控制呼吸持续性监护仪临床应用的可行性和有效性

doi:10.13481/j.1671-587X.20240427

摘要/Abstract

摘要：

目的观察利用人工气道内温度节律性变化原理设计的控制呼吸持续性监护仪在不同人群和不同人工气道内的应用，探讨其监测控制呼吸持续性的可行性和有效性，为临床呼吸监测提供新方法。方法选择择期行全身麻醉术的成人患者60例，1~3岁幼儿患者30例，美国麻醉师协会（ASA）分级Ⅰ-Ⅱ级；60例成人患者随机分为成人气管插管组（ATI组）和成人喉罩组（ALM组），每组30例，1~3岁幼儿患者30例设为幼儿气管插管组（CTI组）。全麻诱导后，CTI组和ATI组患者行气管插管，ALM组患者置入喉罩，连接麻醉机行机械通气，连接控制呼吸持续性监护仪，观察监护仪是否能探测出各组患者呼吸频率（RR），比较各组监护仪探测的RR和麻醉机设定频率；3组患者均于手术开始前模拟呼吸回路断开、麻醉机手控未转换为机控和呼吸回路缓慢漏气3种临床常见控制呼吸持续性改变场景，比较各组间监护仪发出报警方式和报警时间。结果 3组患者应用控制呼吸持续性监护仪均能检测出RR，各组内患者RR和麻醉机设定频率比较差异无统计学意义（P>0.05）。在模拟3种常见呼吸持续性改变的场景中，3组患者呼吸持续性监护仪均发出内容为“注意，呼吸停止”的人工语音报警信号，报警信号均被注意到，ATI组和ALM组控制呼吸持续性监护仪开始报警时间比较差异无统计学意义（P>0.05）。与回路缓慢漏气比较，同一组患者呼吸回路断开和手控未转换为机控场景时开始报警时间缩短（P<0.05）。结论在不同人群和不同人工气道内利用探测人工气道内温度节律性升降变化原理设计的控制呼吸持续性监护仪临床应用具有可行性及有效性，可为术中呼吸持续性监测和保障呼吸安全提供新方法。

关键词: 全身麻醉, 呼吸频率, 控制呼吸持续性, 监护仪, 呼吸气流温度

Abstract:

Objective To observe the application of the controlled respiratory persistence monitor designed based on the principle of rhythmic temperature variations in artificial airways among different populations and in various artificial airways， and to discuss the feasibility and efficacy of monitoring controlled respiration persistence， and to provide a new method for the clinical respiratory monitoring. Methods A total of 60 adult patients scheduled for general anesthesia， and 30 pediatric patients aged from 1 to 3 years old， classified as American Society of Anesthesiologists （ASA） Ⅰ-Ⅱ， were selected. A total of 60 adult patients were randomly divided into adult tracheal intubation （ATI） group and adult laryngeal mask（ALM） group， and there were 30 cases in each group. Additionally， 30 pediatric patients aged from 1 to 3 years old were regarded as pediatric tracheal intubation （CTI） group. After induction of general anesthesia， the patients in CTI and ATI groups were underwent tracheal intubation， while the patients in ALM group were given a laryngeal mask inserted and were connected to the anesthesia machine for mechanical ventilation. Whether or not the device could detect the respiratory rate （RR）of the patients in various groups was observed； the RR detected by the device and the frequency set on the anesthesia machine in various groups were compared. All the patients in three groups were simulated three common clinical scenarios of continuous respiration changes before surgery： disconnection of the breathing circuit， failure to switch from manual to mechanical control on the anesthesia machine， and slow air leakage in the breathing circuit. The ways to report the alert and start time of the atarm by the monitors were compared. Results The controlled respiratory persistence monitor was able to detect the RR of the patients in three groups， and there was no significantly difference between the RR detected by the device and the frequency set on the anesthesia machine （P>0.05）. In the simulated scenarios of common respiratory persistence changes， all the patients in three groups received an artificial voice alarm signaling “Attention， breathing has stopped.”， which was acknowledged. There was no significant difference in the start time of alarm of the controlled respiratory persistence monitor between ATI group and ALM group （P>0.05）. Compared with the start time of alarm of the patients in the same group across different scenarios， compared with slow air leakage in the breathing circuit， the start time to alarm for circuit disconnection and failure to switch from manual to mechanical control was shorter （P<0.05）. Conclusion The clinical application of the controlled respiratory persistence monitor device designed based on the principle of detecting rhythmic temperature variations within artificial airways is feasible and effective in different populations and artificial airways. This device offers a new method for monitoring the respiratory continuity and ensuring the respiratory safety during surgery.

