WO2017079860A1 - 呼吸机压力控制方法 - Google Patents

呼吸机压力控制方法 Download PDF

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WO2017079860A1
WO2017079860A1 PCT/CN2015/000778 CN2015000778W WO2017079860A1 WO 2017079860 A1 WO2017079860 A1 WO 2017079860A1 CN 2015000778 W CN2015000778 W CN 2015000778W WO 2017079860 A1 WO2017079860 A1 WO 2017079860A1
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pressure
ventilator
trigger
value
sensitivity
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石洪
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石洪
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
    • A61M16/021—Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes operated by electrical means
    • A61M16/022—Control means therefor
    • A61M16/024—Control means therefor including calculation means, e.g. using a processor

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  • the invention relates to the field of ventilator trigger control, and in particular to a ventilator pressure control method.
  • a ventilator is a device that can replace, control or change a person's normal physiological breathing, increase lung ventilation, improve respiratory function, reduce respiratory power consumption, and save heart reserve.
  • the ventilator has become more and more widely used in the fields of first aid, anesthesia, ICU and respiratory therapy, and has become an indispensable device in clinical treatment.
  • it can be divided into constant pressure type, timing type, constant volume type, and fixed flow type ventilator.
  • high-end ventilators are generally capable of triggering pressure and flow rates.
  • the ventilator is most commonly used for pressure triggering.
  • the sensitivity of the pressure trigger depends on the type of pressure sensor and the position of the pressure sensor.
  • the pressure sensor measures the pressure at the location of the Y-tube outside the patient's end of the loop, and there is also a suction branch in the loop. The inside of the gas branch is measured.
  • the sensor actually monitors the pressure of the connecting line, not the airway pressure, and does not reflect the alveolar or chest pressure. Although the pressure and airway pressure measured from inside the loop are not the same, it is often used as a reference to understand the airway pressure.
  • the pressure sensor may measure pressure of generally 2 O highest 150cmH, but due to the water within the loop, secretion blockage affect the accuracy, so in order to make accurate measurements, the loop will be different for different portions to disinfect according to factors like Treatment, to minimize the impact of water and secretions in the loop.
  • the ventilator trigger sensitivity setting is different depending on the patient. The stronger the self-breathing, the higher the sensitivity setting, the weaker self-breathing, and the lower the sensitivity setting. If the value of the trigger sensitivity is set too low or there is a leak in the system, the ventilator may be falsely triggered. That is to say, the trigger pressure sensitivity of the ventilator at this time is set to the minimum dynamic PEEPI in the pressure curve where the end-tidal pressure sensor is located.
  • PEEPI Intrinsic positive end-expiratory pressure
  • the alveolar pressure maintains a positive pressure throughout the exhalation without the ventilator's preset PEEP, ie, the alveolar pressure is higher than the atmospheric pressure.
  • the effective triggering of the ventilator is usually controlled by the patient overcoming the end-tidal pressure and the pressure-trigger sensitivity value.
  • the patient's respiratory system has PEEPI, it is necessary to overcome the PEEPI to perform work.
  • the trigger level can be adjusted artificially to make it close to zero.
  • the invention provides a ventilator pressure control method, which can not only reduce false triggering, but also make the patient easy to trigger when there is PEEPI in the respiratory system.
  • the technical problem to be solved by the present invention is to provide a ventilator pressure control Method of production.
  • the invention discloses a ventilator pressure control method, comprising the following steps:
  • step S1 includes setting a minimum exhalation time in the breathing cycle.
  • the end-expiratory pressure value is calculated by averaging the pressure values when the substantially constant changes are detected in the same breathing cycle.
  • the pressure trigger sensitivity range in the step S2 includes -30 cmH2O to 0 cmH2O.
  • the step S3 further comprises detecting the airway pressure of the ventilator, and determining whether the ventilator performs the pressure trigger according to the end-expiratory pressure value, the pressure triggering sensitivity, and the airway pressure.
  • the airway pressure is obtained by real-time detection by a pressure sensor.
  • the step of determining the pressure trigger of the ventilator comprises: a. calculating the sum of the end-tidal pressure and the pressure-trigger sensitivity; b. comparing the detected airway pressure with the sum obtained in a; c. When the airway pressure is less than the result obtained in b, the trigger is effective for the patient to have spontaneous breathing.
  • the step of determining the pressure trigger of the ventilator comprises: a. the preset PEEP value of the ventilator, and the sum of the preset PEEP value and the trigger pressure sensitivity when the monitored value of the PEEP is consistent with the set value; b. The detected airway pressure is compared with the sum obtained in a; c. When the airway pressure is less than the result obtained in b, the trigger is effective.
