Theissen J, Lunkenheimer P P, Frieling G, Niederer P, Stroh N, Bossler R, Mersch J, Redmann K
Klinik für Anaesthesiologie und operative Intensivmedizin, Westfälischen Wilhelmsuniversität, Mäunster.
Anaesthesist. 1988 Mar;37(3):182-6.
From the history of ventilatory support, the early studies of Auer und Meltzer only now seem to find a functional explanation. A rotating valve mounted on the tip of an endotracheal tube delivers a widespread gas bolus. The turbulent flow acts as a stirring device on the intrapulmonary gas volume. The method reduces the directional selectivity that typically limits the efficiency of jet ventilation. Systematically changing the rotational frequency between 10 and 80 Hz allows sequential stimulation, compartment by compartment, of the entire lung, which also gives rise to frequency-dependent local air-trapping that sequentially inflates different compartments. Jet ventilation and high-frequency oscillation were compared in dogs with the rotating valve tube by taking blood gas samples from 4-6 intrapulmonary veins: jet ventilation is characterized by preponderant ventilation of lung compartments opposite the lower aperture of the endotracheal tube. High-frequency oscillation induces a frequency dependent repartition of alveolar ventilation. The rotating valve tube definitely contributes to the homogenisation of alveolar ventilation in a manner that is less dependant upon segmental compliance than conventional ventilation.
从通气支持的历史来看,奥尔和梅尔策早期的研究直到现在似乎才找到一种功能上的解释。安装在气管导管尖端的旋转阀可输送广泛分布的气体团块。湍流对肺内气体量起到搅拌装置的作用。该方法降低了通常限制喷射通气效率的方向选择性。系统地将旋转频率在10至80赫兹之间变化,能够逐区顺序刺激整个肺部,这也会导致频率依赖性局部气体潴留,从而使不同区域依次充气。通过从4至6条肺内静脉采集血气样本,对使用旋转阀导管的犬进行喷射通气和高频振荡的比较:喷射通气的特点是气管导管下口相对的肺区通气占优势。高频振荡会引起频率依赖性的肺泡通气重新分布。旋转阀导管确实有助于肺泡通气的均匀化,其方式比传统通气更少依赖节段顺应性。