摘要
目的定量评价目前传统使用的面罩通气的重复呼吸量,探讨改进的双通道面罩对减少死腔效应的作用。方法选择7例慢性阻塞性肺疾病(COPD)并轻中度二氧化碳(CO2)潴留患者,进行随机交叉自身对照试验。采用中号面罩,BiPAP-30呼吸机及平台型排气阀。应用电脑数据采集和分析方法,持续同步监测呼吸流量及CO2浓度,比较改进与传统面罩的重复呼吸量。结果改进面罩内呼气末CO2浓度明显低于传统法,分别为(3.0±1.0)%和(7.2±1.7)%(P<0.001)。传统面罩通气存在明显CO2重复呼吸,重复呼吸量为(83.1±32.9)ml;改进面罩通气几乎能完全消除重复呼吸[(0.1±0.4)ml,P<0.01]。结论传统面罩正压通气存在明显的CO2重复呼吸;改进面罩可基本消除 CO2重复呼吸,在治疗Ⅱ型呼吸衰竭患者时可能有重要的临床意义。
Objective There were reports concerning the CO2 rebreathing during non-invasive positive pressure ventilation (NIPPV) with full face mask. It is our hypothesis that modification of the mask from one way connection to two ways connection by making a side hole in the mask makes it possible that CO2 inside the mask could be washed out by a constant flow through the mask. Methods A randomized self-control study on CO2 rebreathing was conducted in 7 COPD patients to compare the modified set-up with the conventional one. A BiPAP- 30 ventilator and a plateau exhaustion valve (Respironics USA) were employed in the study. In the modified two ways set-up, the exhaustion valve (with distal end blocked) was connected to the side hole of the mask, so that a constant base flow could pass through the mask to the exhaustion valve. The average base flow was 0.43 LPS. The parameters were set as following: S/T mode, f: 15 BPM, pressure support level: 8 cm H2O. Three different levels of PEEP (2, 3 and 5 cm H2O) were used to investigate the PEEP level on CO2 rebreathing. Flow and CO2% were constantly recorded with computer data acquisition and analysis system (Microcal Origin). Results In conventional set-up, there was obvious CO2 rebreathing (rebreathing volume: 83.1 ± 32.9 ml). In modified connection, the rebreathing volume was only (0. 1 ± 0.4)ml (P<0.001). Conclusion There was obvious CO2 rebreathing during full face mask NIPPV in conventional set-up. A modified two ways connection could reduce CO2 rebreathing to be near zero, which might be important in the management of hypercapnic respiratory failure with NIPPV.
出处
《中华结核和呼吸杂志》
CAS
CSCD
北大核心
2000年第12期734-736,共3页
Chinese Journal of Tuberculosis and Respiratory Diseases