  • the step of determining the pressure trigger of the ventilator includes: a. the preset PEEP value of the ventilator, and the difference between the monitoring value of the PEEP and the pressure trigger sensitivity when the monitored value of the PEEP is inconsistent with the set value; b. The detected airway pressure is inferior to the sum obtained in a; c. When the airway pressure is less than the result obtained in b, the trigger is effective.
  • the steps of determining that the ventilator performs pressure triggering include:
  • Figure 1 is a flow chart of a ventilator pressure control method of the present invention
  • FIG. 2 is a specific embodiment of a ventilator pressure control method of the present invention.
  • FIG. 1 a ventilator pressure control method according to an embodiment of the present invention
  • the breathing cycle usually refers to the time from the start of one inspiration to the start of the next inhalation after the end of exhalation.
  • the whole process is divided into inhalation time and forced exhalation time.
  • the setting of the ventilator's suction ratio should consider the effects of mechanical ventilation on patient flow dynamics, oxygenation status, and spontaneous breathing levels.
  • the ventilator air supply should be matched with the patient's inspiratory phase to ensure synchronization between the two.
  • the inspiratory need is 0.8-1.2 s
  • the suction ratio is 1:2-1:1.5;
  • the general inhalation time is longer, the suction is higher, the average airway pressure can be increased, and oxygenation can be improved.
  • the minimum expiratory time is set when the breathing control is performed, and the minimum expiratory time refers to the shortest time during which the inhaled gas can be completely exhaled.
  • the forced expiratory time uses the minimum expiratory time. After the forced exhalation time of exhalation, the pressure is basically maintained during the same breathing cycle. The average pressure value at the time of constant is used as the end-expiratory pressure value.
  • the pressure in the airway drops to the pressure sensitivity value set by the operator, and a effectively triggered breathing process begins.
  • the setting of the ventilator trigger sensitivity is also different. The stronger the self-breathing, the higher the sensitivity setting, the weaker the spontaneous breathing, and the lower the sensitivity setting.
  • the ventilator detects the pressure signal in the circuit, and when the patient has an inhalation effort, the pressure in the conduction tube drops, and when the sensitivity falls below the set sensitivity, the ventilator triggers ventilation to the patient.
  • the ventilator when the airway pressure drops to the baseline pressure at the beginning, when the airway pressure drops to the pressure trigger sensitivity setting, the ventilator generates a patient to trigger the inhalation. From the baseline position to the sensitivity setpoint position, the more the airway pressure drops. Faster, the larger the inspiratory force, the shorter the interval, the lower the set value of the pressure trigger sensitivity, and the shorter the interval from the baseline position to the sensitivity set value.
  • the pressure trigger sensitivity of the present embodiment can be selected according to actual conditions, and the pressure trigger sensitivity is generally a negative value, which can be -30 cmH2O to 0 cmH2O.
  • PEEP positive end-expiratory pressure
  • PEEPI endogenous positive end expiratory pressure
  • the ventilator when the ventilator sets the PEEP, when the monitored value of the PEEP is consistent with the set value, the ventilator determines whether to perform the pressure trigger according to the set value of the PEEP; generally, the higher the PEEP value, For patients with weak self-breathing ability, the trigger is more difficult.
  • the set PEEP value is 5cmH2O
  • the set pressure trigger sensitivity is -3cmH2O.
  • the sum of the value and the pressure trigger sensitivity, the calculated trigger pressure value of the ventilator is 2cmH2O, and the effective trigger can be triggered when the detected airway pressure is lower than 2cmH2O; if the actual PEEP monitoring value is inconsistent with the set value, Set the PEEP value of the actual monitoring to 1cmH2O.
  • the patient does not trigger at this time, the airway pressure is lower than 2cmH2O, and the breathing opportunity triggers ventilation, that is, false triggering occurs.
  • the monitoring value of PEEP is summed with the pressure triggering sensitivity, and the ventilator triggering pressure value obtained at this time is -2 cmH2O, that is, the effective triggering can be performed when the detected airway pressure is lower than -2 cmH2O.
  • the ventilator triggers whether the ventilator is pressure triggered based on the pressure in the airway circuit, the end-expiratory pressure value, and the pressure-trigger sensitivity value.
  • the pressure in the airway is reduced, and the airway pressure value can be detected by the pressure sensor in real time; when the airway pressure is low
  • the ventilator performs the triggering ventilation.
  • the ventilator can adjust the breathing ratio according to the frequency of the patient, thereby improving the synchronization between the ventilator and the patient. To make the patient feel more comfortable.

