国际呼吸杂志
國際呼吸雜誌
국제호흡잡지
INTERNATIONAL JOURNAL OF RESPIRATION
2012年
24期
1870-1875
,共6页
双水平正压呼吸机%压力支持%触发同步
雙水平正壓呼吸機%壓力支持%觸髮同步
쌍수평정압호흡궤%압력지지%촉발동보
Bilevel ventilation devices%Pressure support%Trigger synchrony
目的 观察不同系统泄漏水平对7款不同型号双水平正压呼吸机的吸气触发同步性的影响.方法 使用Hans Rudolph Series 1101机械肺模拟器模拟慢性阻塞性肺疾病患者,设置顺应性为50 ml/cm H2O,气道阻力为20cmH2O ·L-1·s-1.吸气时间为1.0 s,呼吸频率为15次/min.双水平正压呼吸机以压力支持通气模式运行,参数设置为15 cm H2O的压力支持及5 cm H2O的呼气末正压,后备通气频率为10次/min.收集在泄漏量为25～28 L/min和45～48 L/min吸气触发阶段的通气参数.结果 在低水平泄漏(25～28 L/min)时,Vivo 30出现较频繁的自动触发,降低泄漏量至14～15 L/min后同步通气稳定；Smartair Plus和VENTImotion则出现触发失败而启用后备通气,增加吸气努力后改善,但吸气做功增加.随着泄漏增高,Vision、Synchrony、Flexo 30和VPAPⅢ无需调整即能适应,VENTImotion和Smartair Plus则需通过调整触发灵敏度来保持同步通气.Synchrony和VPAPⅢ的吸气触发压力和吸气做功最低,但呼吸机所提供的吸气流量偏小.结论 7款双水平正压呼吸机均能提供同步通气,但吸气触发同步性各不相同.Vision和Flexo 30能较好地适应高水平泄漏并无需调整设置,吸气触发同步性能优,且呼吸机能迅速提供相适应的吸气流量以达到预设吸气压力.
目的 觀察不同繫統洩漏水平對7款不同型號雙水平正壓呼吸機的吸氣觸髮同步性的影響.方法 使用Hans Rudolph Series 1101機械肺模擬器模擬慢性阻塞性肺疾病患者,設置順應性為50 ml/cm H2O,氣道阻力為20cmH2O ·L-1·s-1.吸氣時間為1.0 s,呼吸頻率為15次/min.雙水平正壓呼吸機以壓力支持通氣模式運行,參數設置為15 cm H2O的壓力支持及5 cm H2O的呼氣末正壓,後備通氣頻率為10次/min.收集在洩漏量為25～28 L/min和45～48 L/min吸氣觸髮階段的通氣參數.結果 在低水平洩漏(25～28 L/min)時,Vivo 30齣現較頻繁的自動觸髮,降低洩漏量至14～15 L/min後同步通氣穩定；Smartair Plus和VENTImotion則齣現觸髮失敗而啟用後備通氣,增加吸氣努力後改善,但吸氣做功增加.隨著洩漏增高,Vision、Synchrony、Flexo 30和VPAPⅢ無需調整即能適應,VENTImotion和Smartair Plus則需通過調整觸髮靈敏度來保持同步通氣.Synchrony和VPAPⅢ的吸氣觸髮壓力和吸氣做功最低,但呼吸機所提供的吸氣流量偏小.結論 7款雙水平正壓呼吸機均能提供同步通氣,但吸氣觸髮同步性各不相同.Vision和Flexo 30能較好地適應高水平洩漏併無需調整設置,吸氣觸髮同步性能優,且呼吸機能迅速提供相適應的吸氣流量以達到預設吸氣壓力.
목적 관찰불동계통설루수평대7관불동형호쌍수평정압호흡궤적흡기촉발동보성적영향.방법 사용Hans Rudolph Series 1101궤계폐모의기모의만성조새성폐질병환자,설치순응성위50 ml/cm H2O,기도조력위20cmH2O ·L-1·s-1.흡기시간위1.0 s,호흡빈솔위15차/min.쌍수평정압호흡궤이압력지지통기모식운행,삼수설치위15 cm H2O적압력지지급5 cm H2O적호기말정압,후비통기빈솔위10차/min.수집재설루량위25～28 L/min화45～48 L/min흡기촉발계단적통기삼수.결과 재저수평설루(25～28 L/min)시,Vivo 30출현교빈번적자동촉발,강저설루량지14～15 L/min후동보통기은정；Smartair Plus화VENTImotion칙출현촉발실패이계용후비통기,증가흡기노력후개선,단흡기주공증가.수착설루증고,Vision、Synchrony、Flexo 30화VPAPⅢ무수조정즉능괄응,VENTImotion화Smartair Plus칙수통과조정촉발령민도래보지동보통기.Synchrony화VPAPⅢ적흡기촉발압력화흡기주공최저,단호흡궤소제공적흡기류량편소.결론 7관쌍수평정압호흡궤균능제공동보통기,단흡기촉발동보성각불상동.Vision화Flexo 30능교호지괄응고수평설루병무수조정설치,흡기촉발동보성능우,차호흡궤능신속제공상괄응적흡기류량이체도예설흡기압력.
Objective Pressure support ventilation (PSV) delivered by a bilevel device has become the standard technique of choice for noninvasive home ventilation.The present study was designed to compare the inspiratory triggering synchronization of seven bilevel ventilators under different conditions of system leak.Methods Ventilators were connected to a lung model (Hans Rudolph Series 1101simulator),the mechanics of which was set at a compliance of 50 ml/cm H2O,an expiratory resistance of 20 cm H2O · L-1 · s-1,and a respiratory rate of 15 breaths/min (inspiratory time was 1.5 s).All of the ventilators were set at 15 cm H2O pressure support and 5 cm H2O positive end-expiratory pressure.Tests were conducted at two level of leaks in the system.Trigger delay,trigger pressure and triggerassociated inspiratory workload were collected.Results At the leak level of 25～28 L/min,Breas Vivo 30was unable to synchronize with the simulator,auto-triggering was occurred frequently.Missed efforts and back-up ventilation were observed in Weinmann VENTImotion and Airox Smartair Plus and needed adjustment of trigger effort.Significant differences in triggering were found among these machines.As the leak was increased (45～48 L/min),Respironics Vision/Synchrony,Curative Flexo 30 and VPAP Ⅲ ventilators were shown that no asynchrony even if the leak setting was changed.The inspiratory trigger pressure was lower in Synchrony and VPAP Ⅲ ventilators,but the inflating flow was also decreased.Conclusions The Vision and Flexo 30 are the ventilators that require no adjustments as they adapt to increasing leaks.There are fewer inspiratory workload and higher inflating flow during the inspiratory phase,which is better suited for COPD patients' respiratory mechanics and inspiratory demand.Clinicians should be aware that in the presence of leaks,some ventilators require adjustments to improve patient-ventilator synchrony.
