目的探讨无创通气中测压管前连接不同大小的气囊和气囊在不同充盈状态下对压力传导和人机同步的影响。
方法(1)密闭容器与测压管相连，测压管在容器内的开口处分别连接大、中、小3种气囊，通过三通阀调节气囊内气体容量的充盈状态，测压管在容器外的另一端接压力感受器监测测压管内压力，逐渐改变容器内压力大小，观察测压管内相应的压力变化情况。(2)选择12名健康志愿者，无创正压通气期间在测压管前端分别连接大、中、小3种气囊，调节气囊内气体容量的充盈状态，观察面罩内压力(Pmask)和测压管内压力(Ptube)的动态变化。正态分布资料采用 t检验，非正态分布资料采用K－W检验。
结果(1)当容器内压力从0逐渐升至50 cmH 2O(1 cmH 2O＝0.098 kPa)和从50 cmH 2O逐渐降至0的过程中，小气囊在充盈4/5状态下，中气囊在充盈3/5、4/5和完全充盈状态下，大气囊在充盈1/5、2/5、3/5和4/5状态下，测压管内压力值和容器内压力值均保持一致，差异均无统计学意义( P>0.05)；小气囊在无充盈和充盈1/5状态下，中气囊在无充盈状态下，测压管内压力达到一定水平后均不再随容器内的压力升高而变化；小气囊在无充盈、充盈1/5、2/5、3/5和完全充盈状态下，中气囊在无充盈、充盈1/5、2/5状态下，大气囊在无充盈和完全充盈状态下测压管内压力和容器内压力差异均有统计学意义。(2)测压管前连接气囊后，面罩内的平台压稍高于测压管，面罩内的基线压稍低于测压管；测压管前连接中气囊在充盈2/5、3/5、4/5，大气囊在充盈1/5、2/5、3/5、4/5状态下，呼吸机参数在10/4 cmH 2O～30/14 cmH 2O之间调节，面罩与测压管内压力差均<0.5 cmH 2O，为临床可接受范围；与测压管前无气囊状态比较，测压管前连接大气囊在充盈1/5、2/5、3/5状态下，中气囊在充盈2/5、3/5状态下，触发做功差异无统计学意义( P>0.05)。
结论测压管前连接气囊可防止测压管内冷凝液的形成，合适大小和充盈状态的气囊对压力传导性好，可用于无创通气回路。
ObjectiveTo investigate the effect of connecting airbag in different filling state at the front end of piezometric tube in the noninvasive ventilation circuit on pressure transmission and human-machine synchronization.
MethodIn test 1, the airbag was connected to a piezometric tube which was placed in a closed container, the filling state of the airbag was regulated, and the pressure inside the container was changed to observe the corresponding pressure change in the piezometric tube. In test 2, the airbag in different filling state was connected at the front end of piezometric tube in noninvasive ventilation circuit. Twelve subjects were connected to the ventilator such that dynamic changes in the pressure inside the mask (Pmask) and piezometric tube (Ptube) could be measured. Data with normal distribution was analyzed by t test, while data with abnormal distribution was analyzed by K-W test.
ResultsIn test 1, the pressure inside the container changed between 0 and 50 cmH 2O(1 cmH 2O=0.098 kPa), when the big airbag was filled at 1/5, 2/5, 3/5, 4/5, the medium-sized airbag was filled at 3/5, 4/5, 5/5, and the small airbag was filled at 4/5, the pressure inside the piezometric tube changed synchronously with the pressure inside the container with no statistically significant difference( P>0.05). In a state of no filling in the small airbag and the medium-sized airbag, and filled at 1/5 in the small airbag, the pressure inside the piezometric tube no longer changed with the pressure in the container when the pressure reached a certain level .When the small airbag was filled at 1/5, 2/5, 3/5, 5/5, the medium-sized airbag at 1/5, 2/5, and the big airbag at 5/5, and all the airbags were in the state of no filling , the difference in the pressure between the piezometric tube and the container was statistically significant. In test 2, respiratory ventilation parameters were set on 10/4 cmH 2O-30/14 cmH 2O , and the connecting airbag at the front end of piezometric tube in noninvasive ventilation circuit. The platform pressure in the mask was slightly higher than that in the piezometer tube, and the baseline pressure in the mask was slightly lower than that of the piezometer tube. When the big airbag was filled at 1/5, 2/5, 3/5, 4/5 and medium-sized airbag at 2/5, 3/5, 4/5, the pressure difference between Pmask and Ptube was less than 0.5 cmH 2O, which was acceptable clinically. When the big airbag was filled at 1/5, 2/5, 3/5 and the medium-sized airbag at 2/5, 3/5, there was no significant difference in trigger work before and after connecting the airbag at the front end of the piezometric tube( P>0.05).
ConclusionConnecting the airbag at the front end of the piezometric tube could avoid the forming of condensate in piezometric tube. The airbag showed good properties of pressure conductivity under ideal size and filling state.
胡杰英,郑则广,刘妮,等. 无创通气中测压管前连接气囊对人机同步的影响[J]. 中华结核和呼吸杂志,2018,41(9)：709-713.
DOI:10.3760/cma.j.issn.1001-0939.2018.09.011版权归中华医学会所有。
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