Abstract

一种呼吸机压力触发控制的方法，包括：S1.设定呼吸周期，计算或监测呼气末压力值；S2.预设压力触发灵敏度值；S3.根据压力触发灵敏度和呼气末压力值计算并判断呼吸机是否进行压力触发；S4.根据触发结果进行触发通气。本呼吸机压力控制方法能够通过算法减少误触发，在呼吸系统存在PEEPI的时候，可以使患者更容易触发，同时该方法适用于麻醉机等的压力触发控制系统。

Description

呼吸机压力控制方法 技术领域
本发明涉及呼吸机触发控制领域，尤其涉及一种呼吸机压力控制方法。
背景技术
呼吸机是一种能代替、控制或改变人的正常生理呼吸，增加肺通气量，改善呼吸功能，减轻呼吸功消耗，节约心脏储备能力的装置。呼吸机在急救、麻醉、ICU和呼吸治疗领域中应用越来越广泛，已成为临床救治中不可缺少的器械。据呼吸机的工作特点，可以分为定压型、定时型、定容型、定流型呼吸机。目前，高档呼吸机一般都可以进行压力和流速触发。呼吸机以压力触发最常用，压力触发敏感性取决于压力传感器的类型和压力传感器的位置，压力传感器测定压力的部位通常在环路病人端Y型管外，也有在环路吸气支和呼气支内部测知。传感器实际上监测的是连接管路的压力，而不是气道压力，更不能反映肺泡或胸腔压力。尽管从环路内部测得的压力和气道压力不尽相同，但往往以此作为参照，了解气道压力的情况。压力传感器通常可以测量最高150cmH2O的压力，但会因环路内积水、分泌物堵塞等影响准确性，因此为了使测量结果准确，对环路会按照影响因素不同对不同部分进行消毒等处理，尽量减少环路内积水、分泌物堵塞等影响。呼吸机在压力触发模式下 工作的时候，根据患者不同，呼吸机触发灵敏度的设置也不一样，自主呼吸越强，灵敏度的值设定要高，自主呼吸微弱，灵敏度的值设定要低。触发灵敏度的值设置过低或系统存在漏气都可引起呼吸机误触发。也就是说，此时呼吸机的触发压力灵敏度设置在呼吸末压力传感器所在的压力曲线中最小的动态PEEPI。PEEPI(Intrinsic positive end-expiratory pressure，内源性呼气末正压)是指在没有呼吸机预设PEEP的情况下，肺泡压力在在整个呼气过程中保持正压，即肺泡压力高于大气压。当加用外源性PEEP后，整个呼吸过程受呼吸机的控制。呼吸机进行有效触发通常是通过患者克服呼气末压力、压力触发灵敏度值进行呼吸做功来控制的，当患者的呼吸系统存在PEEPI的时候，还需要克服PEEPI进行做功。对于呼吸机触发控制的方法，合理调节触发水平非常重要，触发水平可人为进行调节，使其接近于零，这样可缩短触发时间，提高同步性，但部分患者容易导致误触发。此外，当患者的呼吸系统存在PEEPI的时候，根据常规的压力灵敏度计算触发压力值，患者触发比较困难。本发明提出一种呼吸机压力控制方法，不但能够减少误触发，还可以在呼吸系统存在PEEPI的时候，使患者容易触发。
发明内容
本发明要解决的技术问题在于，提供一种呼吸机压力控 制方法。
本发明公开了一种呼吸机压力控制方法，包括如下步骤：
S1.设定呼吸周期，计算或监测呼气末压力值；
S2.预设压力触发灵敏度值；
S3.根据压力触发灵敏度和呼气末压力值计算并判断呼吸机是否进行压力触发；
S4.根据触发结果进行触发通气。
进一步的，所述步骤S1包括设定呼吸周期中最小呼气时间。
进一步的，所述步骤S1中呼气末压力值由同一呼吸周期内测知的基本保持不变时的压力值进行求平均值计算得出。
进一步的，所述步骤S2中压力触发灵敏度范围包括-30cmH2O～0cmH2O。进一步的，所述步骤S3还包括检测呼吸机的气道压力，根据呼气末压力值、压力触发灵敏度、气道压力判断呼吸机是否进行压力触发。
进一步的，所述气道压力由压力传感器实时检测获得。
进一步的，判断呼吸机进行压力触发的步骤包括：a.计算得出呼气末压力与压力触发灵敏度的和；b.将检测的气道压力与a中求得的和作差；c.当气道压力小于b中求得的结果时，触发有效，用于患者有自主呼吸的情况。 进一步的，判断呼吸机进行压力触发的步骤包括：a.呼吸机预设PEEP值，PEEP的监测值与设定值一致的情况下，计算预设的PEEP值、触发压力灵敏度的和；b.将检测的气道压力与a中求得的和作差；c.当气道压力小于b中求得的结果时，触发有效。
进一步的，判断呼吸机进行压力触发的步骤包括：a.呼吸机预设PEEP值，PEEP的监测值与设定值不一致的情况下，计算PEEP的监测值、压力触发灵敏度的和；b.将检测的气道压力与a中求得的和作差；c.当气道压力小于b中求得的结果时，触发有效。
进一步的，呼吸系统存在PEEPI的情况下，判断呼吸机进行压力触发的步骤包括：
