非对称高流量鼻塞界面对COPD模型呼气末二氧化碳和呼气末正压影响的体外研究  

An in vitro study on the effects of an asymmetrical high-flow nasal cannula interface on end-tidal carbon dioxide and positive end-expiratory pressure in COPD models

作　　者：李海超[1] 赵宇 李萌 孙兵 王睿[1] Li Haichao;Zhao Yu;Li Meng;Sun Bing;Wang Rui(Beijing Institute of Respiratory Medicine,Department of Respiratory and Critical Care Medicine,Beijing Chao-Yang Hospital,Capital Medical University,Beijing 100020,China)

机构地区：[1]首都医科大学附属北京朝阳医院呼吸与危重症医学科,北京呼吸疾病研究所,北京100020

出　　处：《国际呼吸杂志》2024年第12期1392-1400,共9页International Journal of Respiration

基　　金：北京市属医院科研培育项目(PX2023010);北京市呼吸疾病研究所改革与发展项目(Ggyfz202413)。

摘　　要：目的探讨使用非对称高流量鼻塞界面对慢性阻塞性肺疾病(COPD)模型呼气末二氧化碳(ETCO_(2))和呼气末正压(PEEP)水平的影响。方法本研究为实验研究。将经鼻高流量氧疗(HFNC)设备、成人气道模型、模拟肺和CO_(2)气源相连接,在模型面部连接一个口鼻面罩以收集呼出的CO_(2)气体,并使用相应设备监测ETCO_(2)和PEEP水平。通过配套的模拟肺控制软件设置模拟肺的参数,模拟COPD患者的稳定期和加重期。比较在模拟的COPD稳定期和加重期状态下,使用不同鼻塞类别(对称鼻塞、单孔鼻塞和非对称鼻塞)、不同流速(0、10、20、30、40、50、60、70 L/min)和不同呼吸频率(25、30、35次/min)条件下,ETCO_(2)和PEEP水平的变化,并使用多元线性回归分析ETCO_(2)和PEEP的影响因素。结果当流速为40 L/min和50 L/min时,COPD稳定期模型中非对称鼻塞的ETCO_(2)水平最低,对称鼻塞的ETCO_(2)水平最高,单孔鼻塞居中(均P<0.05);当流速为10、20、40、50、60、70 L/min时,COPD加重期模型中非对称鼻塞的ETCO_(2)水平最低,对称鼻塞的ETCO_(2)水平最高,单孔鼻塞居中(均P<0.05);随着HFNC流速的增加,ETCO_(2)水平逐渐下降,在较低流速时,ETCO_(2)水平下降较为显著,而在较高流速时,ETCO_(2)水平下降趋于平缓。当流速为20、30、40、50、60、70 L/min时,COPD稳定期模型中对称鼻塞的PEEP水平最高,单孔鼻塞的PEEP水平最低,非对称鼻塞居中(均P<0.01);当流速为10、20、30、40、50、60、70 L/min时,COPD加重期模型中对称鼻塞的PEEP水平最高,单孔鼻塞的PEEP水平最低,非对称鼻塞居中(均P<0.01);随着HFNC流速的增加,PEEP水平逐渐升高。在COPD加重期模型中,使用非对称鼻塞,相同流速情况下,将呼吸频率分别调节至25、30、35次/min,结果显示ETCO_(2)和PEEP水平在呼吸频率35次/min时最高,呼吸频率25次/min时最低,呼吸频率30次/min时居中(均P<0.05)。随着流速的增加,不同呼吸频率间�Objective This study aims to investigate the effects of asymmetrical high-flow nasal cannula interface on end-tidal carbon dioxide(ETCO_(2))and positive end-expiratory pressure(PEEP)levels in chronic obstructive pulmonary disease(COPD)models.Methods This was an in vitro experimental study.The high-flow nasal cannula oxygen therapy(HFNC)device,adult airway model,simulated lung,and a CO_(2)source were connected.An oronasal mask was attached to the face of the model to collect exhaled CO_(2),and an appropriate equipment was used to monitor the levels of ETCO_(2)and PEEP.The parameters of the simulated lung were set using dedicated control software to simulate the stable and exacerbation phases of COPD.Changes in ETCO_(2)and PEEP levels were compared under simulated stable and exacerbation conditions of COPD using various nasal cannula types(symmetric,single-lumen,and asymmetric),various flow rates(0 L/min,10 L/min,20 L/min,30 L/min,40 L/min,50 L/min,60 L/min,and 70 L/min),and respiratory rates(25 breaths/min,30 breaths/min,and 35 breaths/min).Multivariate linear regression analysis was used to identify the factors influencing ETCO_(2)and PEEP levels.Results At flow rates of 40 L/min and 50 L/min,in the COPD stable-phase model,the highest ETCO_(2)was obtained in the symmetric nasal cannula,followed by the single-lumen nasal cannula and asymmetric nasal cannula(all P<0.05).At flow rates of 10 L/min,20 L/min,40 L/min,50 L/min,60 L/min,and 70 L/min,in the COPD exacerbation-phase model,the highest ETCO_(2)level was obtained in the symmetric nasal cannula,followed by the single-lumen nasal cannula and the asymmetric nasal cannula(all P<0.05).With increasing HFNC flow rates,ETCO_(2)levels gradually decreased.The decline in ETCO_(2)was more significant at lower flow rates,whereas at higher flow rates,the decrease plateaued.At flow rates of 20 L/min,30 L/min,40 L/min,50 L/min,60 L/min,and 70 L/min,in the COPD stable-phase model,the PEEP levels were the highest with the symmetric nasal cannula,followed by the asymmetric nasal

关 键 词：肺疾病 慢性阻塞性 非对称鼻塞 经鼻高流量氧疗 呼气末二氧化碳 呼气末正压 

分 类 号：R56[医药卫生—呼吸系统]