压力支持通气时的双重触发与肺内气体异常移动--一项前瞻性生理学研究  

Pendelluft volume during double-triggered asynchronous breaths under pressure support ventilation:a prospective physiological study

作　　者：周益民 罗旭颖[1] 王玉妹[1] 何璇[1] 陈静然 王岩[1] 杨燕琳[1] 张琳琳 周建新[1] Zhou Yimin;Luo Xuying;Wang Yumei;He Xuan;Chen Jingran;Wang Yan;Yang Yanlin;Zhang Linlin;Zhou Jianxin(Department of Critical Care Medicine,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China)

机构地区：[1]首都医科大学附属北京天坛医院重症医学科,北京100070

出　　处：《中华危重病急救医学》2021年第6期680-685,共6页Chinese Critical Care Medicine

基　　金：北京市科技计划项目(Z161100000116081)。

摘　　要：目的探讨压力支持通气(PSV)时双重触发与肺内气体异常移动的关系。方法采用前瞻性观察性研究方法,选择2019年4月1日至2020年8月31日首都医科大学附属北京天坛医院重症医学科收治的全麻术后接受有创机械通气且模式为PSV的患者作为研究对象。采用电阻抗成像(EIT)对患者进行监测,同步采集患者气道压力-时间波形、流速-时间波形、总体及各个分区的阻抗值-时间波形进行离线分析。测量吸气初肺内气体异常移动的容积,并将其定义为钟摆容积。由经过培训的研究者进行双重触发的识别,观察正常呼吸和双重触发初次呼吸、双重呼吸和双重触发后正常呼吸的钟摆容积。根据双重触发的发生频次将患者分为重度(≥1次/min)和非重度双重触发组,比较两组患者各种类型呼吸的钟摆容积、呼吸力学参数以及临床转归的差异。结果共纳入40例患者,采集分析9711次呼吸,(243±63)呼吸/例,其中222次呼吸(占2.3%)被识别为双重触发,双重触发识别的Kappa一致性系数为0.964,95%可信区间(95%CI)为0.946-0.982。在222次双重触发中,有7次(占3.2%)无法测量钟摆容积,但EIT提示确实存在肺内气体异常移动现象。最终测量了215次双重触发的钟摆容积,同时还标识了400次有代表性的正常呼吸(每例患者随机选取10次正常呼吸)作为对照。与正常呼吸相比,在双重触发过程中,初次呼吸、双重呼吸和双重触发后正常呼吸的钟摆容积均明显升高〔mL:3.0(1.4,6.4)、8.3(3.6,13.2)、4.3(1.9,9.1)比1.4(0.7,2.8),均P<0.05〕。重度双重触发组患者正常呼吸的钟摆容积和双重呼吸的钟摆容积均明显高于非重度组〔mL:1.8(0.9,3.2)比1.1(0.5,2.1),P<0.001;8.5(3.9,13.4)比2.0(0.6,9.1),P=0.008〕,呼吸频率亦明显高于非重度组(次/min:20.9±3.5比15.2±3.7,P<0.001)。两组其余呼吸力学参数和主要临床转归指标比较差异均无统计学意义。结论在PSV通气过程中,Objective To investigate the relationship between double-triggering and abnormal movement of air in the lungs(pendelluft phenomenon)under pressure support ventilation(PSV).Methods A prospective observational study was conducted,postoperative patients admitted to department of critical care medicine of Beijing Tiantan Hospital,Capital Medical University from April 1,2019 to August 31,2020 and received invasive mechanical ventilation with PSV mode were enrolled.Electrical impedance tomography(EIT)monitoring was performed.Airway pressure-time,flow-time,global and regional impedance-time curves were synchronously collected and analyzed offline.The volume of abnormal movement of air in the lungs at the beginning of inspiration was measured and defined as pendelluft volume.Double-triggered breaths were identified by trained researchers.Pendelluft volume during double-triggering was measured including the first triggered breath,the double-triggered breath,and the breath immediately following the double-triggered breath.Pendelluft volume was also measured for normal breath during the study.According to the frequency of double-triggering,patients were divided into severe(≥1 time/min)and non-severe double-triggering group.Pendelluft volume,parameters of respiratory mechanics,and clinical outcomes between the two groups were compared.Results In 40 enrolled patients,a total of 9711 breaths[(243±63)breaths/patient]were collected and analyzed,among which 222 breaths(2.3%)were identified as double-triggering.The Kappa of interobserver reliability to detect double-triggering was 0.964[95%confidence interval(95%CI)was 0.946-0.982].In 222 double-triggered breaths,pendelluft volume could not be measured in 7 breaths(3.2%),but the pendelluft phenomenon did exist as shown by opposite regional impedance change at the beginning of double-triggered inspiration.Finally,pendelluft volume was measured in 215 double-triggered breaths.Meanwhile,400 normal breaths(10 normal breaths randomly selected for each patient)were identified as cont

关 键 词：压力支持通气 双重触发 电阻抗成像 钟摆现象 

分 类 号：R459.7[医药卫生—急诊医学]