内科

目的探讨无创神经调节辅助通气（NIV‑NAVA）对慢性阻塞性肺疾病急性加重（AECOPD）合并肺性脑病患者人机同步程度、氧化应激水平和气体交换效果的影响。方法选取102例AECOPD合并肺性脑病患者作为研究对象，随机将其分为机械通气（MV）组和NIV‑NAVA组，每组51例。MV组应用无创通气‑压力支持通气（NIV‑PSV）模式，NIV‑NAVA组应用NIV‑NAVA模式，两组均干预3 d。比较两组患者人机同步程度、氧化应激水平、气体交换效果，以及脱机成功率。结果 NIV‑NAVA组吸呼气切换延迟时间、吸气触发延迟时间均短于MV组（均P<0.05）。干预前，两组血清谷胱甘肽、超氧化物歧化酶（SOD）、丙二醛水平差异均无统计学意义（均P>0.05）；干预3 d后，两组血清谷胱甘肽、SOD水平均升高，且NIV‑NAVA组血清谷胱甘肽、SOD水平均高于MV组（均P<0.05）；两组血清丙二醛水平均降低，但差异无统计学意义（P>0.05）。干预前，两组动脉血氧分压（PaO2）、动脉血二氧化碳分压（PaCO2）水平差异均无统计学意义（均P>0.05）；干预3 d后，两组PaO2水平均升高，且NIV‑NAVA组PaO2均高于MV组，两组PaCO2水平均降低，且NIV‑NAVA组PaCO2低于MV组（均P<0.05）。NIV‑NAVA组最终脱机成功率（94.12%）高于MV组（70.59%）（P<0.05）。结论 NIV‑NAVA应用于AECOPD合并肺性脑病患者有助于增加人机同步程度，改善氧化应激反应，增强气体交换效果，提高脱机成功率。

Objective To investigate the effects of noninvasive ventilation with neurally adjusted ventilatory assist (NIV-NAVA) on the patient-ventilator synchrony degree, oxidative stress levels, and gas exchange effectiveness in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and pulmonary encephalopathy. Methods A total of 102 patients with AECOPD and pulmonary encephalopathy were selected as the study subjects and randomly divided into a mechanical ventilation (MV) group or an NIV-NAVA group, with 51 cases in each group. The noninvasive ventilation-pressure support ventilation (NIV-PSV) mode was applied in the MV group, and the NIV-NAVA mode was applied in the NIV-NAVA group, and both groups were intervened for 3 days. The patient-ventilator synchrony degree, oxidative stress levels, gas exchange effectiveness, and successful weaning rate were compared between the two groups. Results The cycling delay time of inspiratory and expiratory and inspiratory trigger delay time in the NIV-NAVA group were shorter than those in the MV group (all P<0.05). Before the intervention, there was no statistically significant difference in serum glutathione, superoxide dismutase (SOD), or malondialdehyde level between the two groups (all P>0.05). After 3 days of the intervention, the serum glutathione and SOD levels in the two groups increased, and the serum glutathione and SOD levels in the NIV-NAVA group were higher than those in the MV group (all P<0.05); the serum malondialdehyde levels in the two groups decreased (all P<0.05), but the difference between the two groups was not statistically significant (P>0.05). There was no statistically significant difference in the level of arterial partial pressure of oxygen (PaO2) or arterial partial pressure of carbon dioxide (PaCO2) between the two groups before the intervention (all P>0.05). After 3 days of the intervention, the levels of PaO2 in the two groups increased, and the PaO2 level in the NIV-NAVA group was higher than that in the MV group; the PaCO2 levels in the two groups decreased, and the PaCO2 level in the NIV-NAVA group was lower than that in the MV group (all P<0.05). The final successful weaning rate of the NIV-NAVA group (94.12%) was higher than that of the MV group (70.59%) (P<0.05). Conclusion The application of NIV-NAVA in patients with AECOPD and pulmonary encephalopathy contributes to increasing patient-ventilator synchrony degree, improving oxidative stress response, strengthening gas exchange effectiveness, and enhancing the final successful weaning rate.