Key words: General anesthesia, Respiratory rate, Controlled respiratory persistence, Monitor, Respiratory airflow temperature

中图分类号:

R443.8

封俊杰,路畅,程圣权,张霄,孙旭芳. 控制呼吸持续性监护仪临床应用的可行性和有效性[J]. 吉林大学学报(医学版), 2024, 50(4): 1123-1129.

Junjie FENG,Chang LU,Shengquan CHENG,Xiao ZHANG,Xufang SUN. Feasibility and efficacy of controlled respiratory persistence monitor in clinical application[J]. Journal of Jilin University(Medicine Edition), 2024, 50(4): 1123-1129.

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参考文献 29

1	柯宏，梅丽君，杨品玉. 麻醉中呼吸功能监测管理的重要性［J］. 中国现代药物应用， 2009， 3（15）： 184-185.
2	GAUCHER A， FRASCA D， MIMOZ O， et al. Accuracy of respiratory rate monitoring by capnometry using the Capnomask（R） in extubated patients receiving supplemental oxygen after surgery［J］. Br J Anaesth， 2012， 108（2）： 316-320.
3	金双燕，祁海鸥，周大春. 呼气末二氧化碳分压监测在麻醉复苏室中的应用［J］. 中华护理杂志， 2015，50（4）： 498-499.
4	BRANSON R D， MANNHEIMER P D. Forehead oximetry in critically ill patients： the case for a new monitoring site［J］.Respir Care Clin N Am，2004，10（3）： 359-367.
5	LEE L A， CAPLAN R A， STEPHENS L S， et al. Postoperative opioid-induced respiratory depression： a closed claims analysis［J］.Anesthesiology，2015，122（3）： 659-665.
6	VÁRADY P， MICSIK T， BENEDEK S， et al. A novel method for the detection of apnea and hypopnea events in respiration signals［J］. IEEE Trans Biomed Eng， 2002， 49（9）： 936-942.
7	蔡晓岚，刘洪英，范献良，等. 儿童阻塞性睡眠呼吸暂停低通气综合征的诊断［J］. 中华耳鼻咽喉科杂志， 2003， 38（3）： 161-165.
8	欧阳顺林，郑佩霞，褚玉敏，等. 便携式多导睡眠呼吸监测在成人阻塞性睡眠呼吸暂停低通气综合征诊断中的应用［J］. 中国耳鼻咽喉颅底外科杂志， 2012， 18（2）： 111-113.
9	MA X X， ZHANG S X， ZOU P K， et al. Paper-based humidity sensor for respiratory monitoring［J］. Materials， 2022， 15（18）： 6447.
10	MARJANOVIC N， MIMOZ O， GUENEZAN J. An easy and accurate respiratory rate monitor is necessary［J］.J Clin Monit Comput，2020，34（2）：221-222.
11	CRETIKOS M A， BELLOMO R， HILLMAN K，et al. Respiratory rate： the neglected vital sign［J］. Med J Aust， 2008， 188（11）： 657-659.
12	HAKIMI N， SHAHBAKHTI M， HORSCHIG J M，et al.Respiratory rate extraction from neonatal near-infrared spectroscopy signals［J］. Sensors （Basel）， 2023， 23（9）： 4487.
13	ADDISON P S， ANTUNES A， MONTGOMERY D， et al. Robust non-contact monitoring of respiratory rate using a depth camera［J］. J Clin Monit Comput， 2023， 37（4）： 1003-1010.
14	NUNZIA M， EMILIANO S， SERGIO S，et al. Breathing chest wall kinematics assessment through a single digital camera： A feasibility study［J］.Sensors （Basel， Switzerland），2023，23（15）：6960.
15	YOO W J， JANG K W， SEO J K， et al.Development of respiration sensors using plasticoptical fiber for respiratory monitoring inside MRI system［J］. J Opt Soc Korea， 2010， 14（3）： 235-239.
16	BAI Y E， XIE E， LI Q，et al. Fabrication and characterization of yarn-based temperature sensor for respiratory monitoring［J］. J Donghua Univ Engl Ed， 2022， 39（6）： 527-532.
17	MANSOUR E， VISHINKIN R， RIHET S， et al. Measurement of temperature and relative humidity in exhaled breath［J］. Sens Actuat B Chem， 2020， 304： 127371.
18	HÖPPE P. Temperatures of expired air under varying climate conditions［J］.Int J Biometeorol， 1981， 25（2）： 127-132.
19	ALLAN D. Eyes wide shut： improving physiologic monitoring during mechanical ventilation［J］.Pediatr Crit Care Med， 2016， 17（12）： 1180-1181.
20	NEJI B， FERKO N， GHANDOUR R， et al. Micro-fabricated RTD based sensor for breathing analysis and monitoring［J］. Sensors， 2021， 21（1）： 318.
21	CHIUMELLO D. Is humidification always necessary during noninvasive ventilation in the hospital？［J］. Respir Care， 2010， 55（7）： 950.
22	PLEIL J D， ARIEL GEER WALLACE M， DAVIS M D，et al. The physics of human breathing： flow， timing， volume， and pressure parameters for normal， ondemand， and ventilator respiration［J］. J Breath Res， 2021， 15（4）： 042002.
23	FIORILLO A S， CRITELLO C D， PULLANO S A. Theory， technology and applications of piezoresistive sensors： a review［J］. Sens Actuat A Phys， 2018， 281： 156-175.
24	ZHAO C， LIU D， XU G X， et al. Recent advances in fiber optic sensors for respiratory monitoring［J］. SSRN J， 2022，72：103000.
25	杨玉志. 医疗设备报警提示系统的探讨［J］. 中国医疗设备， 2010， 25（7）： 20-22.
26	QUATRARA B， COFFMAN J， JENKINS T， et al. The effect of respiratory rate and ingestion of hot and cold beverages on the accuracy of oral temperatures measured by electronic thermometers［J］. Medsurg Nurs， 2007， 16（2）： 105-108， 100.
27	佘守章. 围术期呼吸功能监测的进展［J］. 临床麻醉学杂志， 2007， 23（7）： 588-590.
28	郑嘉玲，吕杰，刘杨，等. 麻醉机不良事件相关数据分析［J］. 中国医学装备， 2020， 17（1）： 55-58.
29	程子雯，王清秀. 睡眠觉醒环路与全身麻醉后苏醒延迟神经机制的研究进展［J］. 同济大学学报（医学版），2023， 44（3）： 438-445.

