无创气道正压通气下呼气末测算气道阻力和胸肺顺应性实验研究
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1.湖南城市学院 机电工程学院;2.中国人民解放军总医院 呼吸与危重症医学部 北京;3.上海市胸科医院 呼吸内科;4.湖南明康中锦医疗科技发展有限公司

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Experimental Investigation on Calculating the Resistance and the Compliance of airway in the End of Expiration under Noninvasive Positive Airway Pressure Ventilation
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    摘要:

    目的 在使用正压呼吸机进行通气治疗时,患者气道阻力(R)和胸肺顺应性(C)的连续监测,是保障保证合理设置通气参数、减少呼吸机相关肺损伤(VALI)的关键之一。为此,本研究通过采用呼气末压力短暂释放的方式,测算无创正压通气(NPPV)条件下的气道阻力和胸肺顺应性,并评估其测算精度。方法 首先,将测算方法程序移植到NPPV呼吸机的控制器,设计基于主动模拟肺ASL5000的通气实验平台。然后,模拟正常成人【R=5 (cmH2O),C=50 [mL? (cmH2O) -1]】、急性呼吸窘迫综合征患者【R=10 (cmH2O),C=30 [mL? (cmH2O) -1]】和慢性阻塞性肺疾病患者【R=20(cmH2O),C=50 [mL? (cmH2O) -1]】的R和C进行实验。结果 测算所得R最大相对误差出现在对正常成人的测定,达到-12.67%,C最大相对误差出现在对急性呼吸窘迫综合征患者的测定,达到17.37%。采用均值配对双样本t检验法对每组测试数据进行分析得到P值均>0.05。结论 本研究表明实验所得R、C与在ASL5000上的设置值相一致。NPPV下呼气末气道阻力和胸肺顺应性的测算方法具有良好的可行性,其实现与应用将有助于呼吸机通气治疗的精准化和个体化。

    Abstract:

    Objective Correctively monitoring the values of resistance (R) in respiratory tract and the compliance (C) in lung, it’s one of critical technologies for ensuring reasonable setting the parameters of ventilation and reducing ventilator-associated lung injury (VALI). Therefore, in this paper, we investigated the method of measuring R and C under non-invasive positive pressure ventilation (NPPV) conditions by using a brief pressure release in the end of expiration. Method Firstly, a NPPV respirator was developed with programming the method of calculating the R and C. And based on employing the developed respirator and the active servo lung ASL5000, an experimental platform was designed for studying the method of calculating the R and C. Then, to set the ASL5000 simulating a healthy adult with R=5 (cmH2O) and C=50 [mL? (cmH2O) -1], an adult patient in acute respiratory distress syndrome with R=10 (cmH2O)and C=30 [mL? (cmH2O) -1], and an adult patient in chronic obstructive pulmonary disease with R=20(cmH2O),C=50 [mL? (cmH2O) -1], we conducted a serial of experiments for calculating the R and C. Results In the experimental results, we found the maximum relative error of R = -12.67% in calculating the R of normal adult, and the maximum relative error of C = 17.37% in calculating the C of the patient in acute respiratory distress syndrome. By employing the paired T-Test, the statistic?results?showed all P values > 0.05. Conclusions The calculated values of R and C are?similar?to?the set values in ASL5000. The experimental results suggest that it’s practicable to calculate the R and C during NPPV. The development of calculating the R and C will be beneficial for achieving the precise ventilation and the personalized ventilation.

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  • 收稿日期:2023-10-01
  • 最后修改日期:2023-11-15
  • 录用日期:2023-11-22
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