Wassermann K, Koch A, Warschkow A, Mathen F, Müller-Ehmsen J, Eckel H E
IIIrd Medical Department, University of Cologne, Germany.
Laryngoscope. 1999 Sep;109(9):1516-20. doi: 10.1097/00005537-199909000-00029.
To evaluate a newly developed bronchoscopic technique for the assessment of intratracheal pressures.
In situ measurement of central airway resistance in 20 consecutive spontaneously breathing subjects. Thirteen patients had benign glottic or subglottic stenosis. Seven patients without central airway disease served as normal control subjects.
A pressure catheter was introduced into the trachea via the working channel. The pressure swing was measured upstream and downstream of the stenosis. Central airflow was monitored simultaneously using a commercial pneumotachograph attached to a mouthpiece. Data acquisition frequency was 500 Hz. Prestenotic and poststenotic inspiratory and expiratory resistances could be calculated and displayed from the raw data off-line.
Inspiratory and expiratory resistances measured in mid-trachea or below the stenosis (subglottic) were 0.36 +/- 0.13 and 0.35 +/- 0.13 kPa.s/L for the control subjects (C), 1.11 +/- 0.47 and 0.65 +/- 0.26 kPa.s/L for patients who did not need to be operated on (NOOP), 7.11 +/- 7.19 and 3.35 +/- 2.25 kPa.s/L respectively for those who required surgical correction (OP). Supraglottic inspiratory and expiratory resistances for C were 0.22 +/- 0.09 and 0.25 +/- 0.06 kPa.s/L, for NOOP 0.15 +/- 0.10 and 0.14 +/- 0.11 kPa.s/L, and for OP 0.26 +/- 0.13 and 0.24 +/- 0.07 kPa.s/L respectively. The cut-off point for surgical correction was estimated to be > 2.5 kPa.s/L of inspiratory resistance. Concurrent expiratory values showed a considerable overlap between OP and NOOP. No correlation could be established between local resistance values and dyspnea score.
In situ subglottic flow-pressure tracing in spontaneously breathing patients who present with benign obstruction of the upper airways is well tolerated and may help to identify patients who need surgical correction.
评估一种新开发的用于评估气管内压力的支气管镜技术。
对20名连续的自主呼吸受试者进行中央气道阻力的原位测量。13例患者患有良性声门或声门下狭窄。7例无中央气道疾病的患者作为正常对照。
通过工作通道将压力导管插入气管。在狭窄部位的上游和下游测量压力波动。使用连接到咬嘴的商用呼吸流速计同时监测中央气流。数据采集频率为500Hz。可以从离线的原始数据中计算并显示狭窄前和狭窄后的吸气和呼气阻力。
对照组（C）在气管中部或狭窄下方（声门下）测量的吸气和呼气阻力分别为0.36±0.13和0.35±0.13kPa·s/L，无需手术的患者（NOOP）为1.11±0.47和0.65±0.26kPa·s/L，需要手术矫正的患者（OP）分别为7.11±7.19和3.35±2.25kPa·s/L。C组声门上吸气和呼气阻力分别为0.22±0.09和0.25±0.06kPa·s/L，NOOP组为0.15±0.10和0.14±0.11kPa·s/L，OP组分别为0.26±0.13和0.24±0.07kPa·s/L。手术矫正的临界点估计为吸气阻力>2.5kPa·s/L。同时测量的呼气值显示OP组和NOOP组之间有相当大的重叠。局部阻力值与呼吸困难评分之间未发现相关性。
对上气道良性梗阻的自主呼吸患者进行原位声门下血流-压力描记耐受性良好，可能有助于识别需要手术矫正的患者。
