气流阻塞对面罩比例辅助通气时人机同步性和呼吸做功的影响  

Impact of airflow obstruction on patient-ventilator synchrony and work of breathing during facial mask proportional assisted ventilation

作　　者：卢刚 陈宇清 袁越阳 张海 李锋[2] 李兴旺[4] Lu Gang;Chen Yuqing;Yuan Yueyang;Zhang Hai;Li Feng;Li Xingwang(Department of Pulmonary and Critical Care Medicine,Shanghai Boai Hospital,Shanghai 200040,China;Department of Pulmonary and Critical Care Medicine,Shanghai Chest Hospital,Shanghai Jiao Tong University,Shanghai 200030,China;School of Mechanical and Electrical Engineering,Hunan City University,Yiyang 413099,Hunan,China;The Bio-X Institutes,Shanghai Jiao Tong University,Shanghai 200030,China)

机构地区：[1]上海博爱医院呼吸与危重医学内科,上海200031 [2]上海交通大学医学院附属胸科医院呼吸与危重医学科,上海200030 [3]湖南城市学院机械与电气工程学院,益阳413049 [4]上海交通大学Bio-X研究院,上海200030

出　　处：《中华生物医学工程杂志》2022年第4期374-380,共7页Chinese Journal of Biomedical Engineering

基　　金：上海交通大学"交大之星"医工交叉研究基金(YG2019ZDB08)。

摘　　要：目的观察面罩比例辅助通气(PAV)时气流阻塞严重程度对人机同步性和呼吸做功的影响。方法使用ASL 5000机械肺模拟器模拟慢性阻塞性肺疾病(COPD)患者, 系统顺应性(C_(rs))为50.0 ml/cmH_(2)O[弹性阻力(E_(rs))为20.0 cmH_(2)O/L]、气道阻力(R_(aw))分别为5.0、10.0和20.0 cmH_(2)O·L^(-1)·s^(-1)。吸气时间为1.6 s, 呼吸频率为15次/min。Respironics V60呼吸机在压力支持通气(PSV)时输出潮气量(VT)为7.0 ml/kg, PAV通气时流量辅助(FA)设置为5.0、10.0和20.0 cmH_(2)O·L^(-1)·s^(-1), 容量辅助(VA)为20.0~40.0 cmH_(2)O/L, 辅助比例为50%。呼气末正压(PEEP)为5.0 cmH2O, 后备通气频率为10次/min。收集在系统泄漏量为25~28 L/min时通气参数和呼吸做功的变化。结果随着Raw的增高, PAV通气时需要设置更高水平的VA, 才能维持与PSV相近的VT。PAV时的吸气峰流速(PIF)较PSV时稍低, 气道峰压(PIP)则略高, 呼气峰流速(PEF)差异无统计学意义(P>0.05)。随着气流阻塞的加重, 二种通气模式的吸气触发延迟时间(Td)和吸气至90%PIP的时间(T90%)均显著增大, Raw为20.0 cmH_(2)O·L^(-1)·s^(-1)时吸呼过早切换现象消失, PSV时的切换延迟时间(Cdelay)为(-20.25±7.29)ms, PAV时为(27.63±22.58)ms(P<0.001);二种通气模式下的呼吸做功比(WOB_(pat/tot))无统计学意义(P=0.179)。结论对于重度气流阻塞患者, PAV通气时中等水平FA联合高水平VA辅助, 才能提供与PSV相近的通气支持, 人机同步性和呼吸做功也与PSV相近。Objective To evaluate the impact of airflow obstruction severity on patient-ventilator synchrony and work of breathing(WOB)during facial mask proportional assist ventilation(PAV).Methods ASL5000 lung simulator was used to simulate the lung mechanics in patients with chronic obstructive pulmonary disease(COPD),set with a respiratory system compliance(C_(rs))of 50.0 ml/cmH_(2)O,a respiratory system elastance(E_(rs))of 20.0 cmH_(2)O/L,airway resistance(R_(aw))of 5.0,10.0 or 20.0 cmH_(2)O·L^(-1)·s^(-1),inspiratory time(TI)of 1.6 sec,and a breathing rate of 15 bpm.The ventilation was performed by using a Respironics V60 ventilator,set to a tidal volume(VT)of 7.0 ml/kg with pressure support ventilation(PSV);flow assist(FA)of 5.0,10.0,or 20.0 cmH_(2)O·L^(-1)·s^(-1),volume assist(VA)of 20.0 to 40.0 cmH_(2)O/L,and an assist proportion of 50%with PAV.The positive end-expiratory pressure(PEEP)was set to 5.0 cmH_(2)O,and the backup rate to 10 bpm.The changes in ventilatory parameters and WOB were measured when the system leaks reached 25-28 L/min.Results Along with increase in R_(aw),a higher value of preset VA was needed in PAV to maintain a similar VT as in PSV.Compared with PSV,the PAV presented with slightly lower peak inspiratory flow(PIF)and slightly higher peak inspiratory pressure(PIP),but comparable peak expiratory flow(PEF)(P>0.05).Along with more severe airflow obstruction,either PSV or PAV presented longer trigger delay time(Td)and time to 90% release of PIP(T90%).Premature cycling was no longer observed when the Raw reached 20.0 cmH_(2)O·L^(-1)·s^(-1).Cycling delay time(Cdelay)were(-20.25±7.29)ms during PSV and(27.63±22.58)ms during PAV(P<0.001).There was no significant difference in WOBpat/tot between PSV and PAV mode(P=0.179)in severe airflow obstruction model.Conclusion In patients with severe airflow obstruction,PAV offers comparable patient-ventilator synchrony and work of breathing,but requires moderate FA and higher VA to maintain similar ventilation support as in PSV.

关 键 词：肺疾病 慢性阻塞性 通气机 机械 肺通气 人机同步 

分 类 号：R563.9[医药卫生—呼吸系统]