Group	Start time of alarm
Group	Disconnection of breathing circuit	Failure to switch from manual to mechanical control	Slow air leakage in breathing circuit
	Disconnection of breathing circuit	Failure to switch from manual to mechanical control	Slow air leakage in breathing circuit
CTI	7.739±0.344^*	9.223±0.523^*	16.409±0.462
ATI	15.120±1.285^*	18.428±0.995^*	33.137±0.980
ALM	15.295±0.568^*	18.126±0.902^*	33.306±1.082
^*P<0.05 compared with slow air leakage in breathing circuit.

[1]	张宁, 朴美花, 王美堃, 刘楠, 冯春生. 全身麻醉非眼科手术患者术后发生眼损伤2例报告及文献复习[J]. 吉林大学学报(医学版), 2019, 45(01): 156-159.
[2]	王旭, 纪茗馨, 郝明月, 贾丽娜, 杨桐伟. 甲基强的松龙对全身麻醉老年患者术中呼吸力学参数的影响及其临床意义[J]. 吉林大学学报(医学版), 2017, 43(02): 361-364.
[3]	陈冰，刘昊川，陈鹏，赵国庆，高明. 右旋美托咪定对全髋置换择期手术全身麻醉患者围拔管期 血流动力学及苏醒过程的影响[J]. 吉林大学学报(医学版), 2013, 39(4): 804-809.