高频喷射通气时喷射头位置对气道狭窄相关的肺内压上升的影响  

作　　者：Gerald C. Ihra Andreas Heid Thomas Pernerstorfer 周全红(译) 江伟(校) 

机构地区：[1]Department of Anesthesiology, Intensive Care Medicine and Pain Therapy,Medical University Vienna, Vienna [2]Department of Anesthesia andIntensive Care Medicine I, Klinikum Kreuzschwestern Wels, Wels, Austria

出　　处：《麻醉与镇痛》2013年第1期93-97,共5页Anesthesia & Analgesia

摘　　要：背景高频喷射通气 （high-frequency jet ventilation, HFJV）在某些情况下可以导致气道高压。本研究评估了喷射头与气道阻塞处之间的位置关系对气管一肺模型中气道峰压的影响。方法通过改变金属喷射器与模拟的喉气管狭窄处距离进行HFJV，测定肺内气道压峰值。结果当喷射器的喷嘴与模拟的狭窄处靠近时，肺内气道压峰值上升。即使喷射气流的参数不变，狭窄处直径进一步减小可以使气道峰压达到最大值。当喷射头在狭窄处前方8-10cm时，气道直径的减小并不使远端气道峰压上升。在所有的气流参数下（0．5-1．5bar驱动压和频率）都可以观察到这些结果。结论本项肺模型的研究表明将喷射头放在喉气管狭窄处的近端8cm可以防止与HFJV驱动压和气道狭窄程度相关的肺内气道峰压的变化。临床上在选择喷射头的位置时应该权衡有效通气需求和气压伤的风险。BACKGROUND： High-frequency jet ventilation （HFIV） can lead to high-airway pressures under certain conditions. In this laboratory study, we evaluated the influence of the injector＇s position relative to a fixed airway obstruction on peak pressures ina tracheal-lung model. METHODS： We administered HFIV via a metal jet injector at varying distances from connectors simulating laryngotracheal airway stenosis. Peak pressures were measured inside the lung model. RESULTS： When the jet nozzle was near the simulated stenosis, peak pressure within the test lung increased and reached a maximum when the stenosis＇ lumen decreased despite unchanged parameters of iet gas flow. With the injector＇s tip placed 8 -10 an in front of the stenosis, reduction of airway diameter did not result in an increase of distal peak pressures. These observations were similar for all settings of gas flow （0.5 - 1.5 bar driving pressure） and frequencies. CONCLUSIONS： This study in a lung model suggests that placing an injector more than 8 an proximal to a laryngotracheal stenosis will prevent changes in intrapulmonary pressure related to the degree of stenosis or driving pressure during HFIV. The location of the injector chosen for dinical care should balance the need for effective ventilation with the risk of barotrauma.

关 键 词：高频喷射通气 气道狭窄 肺内压 喉气管狭窄 气道峰压 头位 HFJV 位置关系 

分 类 号：R563.805[医药卫生—呼吸系统]