递增呼气相阻力的呼吸应答及其对人机同步的影响  

Respiratory response to the progressing expiratory loading and its effect on patient-ventilator synchronization

作　　者：郑则广[1] 陈荣昌[1] 王鑫[1] 李寅环[1] 罗群[1] 刘杰[1] 江荣斌[1] 江梅[1] 钟南山[1] 

机构地区：[1]广州呼吸疾病研究所,广州医学院第一附属医院,510120

出　　处：《中华生物医学工程杂志》2008年第1期-,共5页Chinese Journal of Biomedical Engineering

基　　金：广东省自然科学基金，广东省科技厅科研项目，广东省科技厅团队项目

摘　　要：目的 观察不同呼气阻力下正常人呼吸力学的改变,了解呼气阻力对人机同步性的影响.方法9例正常人在呼气阻力分别为0、5、10和15 cm H2O时进行呼气相阻力呼吸运动,观察膈肌肌电图(EMGdi)、胃内压(Pgas)、食管内压(Peso)、跨膈压(Pdi)、口腔压(Pm)和流量(Flow)的动态变化.结果(1) 随着阻力的增加,吸气相Peso和Pm的谷值(NPeso-in和NPm-in)逐渐减低,Pgas的峰值(PPgas-in)没有变化;而呼气相时,Peso、Pm和Pgas的峰值(PPeso-ex、PPm-ex和PPgas-ex)则逐渐增高.(2)吸气前,随着呼气阻力的增加,Peso、Pgas和Pm的基础压力(BPeso、BPgas和BPm)均逐渐升高.(3)在没有阻力或低阻力时,Peso、Pm和Pdi开始时间均迟于EMGdi.随着阻力的增加,这种差值逐渐减少,且在10和15 cm H2O时,Peso和Pm出现时间早于EMGdi;随着阻力的增加,Pgas和Flow出现时间均比EMGdi迟,且Pgas出现时间有延迟的倾向.(4)随着呼气阻力的增加,从吸气峰流速(FPeak-in)、75%峰流速(F75%Peak-in)和25%峰流速(F25%Peak-in)各时刻点与出现呼气流量时刻的时间差逐渐增加,而以Tdif[F25%(Peak-in)](F25%Peak-in时刻点与出现呼气流星时刻的时间差)的延长最明显,有统计学意义(P<005).结论 存在呼气阻力时,吸气肌肉和呼气肌肉的活动均增强;当阻力较高时,腹肌的剧烈收缩将引起吸气前Peso和Pm升高,但没有影响吸气流速出现的时间;以峰流速的下降百分值作为吸气-呼气切换参数时,呼气阻力可引起呼气气流的延迟出现.Objective To observe the changes of respiratory mechanics of normal adults under the condition of expiratory load and investigate the effect of expiratory load on patient-ventilator synchronization.Methods Nine normal adults were asked to breath under the expiratory load of 0,5,10 and 15 cm H2O,and the diaphragmatic electromyography(EMGdi),gastral pressure(Pgas),esophageal pressure(Peso),mouth pressure(Pm),transdiaphramatic pressure(Pdi) and Flow were measured.Results (1)As the expiratory loading increased,the nadir of Peso and Pm became deeper,while the peak of Pgas did not increase during inspiration;and all the peak of Pgas,Peso and Pm increased during expiration. (2)As the expiratory loading increased,the basic pressure of Pgas,Peso and Pm just before the onset of inspiration increased. (3)The onset of Peso,Pm and Pdi was later than that of EMGdi in the condition of lower or no expiratory loading.As the expiratory loading increased,the time interval difference was decreased;and when the expiratory loading was 10 or 15 cm H2O,the onset of Peso and Pm was earlier than that of EMGdi. As the expiratory loading increased,the onset of Pgas and Flow was later than that of EMGdi and the time interval difference between Pgas and EMGdi tended to increase. (4)As the expiratory loading increased,the time from the peak of inspiratory Flow (Fpeak-in),F75%Peak-in or F25%Peak-in to the onset of expiration Flow increased and the changing of time interval difference between F25%Peak-in to the onset of expiration Flow increased much more(P<0.05).Conclusions Both the activity of inspiratory and expiratory muscle increase in the condition of expiratory loading. The expiratory loading may lead to the higher value of Peso and Pm just before the beginning of inspiration,but dose not delay the onset of Flow. Expiratory loading could lead to the delay of expiration.

关 键 词：膈 肌电描记术 阻力呼吸 人机同步性 

分 类 号：R459.6[医药卫生—治疗学]