.92) 显著相关,并具有良好的一致性.
- 增加的神经刺激导致更高的PTPdi和PTPmus,同时减少PTPaw.
- ΔPTPaw显示出在识别不足和过度的隔膜努力 (AUROC ≥ 0.86) 方面具有很好的区分能力.
结论:
- 气道压力-时间产量的减少 (ΔPTPaw) 作为DNAV期间隔膜负荷的可靠,非侵入性指标.
- 在机械通风患者中,ΔPTPaw可以有效指导隔膜神经刺激的定位.
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