计算内源性呼气末正压与触发压力灵敏度的和；b.将检测的气道压力与a中求得的和作；c.当气道压力小于b中求得的结果时，触发有效。
本发明的呼吸机压力控制方法，具有以下有益的技术效果：
1.能够通过算法减少误触发；
2.在呼吸系统存在PEEPI的时候，使患者容易触发；
3.应用到麻醉机等的压力触发控制系统中。
附图说明
图1为本发明呼吸机压力控制方法流程图；
图2为本发明呼吸机压力控制方法具体实施例。
具体实施方式
为详细说明本发明的技术内容及所实现目的及效果，以下结合实施方式并配合附图予以详细说明。
参见图1，本发明实施例一种呼吸机压力控制方法，
包括：S1.设定呼吸周期，计算呼气末压力值；
呼吸周期通常是指从一次吸气开始到呼气结束后下一次吸气开始的时间，整个过程分为吸气时间和强制呼气时间。机械通气时，呼吸机吸呼比的设定应该考虑机械通气对患者流动力学的影响、氧合状态、自主呼吸水平等因素。存在自主呼吸的病人，呼吸机辅助呼吸时，呼吸机送气应当与病人吸气相配合，以保证两者同步，一般吸气需要0.8-1.2s，吸呼比为1∶2-1∶1.5；对于控制通气的患者，一般吸气时间较长、吸呼比较高、可提高平均气道压力，改善氧合。但延长吸气时间，应注意监测患者血流动力学的变化，吸气时间过长，患者不易耐受，需要使用镇静剂或肌松剂，呼气时间过短可导致内源性呼气末正压(PEEPI)。为了保障患者能够顺利的呼出气体，避免过度通气，本实施方案中在进行呼吸控制的时候设定了最小呼气时间，最小呼气时间是指能够将吸入的气体完全呼出的最短时间，所述的强制呼气时间采用最小呼气时间，在呼气的强制呼气时间结束后，选择同一呼吸周期内压力基本保持 不变时候的平均压力值作为呼气末压力值。
S2.预设压力触发灵敏度值；
当选择压力触发时，气道内的压力下降至操作者设定的压力灵敏度值，就开始一个有效触发的呼吸过程。根据患者不同，呼吸机触发灵敏度的设置也不一样，自主呼吸越强，灵敏度的值设定要高，自主呼吸微弱，灵敏度的值设定要低。在设定压力触发灵敏度后，呼吸机检测回路中的压力信号，病人有吸气努力时导通管内的压力下降，降至低于设置的灵敏度时，呼吸机触发给病人通气。比如开始时气道压力降至基线压力，当气道压力降至压力触发灵敏度设定值是，呼吸机产生一个病人触发吸气，从基线位置到灵敏度设定值位置，气道压力下降的越快，吸气作用力越大，间隔越短，压力触发灵敏度的设定值越低，从基线位置到灵敏度设定值位置间隔越短。当触发灵敏度的值设置过低或系统存在漏气都可引起呼吸机误触发。因此，本实施方案压力触发灵敏度可以根据实际情况进行选择，压力触发灵敏度一般为负值，可以为-30cmH2O～0cmH2O。
S3.根据压力触发灵敏度和呼气末压力值计算并判断呼吸机是否进行压力触发；[0034]呼气末正压(PEEP)主要目的是增加肺容积，提高平均气道压力，改善氧合，另外，呼气末正压还能抵消内源性呼气末正压(PEEPI)，降低PEEPI引起的吸气触发功。
本实施方案中，在有呼吸机设定PEEP时，当PEEP的监测值与设定值一致时，呼吸机根据PEEP的设定值判断是否进行压力触发；通常来说，PEEP值越高，对于自主呼吸能力弱的病人来说，触发越困难，同时，由于临床实际应用中PEEP的监测具有不确定性，当PEEP的监测出现一定的误差时，会导致患者出现误触发。例如，设定的PEEP值为5cmH2O，设定的压力触发灵敏度为-3cmH2O，当PEEP的监测值与设定值一致时，即PEEP的监测值为5cmH2O，此种条件下，求PEEP的设定值与压力触发灵敏度的和，计算得出的呼吸机的触发压力值为2cmH2O，当检测到的气道压力低于2cmH2O时，才能进行有效触发；若实际PEEP监测值与设定值不一致时，设实际监测的PEEP值为1cmH2O，按照前述情况下的计算方法，此时患者没有进行触发，气道压力低于2cmH2O，呼吸机会触发通气，即出现误触发，为了避免此种误触发现象，此种情况下将PEEP的监测值与压力触发灵敏度求和，此时得到的呼吸机触发压力值为-2cmH2O，也就是说，当检测到的气道压力低于-2cmH2O时才能进行有效触发。
对于有自主呼吸能力的人来说，呼吸机触发根据气道回路中的压力、呼气末压力值、压力触发灵敏度值判断呼吸机是否进行压力触发。病人有自主呼吸时，气道内压力降低，气道压力值可通过压力传感器实时检测得到；当气道压力低 于呼气末压力值与压力触发灵敏度之和时，认为患者进行了有效触发，呼吸机进行触发通气，此时呼吸机可以根据病人的频率进行吸呼比调整，提高呼吸机与病人的同步性，使病人感觉更舒适。

