目的 通过主动模拟肺(ASL5000)模拟吸气努力,评价肌肉压力指数(pressure muscle index,PMI)与反映吸气努力水平指标包括吸气肌肉呼吸做功比例(percent of inspiratory muscle work of breathing,WOBmus%)和吸气肌肉压力-时间积分比例(percent of inspiratory muscle pressure time product,PTPmus%)之间的相关性.方法 基于ASL5000 平台进行实验设计,模拟 50个不同肺模型参数以及 25 个不同的压力支持(pressure support,PS)水平,共模拟 1 250 例具有不同自主呼吸水平的患者.通过软件对采集到的流速、气道压和食道压-时间波形数据进行线下分析.使用 Spearman 相关性分析对 PMI 和 WOBmus%、PTPmus%进行分析.结果 不同PMI分组患者之间的PS水平、WOBmus%和PTPmus%差异均有统计学意义.并且随着PMI数值增加,PS水平以及驱动压力逐步下降,呼吸机做功也随之减小.PMI与WOBmus%的Spearman相关系数为 0.874(P<0.001),PMI与PTPmus%的Spearman相关系数为 0.875(P<0.001).结论 PMI与WOBmus%、PTPmus%之间具有良好相关性,PMI可能是指导PS水平设置的一种无创、有效的指标.关于PMI在不同临床情境下的适用性,及其指导PS水平设置的有效性,未来需要更多的研究进行调查.
Correlation between pressure muscle index and inspiratory effort levels during pressure support ventilation:based on ASL5000
Objective To evaluate the correlation between pressure muscle index(PMI)and indicators reflecting inspiratory effort including percent of inspiratory muscle work of breathing(WOBmus%)and percent of inspiratory muscle pressure time product(PTPmus%)by using ASL5000.Methods The study was based on ASL5000,including 1 250 cases of patients with different levels of spontaneous breathing by adjusting 50 different lung model parameters and 25 different pressure support(PS)levels.The data of flow,airway pressure,and esophageal pressure-time waveform were analyzed offline.Spearman correlation analysis was performed on PMI and WOBmus%,PTPmus%.Results The significant differences were observed in PS levels,WOBmus%and PTPmus%among patients in different PMI groups.As PMI increased,PS level and driving pressure gradually decreased,and work of breathing of ventilator(WOBvent)also decreased.The Spearman correlation coefficient between PMI and WOBmus%was 0.874(P<0.001),and between PMI and PTPmus%was 0.875(P<0.001).Conclusion PMI shows good correlation between WOBmus%and PTPmus%,suggesting that PMI may be a non-invasive and effective indicator for guiding PS level settings.Further research is needed to investigate the applicability of PMI in different clinical scenarios and its validity in guiding PS level setting.
pressure muscle indexinspiratory effortpressure support ventilationASL5000correlation
NETL
NSTL
万方数据
维普
