无创通气自适应模式对呼吸功耗影响的模拟肺研究

The effects of auto-adaptive non-invasive ventilation on respiratory workload： a bench study

目的探讨时间适应（TA）模式降低呼吸功耗的原理，在不同疾病状态下对TA的效果进行验证。方法模拟肺设置为正常模型，分别在S和TA模式下进行机械通气，比对两种模式下的呼吸功耗相关指标；然后将模拟肺分别设置为阻塞性和限制性疾病模型，最后设置大漏气量模型，均比对S和TA模式下的呼吸功耗相关指标。结果在正常模型下，应用TA时的呼吸功耗相关指标（触发压力、触发功耗、触发流速、触发容量、触发肌肉收缩力量）均小于应用S时，差异有统计学意义。TA降低呼吸功耗的机制在于缩短触发延迟时间[（57±17．508）ms vs（94±7．703）ms，P=0．000]。阻塞性、限制性模型及大漏气量状态下应用TA时的呼吸功耗相关指标均小于S。结论TA通过缩短触发延迟时间降低患者呼吸功耗，在阻塞性、限制性疾病及大漏气量状态下仍可保持这种效应。

Objective To study the mechanism of timed-adaptive mode （TA） reducing respiratory workload,and to confirm the efficacy of TA mode in different clinical scenarios. Methods To explore the mechanism of TA, the lung simulator was set in normal scenario, then ventilated in S and TA mode respectively, the workload associated parameters recorded by the lung simulator were compared between S and TA modes. To confirm the efficacy of TA, the lung simulator was set in obstructive, restrictive or large air leakage scenarios, then ventilated in S and TA mode respectively, the workload associated parameters recorded by the lung simulator were compared between S and TA modes. Results In the normal scenario, respiratory workload associated parameters （trigger pressure, trigger work, trigger flow, trigger volume and muscle strength）of TA were significantly lower than S. The mechanism of TA reducing respiratory workload relied on decreased trigger delay time [（57 ± 17. 508） ms vs （94± 7. 703） ms, （ P = 0. 000）]. In the obstructive, restrictive or large air leakage, respiratory workload associated parameters of TA were all significantly lower than S. Conclusions TA can reduce respiratory workload by decreasing trigger delay time, which also play the role under the pattern of obstructive, restrictive and large air leakage scenarios.