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Anesthesiology:在气道阻塞的情况下，SHFJV能更加有效的增加肺容量

2015-08-21 MedSci MedSci原创

双重喷射通气高频喷射通气气道阻塞
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喷射通气经过30多年的发展，有着比传统通气更显著、独特的优点，如频率高、潮气量低、气道保持开放、不产生因通气产生的手术区干扰、不与自主呼吸对抗，对循环功能干扰轻微等。目前，双重喷射通气(SHFJV)与高频喷射通气(HFJV)都已成功用于气道手术，然而，临床医生发现与HFJV相比，SHFJV可以为非阻塞性气道患者提供更高的肺容量，并显著促进了肺的气体交换功能。   本次研究通过塑造气道

喷射通气经过30多年的发展，有着比传统通气更显著、独特的优点，如频率高、潮气量低、气道保持开放、不产生因通气产生的手术区干扰、不与自主呼吸对抗，对循环功能干扰轻微等。目前，双重喷射通气(SHFJV)与高频喷射通气(HFJV)都已成功用于气道手术，然而，临床医生发现与HFJV相比，SHFJV可以为非阻塞性气道患者提供更高的肺容量，并显著促进了肺的气体交换功能。

本次研究通过塑造气道阻塞模型，旨在比较在不同的通气频率下SHFJV与HFJV的通气效果，并对SHFJV效果的频率依赖性及阻塞程度依赖性进行了描述。

在本次研究中，10只实验动物在麻醉后接受SHFJV和HFJV交替通气，频率梯度介于50-600次/min。通过向动物气管内插入直径介于2-8mm的可交换支架塑造气管阻塞模型。使用光电描记法对胸廓容积进行测定，同时记录气道压，并进行了多次血气分析。


实验结果显示，SHFJV产生的呼气末胸廓容积量高于HFJV1.6倍，并且潮气量始终超过200ml。在HFJV期间，将通气频率从50次/min增加至600次/min导致潮气量（97-130ml）减少了30倍之多以至失去了通气的意义，并导致低氧及高碳酸血症。


在SHFJV期间，插入气管的支架的直径从8减小至2mm,促使呼气末胸廓容积增加了约3倍（大约从100增加值300ml),使潮气量减少了约4.2倍（大约从470减少至110ml）。支架的直径在4mm及以上时尚可维持实验动物的氧化及通气功能，但是当支架的直径小于2mm，就会导致高碳酸血症的发生。



在本次活体动物气管阻塞模型试验中，SHFJV有效的增加了肺容量并维持肺的气体交换功能；在对严重阻塞的气管进行通气时，SHFJV拥有比HFJV更显著的优势。

原始出处：

Robert Sütterlin,Antonella LoMauro,et al.Influence of Tracheal Obstruction on the Efficacy of Superimposed High-frequency Jet Ventilation and Single-frequency Jet Ventilation Anesthesiology. 2015 Aug 8

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  1. [GetPortalCommentsPageByObjectIdResponse(id=127164, encodeId=c09b12e16402, content=文章不错，值得拜读, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzdAIB7UwTkHt6fQkBP8ictliaXtc5gCUmYdAW1sAETC2nhO3q6YjRHkUibyOCtP8ibmXNObTyd63A076/0, createdBy=d4111948983, createdName=1e10c84am36(暂无匿称), createdTime=Thu Sep 15 07:39:00 CST 2016, time=2016-09-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2050477, encodeId=7c9520504e70b, content=<a href='/topic/show?id=95f8e042dd' target=_blank style='color:#2F92EE;'>#EST#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7042, encryptionId=95f8e042dd, topicName=EST)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e9a6357, createdName=xiangyuzhou971, createdTime=Wed Feb 10 12:48:00 CST 2016, time=2016-02-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=47979, encodeId=0d8b4e979ff, content=值得看，好好收藏，谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=98, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=bc301610909, createdName=hixiaoluo, createdTime=Sat Dec 26 14:08:00 CST 2015, time=2015-12-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2029218, encodeId=bbae202921833, content=<a href='/topic/show?id=c46c63893a1' target=_blank style='color:#2F92EE;'>#气道阻塞#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63893, encryptionId=c46c63893a1, topicName=气道阻塞)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8dca2500075, createdName=396094184_42047355, createdTime=Tue Nov 24 00:48:00 CST 2015, time=2015-11-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1696653, encodeId=53ab1696653f0, content=<a href='/topic/show?id=d2e99e651e4' target=_blank style='color:#2F92EE;'>#阻塞#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97651, encryptionId=d2e99e651e4, topicName=阻塞)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a23129903429, createdName=tomyang96, createdTime=Sat Nov 14 00:48:00 CST 2015, time=2015-11-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1588193, encodeId=46d31588193c5, content=<a href='/topic/show?id=1cb8e014e0' target=_blank style='color:#2F92EE;'>#ESI#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=15, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7014, encryptionId=1cb8e014e0, topicName=ESI)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f4f817593223, createdName=skhzy, createdTime=Sun Aug 23 05:48:00 CST 2015, time=2015-08-23, status=1, ipAttribution=)]
    2016-09-15 1e10c84am36(暂无匿称)

