Page 95 - 2023-03-中国全科医学

·344· http: //www.chinagp.net E-mail: zgqkyx@chinagp.net.cn Jaunary 2023, Vol.26 No.3

【Abstract】 Background Noninvasive positive pressure ventilation （NPPV） is a major respiratory support
technique for patients with acute exacerbation of chronic obstructive pulmonary disease （AECOPD） and carbon dioxide（CO 2 ）
retention. However，the obvious dead space in available masks used for NPPV could easily lead to repeated CO 2 inhalation，
which affects the correction of CO 2 retention. Objective To develop a face mask with two channel and constant leakage（TCCL）
used for NPPV，and to examine its value in NPPV treatment of AECOPD patients with CO 2 retention. Methods Thirty patients
with AECOPD and type Ⅱ respiratory failure treated with NPPV were recruited from the ICU，the First Affiliated Hospital of
Chongqing Medical University from 2020 to 2021，and equally randomized into an experimental group（using the TCCL mask）
and an control group（using the traditional mask with an exhalation valve on the side for NPPV）. Treatment effectiveness
was assessed using arterial partial pressure of oxygen（PaO 2 ） and partial pressure of carbon dioxide（PaCO 2 ） monitored at
baseline，and at the end of 4，8，24，and 48 hours of NPPV treatment as well as 24 hours after NPPV cessation. Results

The two-way repeated measures ANOVA indicated that treatment time and treatment approach had no interactive effects on PaO 2
（P>0.05）. Treatment time produced significant main effects on PaO 2 （P<0.001），while treatment approach did not（F=0.153，
P=0.699）. In both groups，the level of PaO 2 at baseline was lower than that at the end of 4，8，24，and 48 hours of NPPV
treatment and 24 hours after NPPV cessation（P<0.05）；the level of PaO 2 at the end of 4 hours of treatment was lower than that
measured at the subsequent four time points（P<0.05）；the PaO 2 level at the end of 8 hours of treatment was lower than that at
48 hours of treatment and 24 hours after NPPV cessation（P<0.05）. The PaO 2 level at 24 hours of treatment was lower than that
at 48 hours of treatment in the control group （P<0.05）. The PaO 2 level at 24 hours of treatment was lower than that at 48 hours
of treatment and 24 hours after NPPV cessation in the experimental group（P<0.05）. But there was no significant difference in
PaO 2 level measured at each time point between the groups（P>0.05）. Treatment time and treatment approach had no interactive
effects on PaCO 2 （P>0.05）. Treatment time produced significant main effect on PaCO 2 （P<0.001），treatment approach also
exerted obvious effect on it（F=5.129，P=0.031）. Compared with the control group，the experimental group demonstrated lower
PaCO 2 levels at the end of 4，8 and 24 hours of treatment（P<0.05）. In both groups，the PaCO 2 level at baseline was higher
than that at the end of 4，8，24，and 48 hours after NPPV treatment and 24 hours after NPPV cessation（P<0.05）. The PaCO 2
level at the end of 4 hours of treatment was higher than that measured at the subsequent four time points（P<0.05）. The PaCO 2
level at the end of 8 hours of treatment was higher than that measured at the subsequent three time points（P<0.05）. The PaCO 2
level of the control group at 24 hours of treatment was higher than that at 48 hours of treatment and 24 hours after NPPV cessation
（P<0.05）. The PaCO 2 level in the experimental group at 24 or 48 hours of treatment was higher than that at 24 hours after NPPV
cessation. Conclusion TCCL mask may contribute to rapid correction of CO 2 retention and effective improvement of oxygenation
in AECOPD patients.
【Key words】 Pulmonary disease，chronic obstructive；Lung diseases；Respiratory failure；Mask；Blood gas
analysis；Positive-pressure respiration；Patent；Treatment outcome；Noninvasive positive pressure

慢性阻塞性肺疾病急性加重（acute exacerbation of 造成 NPPV 面罩内存在显著无效腔效应的主因是呼气阀
chronic obstructive pulmonary disease，AECOPD） 是 呼 安装部位。呼气阀是无创呼吸机的呼气通路，呼吸回路
吸系统多发疾病，常伴显著 CO 2 潴留。无创正压通气 内气体通过呼气阀外排至呼吸机外。呼气阀常规安装在
（noninvasive positive pressure ventilation，NPPV） 是 治 呼吸机管道与面罩之间，安装部位操作简单，但面罩内、
疗 AECOPD 合并 CO 2 潴留患者的重要呼吸支持技术 ［1-2］ 。 面罩与呼气阀之间的管道均存在呼气流和吸气流的气流
但因现有 NPPV 面罩内存在明显无效腔效应，容易导致 通道交叉问题；同时患者呼气时需对抗呼吸机基础气流
CO 2 重复呼吸 ［3-4］ ，影响 AECOPD 患者 CO 2 潴留的纠 的阻碍才能呼出气体，从而进一步增加了面罩内无效腔
正 ［5-6］ 。为有效解决 NPPV 面罩内无效腔效应及 CO 2 重 气体的排出难度。
复呼吸问题，本课题组发明了“具有双通道通气和恒定 为解决上述问题，本课题组创新性设计了 TCCL 面
泄气量功能（two channels and constant leakage，TCCL） 罩（三维模型设计见图 1）。TCCL 面罩将呼气阀由传
的 NPPV 面罩”（即 TCCL 面罩），并获国家实用新型 统安装部位改置于面罩前端，并采用平台型呼气阀。将
专利授权（专利号：ZL201822124366.6） ［7］ 。目前已 呼气阀改置于面罩前端可实现双通道（吸气通道、呼气
经完成 TCCL 面罩的发明设计、产品试制及临床应用研 通道）独立分布，可解决面罩内、面罩与呼气阀之间管
究，现报道如下。 道的吸呼气流通道交叉问题，并可利用呼吸机吸气流和
1 资料与方法 基础气流冲刷面罩内残留的气体，从而促进无效腔气体
1.1 设计思路与结构 外排；采用平台型呼气阀，可动态控制泄气孔大小以维
1.1.1 TCCL面罩设计思路及工作原理 本课题组发现， 持整个呼吸周期泄气量的相对恒定，确保面罩内吸入气