密闭式延长管预防人工气道吸痰作业期间气道漏气的实验研究  

Effect of closed extension tube on preventing airway leakage during artificial airway clearance

作　　者：胡杰英[1] 刘妮[1] 江毓钊 郑森威 杨峰[1] 吴璐璐[1] 苏冠升 陈荣昌 郑则广[1] Jieying Hu;Ni Liu;Yuzhao Jiang;Senwei Zheng;Feng Yang;Lulu Wu;Guansheng Su;Rongchang Chen;Zeguang Zheng(State Key Laboratory of Respiratory Disease,National Clinical Research Center for Respiratory Disease,Guangzhou Institute of Respiratory Health,Department of Respiratory and Critical Care Medicine,the First Affiliated Hospital of Guangzhou Medical University,Guangzhou 510120,China;Department of Respiratory Medicine,Guangdong Hydropower Hospital,Guangzhou 511300,China;Shenzhen Institute of Respiratory Diseases,Department of Respiratory and Critical Care Medicine,Shenzhen People′s Hospital,Shenzhen 518001,China)

机构地区：[1]广州医科大学附属第一医院呼吸与危重症医学科广州呼吸健康研究院呼吸疾病国家重点实验室国家呼吸系统疾病临床医学研究中心,广州510120 [2]广东省水电医院呼吸内科,广州511300 [3]深圳市人民医院呼吸与危重症医学科深圳市呼吸疾病研究所,深圳518001

出　　处：《中华结核和呼吸杂志》2022年第11期1103-1108,共6页Chinese Journal of Tuberculosis and Respiratory Diseases

摘　　要：目的探讨密闭式延长管在人工气道吸痰作业期间预防气道漏气的作用。方法采用人工模肺连接呼吸机进行机械通气,呼吸回路中分别连接开放式延长管或密闭式延长管,呼吸机参数设置为16/5、20/6、24/7、28/8、32/9、36/10 cmH_(2)O(1 cmH_(2)O=0.098 kPa)六组递增压力,观察吸痰作业期间气道压力和潮气量的变化。结果(1)呼吸机参数设置在16/5~36/10 cmH_(2)O之间,连接开放式延长管机械通气回路的气道压力分别为(15.94±0.27)/(4.81±0.04)、(20.09±0.23)/(6.05±0.16)、(23.89±0.41)/(6.94±0.06)、(27.90±0.22)/(7.71±0.18)、(31.92±0.13)/(8.74±0.12)、(35.65±0.31)/(9.72±0.07)cmH_(2)O;相同参数下连接密闭式延长管机械通气回路的气道压力分别为(16.36±0.06)/(4.85±0.04)、(20.54±0.26)/(6.44±0.12)、(24.36±0.24)/(7.01±0.33)、(28.69±0.25)/(8.07±0.08)、(32.97±0.33)/(8.93±0.09)、(37.34±0.29)/(9.75±0.08)cmH_(2)O。连接开放式延长管机械通气回路的气道压力均低于连接密闭式延长管的(均P<0.05);随呼吸机设置压力的增加,两种延长管气道压力的差值逐渐增加,当呼吸机设置最高吸气压力为36 cmH_(2)O时,差值达到1.69 cmH_(2)O。(2)机械通气回路连接开放式延长管,吸痰作业拔插口开放时,通气回路的气道压力分别从(15.94±0.27)/(4.81±0.04)、(20.09±0.23)/(6.05±0.16)、(23.89±0.41)/(6.94±0.06)、(27.90±0.22)/(7.71±0.18)、(31.92±0.13)/(8.74±0.12)、(35.65±0.31)/(9.72±0.07)cmH_(2)O下降至(13.42±0.4)/(3.15±0.14)、(16.81±0.6)/(4.30±0.14)、(20.22±0.5)/(5.48±0.45)、(23.73±1.4)/(6.25±0.22)、(24.78±0.7)/(7.13±0.21)、(20.83±0.4)/(6.61±0.19)cmH_(2)O,(均P<0.05);潮气量分别从(0.328±0.004)、(0.580±0.012)、(0.621±0.003)、(0.626±0.003)、(0.615±0.003)、(0.603±0.002)L下降到(0.272±0.008)、(0.416±0.051)、(0.487±0.047)、(0.396±0.116)、(0.507±0.022)、(0.508±0.079)L(均P<0.05);随呼吸机设置的压力增加,通气回路的压力和潮气量下降幅度逐渐增加,Objective To explore the role of closed extension tube in preventing airway leakage during artificial airway clearance.Methods The test lung was connected with a ventilator for mechanical ventilation.The pressure parameters were set as 16/5,20/6,24/7,28/8,32/9 and 36/10 cmH_(2)O(1 cmH_(2)O=0.098 kPa),respectively.The circuit was connected with an open extension tube or a closed extension tube.The ventilator was set with different pressure parameters to observe the changes of airway pressure and tidal volume during airway clearance.Results(1)The pressure parameters were set as 16/5,20/6,24/7,28/8,32/9 and 36/10 cmH_(2)O,and the airway pressures(in cmH_(2)O)of circuit connected with open extension tube were(15.94±0.27)/(4.81±0.04),(20.09±0.23)/(6.05±0.16),(23.89±0.41)/(6.94±0.06),(27.90±0.22)/(7.71±0.18),(31.92±0.13)/(8.74±0.12)and(35.65±0.31)/(9.72±0.07),respectively.Under the same ventilator pressure parameters,the airway pressures(in cmH_(2)O)of circuit connected with close extension tube were(16.36±0.06)/(4.85±0.04),(20.54±0.26)/(6.44±0.12),(24.36±0.24)/(7.01±0.33),(28.69±0.25)/(8.07±0.08),(32.97±0.33)/(8.93±0.09),(37.34±0.29)/(9.75±0.08),respectively.The airway pressure of circuit connected with open extension tube was lower than that connected with closed extension tube(P<0.05);with the increase of the pressure setting of the ventilator,the difference of the airway pressure between the two extended tubes gradually increased.When the maximum inspiratory pressure of the ventilator was set 36 cmH_(2)O,the difference reached 1.69 cmH_(2)O.(2)The airway pressures(in cmH_(2)O)dropped from(15.94±0.27)/(4.81±0.04),(20.09±0.23)/(6.05±0.16),(23.89±0.41)/(6.94±0.06),(27.90±0.22)/(7.71±0.18),(31.92±0.13)/(8.74±0.12),(35.65±0.31)/(9.72±0.07)to(13.42±0.4)/(3.15±0.14),(16.81±0.6)/(4.30±0.14),(20.22±0.5)/(5.48±0.45),(23.73±1.4)/(6.25±0.22),(24.78±0.7)/(7.13±0.21),(20.83±0.4)/(6.61±0.19)when the suction port of the open extension tube was opened(P<0.05);and the tidal volume(in L

关 键 词：呼吸 人工 气道 压力 密闭式延长管 吸痰 

分 类 号：R459.7[医药卫生—急诊医学]