正压通气下呼吸道气阻与顺应性在线测算方法改进  

Improvement of Online Monitoring of Airway Resistance and Compliance under Positive Pressure Ventilation

作　　者：袁越阳 周理 解立新[2] 胡兴硕 黄皓轩 徐勤鹏 戴征 YUAN Yueyang;ZHOU Li;XIE Lixin;HU Xingshuo;HUANG HaoxuanXU Qinpeng;DAI Zheng(Innovation Base of Respiratory Diagnostic and Therapeutic Equipment,Hunan City University,Yiyang 413099,Hunan,China;Department of Respiratory and Critical Care Medicine,Chinese PLA General Hospital,Beijing 100853,China;Department of Research and Design,Hunan Micomme Medical Technology Co.,Ltd.,Changsha 410205,China)

机构地区：[1]湖南城市学院智能呼吸诊疗装备创新基地,湖南益阳413099 [2]中国人民解放军总医院呼吸与危重症医学部,北京100853 [3]湖南明康中锦医疗科技股份有限公司研发部,长沙410205

出　　处：《医用生物力学》2022年第6期1114-1118,共5页Journal of Medical Biomechanics

基　　金：国家重点研发计划项目(2021YFC0122500);湖南省教育厅重点研究项目(19A093);湖南省自然科学基金项目(2020JJ4159)。

摘　　要：目的 采用气道正压对患者进行通气治疗,实现对通气患者呼吸道气阻(resistance,R)和顺应性(compliance,C)在线测算。方法 当呼气末气流为0时,在呼气支持压(expiratory positive airway pressure, EPAP)之上叠加1个负脉冲气压,使肺内气压在该脉冲期间高于体外气压,从而向外泄放气流,并对该泄放气流进行处理来测算R和C。然后以正常成人、典型急性呼吸窘迫综合征(acute respiratory distress syndrome, ARDS)患者和慢性阻塞性肺疾病(chronic obstructive pulmonary disease, COPD)患者为实验对象,建立仿真实验平台,进行仿真实验来测算R和C。结果 所测算的正常成人R和C误差分别为3.398%和-3.288%,COPD患者R和C误差分别为1.265%和-1.348%,ARDS患者R和C误差分别为3.400%和-3.286%。结论 气道正压通气下,采用呼气末叠加1个负脉冲气压在EPAP上来测算R和C的方法具有良好的可行性,研究结果为智能调控通气、精准通气等技术打下坚实基础。Objective To realize the online estimation of airway resistance(R) by applying positive airway pressure in ventilation treatment. Methods At the end of expiration when the airflow was zero, with a negative pulse pressure superposed upon the expiratory positive airway pressure(EPAP), a discharged airflow in the airway was produced, and the R and C were calculated with the discharged airflow. Then, taking the simulated normal adult, typical patients with acute respiratory distress syndrome(ARDS) and patient with chronic obstructive pulmonary disease(COPD) as experimental subjects, a simulated platform was established and the simulation experiments were conducted to calculate R and C. Results The errors in R and C were 3.398% and-3.288% for the simulated normal adult, 1.265% and-1.348% for the simulated patient with COPD, 3.400% and-3.286% for the simulated patient with ARDS, respectively. Conclusions The method with a negative pulse pressure superposed upon the EPAP to conduct the R and C is well practicable. This study lays solid foundation for the technology of intelligent and precision ventilation.

关 键 词：机械通气 气道正压 呼吸道气阻 肺顺应性 

分 类 号：R318.01[医药卫生—生物医学工程]