应用COPD模型比较不同呼气触发灵敏度设置对5款双水平正压呼吸机呼气同步的影响  

Inspiratory cycling-off synchronization of 5 bilevel mechanical ventilators during pressure-support mode in obstructive conditions with different expiratory triggering sensitivity

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,上海200080 [2]复旦大学附属华山医院宝山分院,上海200431

出　　处：《生物医学工程与临床》2014年第3期219-224,共6页Biomedical Engineering and Clinical Medicine

摘　　要：目的观察存在系统气体泄漏状态下不同呼气触发灵敏度（ETS）设置对5款不同型号双水平正压呼吸机的呼气切换同步性的影响。方法对5款双水平正压呼吸机[V60／Synchrony（Mutrysville，PA）、VENTImotion（Hamburg，Gerrnanv）、VPAPⅢST—A（NoahRyde，Australia）和Flexo ST30（Santa Clara，CA）]，使用机械肺模拟器模拟慢性阻塞性肺疾病（COPD）患者，设置顺应性（Crs）为60mL/0．098kPa（60mL/cmH2O）、气道阻力（Raw）为1．47kPa（15cmH2O）／（L·s）。吸气时间为1．0s．呼吸频率为15次／分。双水平正压呼吸机以压力支持通气（PSV）模式运行。参数为1．47kPa（15cmH2O）的压力支持及0．49kPa（5cmH2O）的呼气末正压，后备通气频率为10次／分。收集在泄漏量为20～22L／min时的通气参数。结果在ETS设置为最敏感时，VPAPUIST—A的潮气量（VT）和呼气峰流量（PEF）最低[（616．33±2．58）mL和（41．45±0．51）L／min]（P〈0．05），同时出现过早切换。VENTImotion的吸气末气道压（P1end）最高[（2．11±0．01）kPa（21．58cmH2O±0．15cmH2O）]，PEF也高达（64．97±0．27）L／min。虽然均采用自动触发／切换技术，Respironics V60与Synchronv的表现各不相同．Synchrony的VT和PIF均显著低于V60。随着ETS设置的改变，FlexoST30、VENTImotion和VPAPⅢST—A的吸气时间（T1）和VT均出现增加，PEF也逐渐增高，VPAPⅢST—A仍有过早切换现象。Flexo ST30在ETS设置为最不敏感时孔可高达4s，导致呼吸频率降低。结论5款双水平正压呼吸机均能提供同步通气．但呼气切换同步性各不相同。除VPAPⅢST—A外，其余4款机型均能较好地完成同步呼气切换：改变ETS水平会对呼气同步产生较明显影响．此时应及时调整通气参数，避免过早切换或严重的延迟切换的发生．Objective To compare the expiratory trigger sensitivity（ETS） synchronization of 5 models of bilevel positive pressure ventilator under the conditions of system leak. Methods Five models of bilevel ventilators[V60/Synchrony （Murrysville, PA）, VENTImotion（Hamburg, Germany）, VPAP III ST-A（North Ryde, Australia） and Flexo ST 30（Santa Clara, CA）] were enrolled and mechanical lung simulator was used to simulate the patients with chronic obstructive pulmonary disease （COPD）, setting the compliance（Crs） at 60 mL/0.098 kPa（60 mL/cmH2O） and the airway resistance（Raw） at 1.47 kPa （15 cmH2O）/（L·s）. The inspiratory time was 1.0 s, and respiratory rate was 15 /minutes. The bilevel positive pressure ventilator was run in pressure support ventilation（PSV） mode, with pressure support at 1.47 kPa（15 cmH2O）, positive end-expiratory pressure（PEEP） at 0.49 kPa （5 cmH2O）, and back-up ventilation frequency at 10 times/min. The data were collected under air leak levels ranging from 20 to 22 IJmin. Results At the most sensitive level of ETS, tidal volume（VT） and peak expiratory flow（PEF） of VPAP III ST-A were the minimum[（616.33 ± 2.58） mL and（41.45 ± 0.51） L/min]（P 〈 0.05）, and premature switching occurred. The end inspiratory airway pressure （P1 end） of VENTImotion was the maximum [（2.11 ± 0.01） kPa（21.58 emH2O ± 0.15 cmH2O）], and PEF reached at （64.97 ± 0.27） L/min. Both of Respironics V60 and Synchrony were adopted automatic trigger / switching technology, but VT and PIF of Synchrony were lower than those of V60. With the change of ETS, the inspiratioy time（T1） and VT of Flexo ST 30,VENTImotion and VPAP Ill ST-A increased, PEF also gradually inereased, but VPAP III ST-A still demonstrated some premature switehing. At the least sensitive of ETS, T1 of Flexo ST 30 reached 4-seeond, leading decreased respiratory frequency. Conclusion It is demonstrated that all the 5 bilevel positive airway pressure ventilators eould provide synch

关 键 词：双水平正压呼吸机 压力支持 模式切换 呼气同步 

分 类 号：R318.6[医药卫生—生物医学工程]