不同连接介质对无创正压通气时CO2重复呼吸和吸入气氧浓度的影响  

Effect of different interfaces on FiO2 and CO2 rebreathing during noninvasive positive pressure ventilation

作　　者：鲁杰 孙宇涵[1] 张婷婷 李欣雨[1] 谭伟 代冰[1] LU Jie;SUN Yu-han;ZHANG Ting-ting;LI Xin-yu;TAN Wei;DAI Bing(Department of Respiratory Medicine, the First Affiliated Hospital of China Medical University, Shenyang 110001, China)

机构地区：[1]中国医科大学附属第一医院呼吸科,辽宁沈阳110001 [2]沈阳市第一人民医院

出　　处：《中国实用内科杂志》2019年第8期685-689,共5页Chinese Journal of Practical Internal Medicine

基　　金：国家自然科学基金(81770089)

摘　　要：目的比较10款连接介质对无创通气时CO2重复呼吸量(ViCO2)和吸入气氧浓度(FiO2)的影响。方法通过体外主动模拟肺模型,从最接近模拟肺出口处注入CO2,维持呼气末CO2分压在80 mmHg,模拟合并高碳酸血症的慢性阻塞性肺疾病患者接受无创正压通气治疗,并且通过连接介质上的小孔注入5 L/min O2,模拟无创正压通气时O2供给。同步采集管路中实时的压力、流速、O2浓度和CO2浓度,进行积分计算不同连接介质时FiO2和ViCO2,比较不同种类连接介质以及各款连接介质对于FiO2和ViCO2的影响,并且应用双变量相关分析比较两者的相关性。结果不同连接介质的内腔容积、漏气量、漏气位置都不尽相同,口鼻面罩和鼻罩的FiO2差异有统计学意义(P<0.05),分别为(39.81±9.06)%和(43.91±6.33)%,各款连接介质的FiO2差异有统计学意义(均P<0.05),4号面罩(费雪派克)的FiO2最低为(28.29±0.08)%,10号面罩(飞利浦伟康)的FiO2最高为(53.83±0.63)%。口鼻面罩和鼻罩的ViCO2差异无统计学意义(P=0.19),分别为(15.26±1.27)mL和(14.79±2.21)mL;各款连接介质的ViCO2差异有统计学意义(P<0.05);8号鼻罩(瑞思迈)的ViCO2最低为(12.48±0.29)mL,10号(飞利浦伟康)鼻罩的ViCO2最高为(18.38±0.31)mL。FiO2和ViCO2有显著相关性(r=0.41,P<0.05),一般线性方程为Y=14.51+1.82X(R^2=0.168)。结论不同连接介质对无创通气时FiO2和ViCO2有显著影响,FiO2和ViCO2呈正相关。Objective To investigate the effect of different interfaces on FiO2 and CO2 rebreathing(ViCO2) during noninvasive positive pressure ventilation. Methods The Active Servo Lung respiratory simulation system was used to simulate a hypercapnia COPD patient received NPPV through injection of CO2 gas from the place closest to the outlet of simulated lung to maintain end-tidal carbon dioxide partial pressure at 80 mmHg,and oxygen delivery during NPPV was simulated by means of injection of 5 L/min oxygen through the hole of interface. FiO2 and ViCO2 were integral calculated through the synchronous collect real-time pressure, flow rate, oxygen concentration and CO2 concentration. The effect of different type and models of interfaces on FiO2 and ViCO2 were compared, and the bivariate correlation analysis was applied to investigate the correlation of FiO2 and ViCO2. Results The inner volume, leak volume and leak position of different interfaces were different. The FiO2 of the oral-nasal mask and nasal mask were significantly different(P<0.05), which were(39.81±9.06)% and(43.91±6.33)%,respectively. The FiO2 of the different models of interfaces was significantly different(P<0.05), the FiO2 of the No.4 oral-nasal mask was the lowest(28.29±0.08)%, and the FiO2 of the No. 10 oral-nasal mask was the highest(53.83±0.63)%. The ViCO2 of the oral-nasal mask and nasal mask wasn’t significantly different(P=0.19), which was(15.26±1.27)mL and(14.79±2.21)mL, respectively. The ViCO2 of the different models of interfaces was significantly different(P<0.05), the FiO2 of the No.8 nasal mask was the lowest(12.48±0.29%), and the ViCO2 of the No. 10 nasal mask was the highest(18.38±0.31)%. There was a significant correlation between FiO2 and ViCO2(r=0.41, P<0.05), and the general linear equation was Y=14.51+1.82 X(R^2=0.168). Conclusion Different interfaces have significant effects on FiO2 and ViCO2 during NPPV,and FiO2 and ViCO2 are positively correlated.

关 键 词：连接介质 面罩 鼻罩 吸入气O2浓度 CO2重复呼吸 

分 类 号：R459.6[医药卫生—治疗学]