    文章不错，值得拜读

    0

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    2016-02-10 xiangyuzhou971

    #EST#

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=127164, encodeId=c09b12e16402, content=文章不错，值得拜读, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzdAIB7UwTkHt6fQkBP8ictliaXtc5gCUmYdAW1sAETC2nhO3q6YjRHkUibyOCtP8ibmXNObTyd63A076/0, createdBy=d4111948983, createdName=1e10c84am36(暂无匿称), createdTime=Thu Sep 15 07:39:00 CST 2016, time=2016-09-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2050477, encodeId=7c9520504e70b, content=<a href='/topic/show?id=95f8e042dd' target=_blank style='color:#2F92EE;'>#EST#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7042, encryptionId=95f8e042dd, topicName=EST)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e9a6357, createdName=xiangyuzhou971, createdTime=Wed Feb 10 12:48:00 CST 2016, time=2016-02-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=47979, encodeId=0d8b4e979ff, content=值得看，好好收藏，谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=98, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=bc301610909, createdName=hixiaoluo, createdTime=Sat Dec 26 14:08:00 CST 2015, time=2015-12-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2029218, encodeId=bbae202921833, content=<a href='/topic/show?id=c46c63893a1' target=_blank style='color:#2F92EE;'>#气道阻塞#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63893, encryptionId=c46c63893a1, topicName=气道阻塞)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8dca2500075, createdName=396094184_42047355, createdTime=Tue Nov 24 00:48:00 CST 2015, time=2015-11-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1696653, encodeId=53ab1696653f0, content=<a href='/topic/show?id=d2e99e651e4' target=_blank style='color:#2F92EE;'>#阻塞#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97651, encryptionId=d2e99e651e4, topicName=阻塞)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a23129903429, createdName=tomyang96, createdTime=Sat Nov 14 00:48:00 CST 2015, time=2015-11-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1588193, encodeId=46d31588193c5, content=<a href='/topic/show?id=1cb8e014e0' target=_blank style='color:#2F92EE;'>#ESI#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=15, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7014, encryptionId=1cb8e014e0, topicName=ESI)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f4f817593223, createdName=skhzy, createdTime=Sun Aug 23 05:48:00 CST 2015, time=2015-08-23, status=1, ipAttribution=)]
    2015-12-26 hixiaoluo

    值得看，好好收藏，谢谢分享

    0

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    2015-11-24 396094184_42047355

    #气道阻塞#

    0

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    2015-11-14 tomyang96

    #阻塞#

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=127164, encodeId=c09b12e16402, content=文章不错，值得拜读, beContent=null, objectType=article, channel=null, level=null, likeNumber=49, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/jW482SpianMayicTRbRZ5RzdAIB7UwTkHt6fQkBP8ictliaXtc5gCUmYdAW1sAETC2nhO3q6YjRHkUibyOCtP8ibmXNObTyd63A076/0, createdBy=d4111948983, createdName=1e10c84am36(暂无匿称), createdTime=Thu Sep 15 07:39:00 CST 2016, time=2016-09-15, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2050477, encodeId=7c9520504e70b, content=<a href='/topic/show?id=95f8e042dd' target=_blank style='color:#2F92EE;'>#EST#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7042, encryptionId=95f8e042dd, topicName=EST)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=e9a6357, createdName=xiangyuzhou971, createdTime=Wed Feb 10 12:48:00 CST 2016, time=2016-02-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=47979, encodeId=0d8b4e979ff, content=值得看，好好收藏，谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=98, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=bc301610909, createdName=hixiaoluo, createdTime=Sat Dec 26 14:08:00 CST 2015, time=2015-12-26, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2029218, encodeId=bbae202921833, content=<a href='/topic/show?id=c46c63893a1' target=_blank style='color:#2F92EE;'>#气道阻塞#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=63893, encryptionId=c46c63893a1, topicName=气道阻塞)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8dca2500075, createdName=396094184_42047355, createdTime=Tue Nov 24 00:48:00 CST 2015, time=2015-11-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1696653, encodeId=53ab1696653f0, content=<a href='/topic/show?id=d2e99e651e4' target=_blank style='color:#2F92EE;'>#阻塞#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=20, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=97651, encryptionId=d2e99e651e4, topicName=阻塞)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=a23129903429, createdName=tomyang96, createdTime=Sat Nov 14 00:48:00 CST 2015, time=2015-11-14, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1588193, encodeId=46d31588193c5, content=<a href='/topic/show?id=1cb8e014e0' target=_blank style='color:#2F92EE;'>#ESI#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=15, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=7014, encryptionId=1cb8e014e0, topicName=ESI)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f4f817593223, createdName=skhzy, createdTime=Sun Aug 23 05:48:00 CST 2015, time=2015-08-23, status=1, ipAttribution=)]
    2015-08-23 skhzy

    #ESI#

    0