Claims (10)

  1. 一种呼吸机压力控制方法，其特征在于，包括如下步骤：
    S1.设定呼吸周期，计算或监测呼气末压力值；
    S2.预设压力触发灵敏度值；
    S3.根据压力触发灵敏度和呼气末压力值计算并判断呼吸机是否进行压力触发；
    S4.根据触发结果进行触发通气。
  2. 根据权利要求1所述的呼吸机压力控制方法，其特征在于，所述步骤S1包括设定呼吸周期中最小呼气时间。
  3. 根据权利要求2所述的呼吸机压力控制方法，其特征在于，所述步骤S1中呼气末压力值由同一呼吸周期内测知的基本保持不变时的压力值进行求平均值计算得出。
  4. 根据权利要求1所述的呼吸机压力控制方法，其特征在于，所述步骤S2中压力触发灵敏度范围包括-30cmH2O～0cmH2O。
  5. 根据权利要求1所述的呼吸机压力控制方法，其特征在于，所述步骤S3还包括检测呼吸机的气道压力，根据呼气末压力值、压力触发灵敏度、气道压力计算并判断呼吸机是否进行压力触发。
  6. 根据权利要求5所述的呼吸机压力控制方法，其特征在于，所述气道压力由压力传感器实时检测获得。
  7. 根据权利要求5所述的呼吸机压力控制方法，其特征在 于，判断呼吸机进行压力触发的步骤包括：a.计算得出呼气末压力与压力触发灵敏度的和；b.将检测的气道压力与a中求得的和作差；c.当气道压力小于b中求得的结果，触发有效，用于患者有自主呼吸的情况。
  8. 根据权利要求5所述的呼吸机压力控制方法，其特征在于，判断呼吸机进行压力触发的步骤包括：a.呼吸机预设PEEP值，PEEP的监测值与设定值一致的情况下，计算预设的PEEP值、触发压力灵敏度的和；b.将检测的气道压力与a中求得的和作差；c.当气道压力小于b中求得的结果时，触发有效。
  9. 根据权利要求5所述的呼吸机压力控制方法，其特征在于，判断呼吸机进行压力触发的步骤包括：a.呼吸机预设PEEP值，PEEP的监测值与设定值不一致的情况下，计PEEP的监测值、压力触发灵敏度的和；b.将检测的气道压力与a中求得的和作差；c.当气道压力小于b中求得的结果时，触发有效。
  10. 根据权利要求5所述的呼吸机压力控制方法，其特征在于，呼吸系统存在PEEPI的情况下，判断呼吸机进行压力触发的步骤包括：a.计算内源性呼气末正压与触发压力灵敏度的和；b.将检测的气道压力与a中求得的和作差；c.当气道压力小于b中求得的结果时，触发有效。
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