应用COPD模型比较系统泄漏对7款双水平正压呼吸机吸气触发同步的影响  

lnspiratory triggering synchronization of seven bilevel mechanical ventilators in pressure-support mode with different system leak： a comparative bench study

作　　者：陈宇清[1] 程克文[2] 周新[1] 

机构地区：[1]上海交通大学附属第一人民医院呼吸科,200080 [2]复旦大学附属华山医院,上海200431

出　　处：《国际呼吸杂志》2012年第24期1870-1875,共6页International Journal of Respiration

摘　　要：目的观察不同系统泄漏水平对7款不同型号双水平正压呼吸机的吸气触发同步性的影响。方法使用Hans Rudolph Series1101机械肺模拟器模拟慢性阻塞性肺疾病患者，设置顺应性为50ml／cmH2O，气道阻力为20cmHzO·L-1·s-1。吸气时间为1．0S，呼吸频率为15次／min。双水平正压呼吸机以压力支持通气模式运行，参数设置为15cmH2O的压力支持及5cmHzO的呼气末正压，后备通气频率为10次／min。收集在泄漏量为25～28L／rain和45～48L／min吸气触发阶段的通气参数。结果在低水平泄漏（25～28L／min）时，Vivo30出现较频繁的自动触发，降低泄漏量至14～15L／min后同步通气稳定；SmartairPlus和VENTImotion则出现触发失败而启用后备通气，增加吸气努力后改善，但吸气做功增加。随着泄漏增高，Vision、Synchrony、Flexo30和VPAPIII无需调整即能适应，VENTlmotion和SmartairPlus则需通过调整触发灵敏度来保持同步通气。Synchrony和VPAPⅢ的吸气触发压力和吸气做功最低，但呼吸机所提供的吸气流量偏小。结论7款双水平正压呼吸机均能提供同步通气，但吸气触发同步性各不相同。Vision和Flexo30能较好地适应高水平泄漏并无需调整设置，吸气触发同步性能优，且呼吸机能迅速提供相适应的吸气流量以达到预设吸气压力。Objective Pressure support ventilation （PSV） delivered by a bilevel device has become the standard technique of choice for noninvasive home ventilation. The present study was designed to compare the inspiratory triggering synchronization of seven bilevel ventilators under different conditions of system leak. Methods Ventilators were connected to a lung model （Hans Rudolph Series 1101 simulator）, the mechanics of which was set at a compliance of 50 ml/cm Hz O, an expiratory resistance of 20 cm H2O · L-1 ·s -1 , and a respiratory rate of 15 breaths/min （inspiratory time was 1.5 s）. All of the ventilators were set at 15 cm H2O pressure support and 5 cm H2O positive end-expiratory pressure. Tests were conducted at two level of leaks in the system. Trigger delay, trigger pressure and triggeassociated inspiratory workload were collected. Results At the leak level of 25-28 L/min, Breas Vivo 30 was unable to synchronize with the simulator, auto-triggering was occurred frequently. Missed efforts and back-up ventilation were observed in Weinmann VENTImotion and Airox Smartair Plus and needed adjustment of trigger effort. Significant differences in triggering were found among these machines. As the leak was increased （45-48 L/min）, Respironics Vision/Synchrony,Curative Flexo 30 and VPAP III ventilators were shown that no asynchrony even if the leak setting was changed. The inspiratory trigger pressure was lower in Synchrony and VPAP III ventilators, but the inflating flow was also decreased. Conclusions The Vision and Flexo 30 are the ventilators that require no adjustments as they adapt to increasing leaks. There are fewer inspiratory workload and higher inflating flow during the inspiratory phase, which is better suited for COPD patients＇ respiratory mechanics and inspiratory demand. Clinicians should be aware that in the presence of leaks, some ventilators require adjustments to improve patient-ventilator synchrony.

关 键 词：双水平正压呼吸机 压力支持 触发同步 

分 类 号：R318.6[医药卫生—生物医学工程]