无创压力支持通气时气流阻塞对吸气流量指数及人机同步的影响研究  

Effect of airflow obstruction on inspiratory flow index and patient-ventilator synchronization in NI-PSV

作　　者：陈肇晖 袁越阳 常青 陈宇清 张海[3] 李锋 Chen Zhaohui;Yuan Yueyang;Chang Qing;Chen Yuqing;Zhang Hai;Li Feng(Shenzhen Resvent Medical Technology Co.,Ltd,Shenzhen 518102,China;School of Mechanical and Electrical Engineering,Hunan City University,Yiyang 413099,China;Department of Respiratory and Critical Care Medicine,Shanghai Chest Hospital Affiliated to Shanghai JiaoTong University,Shanghai 200030,China)

机构地区：[1]深圳融昕医疗科技有限公司,深圳518102 [2]湖南城市学院机械与电气工程学院,益阳413049 [3]上海交通大学附属胸科医院呼吸与危重医学科,上海200030

出　　处：《中国医学装备》2024年第12期44-49,共6页China Medical Equipment

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:探讨无创压力支持正压通气(NI-PSV)时气流阻塞对吸气流量指数和人机同步性的影响。方法:使用ASL5000型机械模拟肺系统模拟体重为70kg的半卧位健康成年人和慢性阻塞性肺疾病(COPD)患者,分别设置健康成年人模型、COPD患者轻度阻塞、中度阻塞和重度阻塞共4种模型。模拟肺系统静态顺应性(C_(st))为60ml/cmH_(2)O;气道阻力(R_(aw))健康成年人、COPD患者轻度阻塞、中度阻塞和重度阻塞模型分别为5.0、10.0、15.0和20.0 cmH_(2)O/(L·s);自主吸气努力(P_(mus))为5.0cmH_(2)O;吸气时间为1.6s,呼吸频率为15次/min。使用Respironics V60型呼吸机以自主与时间控制(S/T)模式运行,呼气末正压(PEEP)为5.0cmH_(2)O,调整吸气压力使呼吸机输出潮气量(V_(T))为7.0~8.0ml/kg。收集模拟肺输出的各项通气参数、呼吸做功变化并计算流量指数。结果:随着COPD患者模型气流阻塞的加重,吸气峰流量(PIF)和呼气峰流量(PEF)逐渐降低,且PEF略低于PIF,流量指数逐渐增大,吸气触发流量(Flow-trig)始终维持在6.0 L/min左右;重度阻塞模型的流量指数达到0.65,吸气触发延迟时间(T_(d))>400 ms,吸呼切换(C_(delay))由健康成年人模型的过早切换(-469.50±16.35)ms转为轻度延迟切换(207.2550±14.86)ms,两者差异有统计学意义(t=69.28,P<0.05)。COPD患者重度阻塞模型的自主吸气做功(WOB_(pat))和呼吸机做功(WOB_(tot))高于健康成年人、COPD患者轻度阻塞及中度阻塞模型,但吸气做功比(WOB_(pat/tot))低于其他3种模型,4种模型的3项指标比较,差异有统计学意义(F=2477.70、46960.87、51222.97,P<0.01)。结论:气流阻塞不仅会降低NI-PSV的峰值气流,改变气流形态及造成吸气流量指数增大,而且会增加呼吸做功,从而影响人机同步性。Objective:To observe and analyze the effect of airflow obstruction on the inspiratory flow index and patient-ventilator synchronization in non-invasive pressure support ventilation(NI-PSV).Methods:The ASL 5000 machine simulation lung system was used to simulate health adult on semi-recumbent position and patients with chronic obstructive pulmonary disease(COPD),whose body weights were 70 kg.The models of health adult,mild obstruction,moderate obstruction and severe obstruction were set.The static compliance(C_(st))of the simulated lung system was 60 mL/cmH_(2)O,and the airway resistance(R_(aw))values of health adult,COPD patients with mild obstruction,moderate obstruction and severe obstruction model were respectively 5.0,10.0,15.0 and 20.0 cmH_(2)O/(L*s),and the effort of spontaneous inhalation(P_(mus))was 5.0 cmH_(2)O,and the inspiratory time was 1.6s,and the respiratory rate was 15 times/min.Using the mode of spontaneous to time control(S/T)of Respironics V60 ventilator to operate,and the positive end-expiratory pressure(PEEP)was 5.0 cmH_(2)O.The output tidal volume(V_(T))of ventilator was controlled at 7.0-8.0 mL/kg through adjusted the inspiratory pressure.The output various ventilation parameters and the change of breathing work of the simulated lung were collected,and the flow index was calculated.Results:Peak inspiratory flow(PIF)and peak expiratory flow(PEF)were decreased gradually with the severity of airflow obstruction of models of COPD patients,which inspiratory triggering flow(Flow-trig)was always remained at approximate 6.0 L/min.The value of flow index of the model with severe obstruction reached to 0.65,and the delay time(T_(d))of inspiratory triggering was more than 400 ms.The switching between inhalation and exhalation was from premature cycling(-469.50±16.35)ms of health adult model to mildly delayed cycling(207.25±14.86)ms,and the difference of that was significant(t=69.28,P<0.05).The inspiratory work of breathing(WOB_(pat))and ventilator work(WOB_(tot))of severe obstruction model of COPD p

关 键 词：压力支持通气 流量指数 人机同步 慢性阻塞性肺疾病 无创通气 

分 类 号：R563.8[医药卫生—呼吸系统]