Gal'perin Iu S, Kassil' V L
Anesteziol Reanimatol. 1997 May-Jun(3):72-7.
The authors analyze main features of high-frequency forced ventilation of the lungs (HF FVL). Estimations indicate that the end-respiration pulmonary positive pressure inevitably develops during HF FVL; its value is 30 cm H2O and it starts no later than 10 sec after the beginning of HF FVL. Experiments showed that the maximal and minimal pressure of the respiratory cycle measured at the site accessible for measurements outside the device (at the exit) differ appreciably from pulmonary pressure which is clinically impossible to measure but is much more valuable. For assessing this value the mean respiratory cycle pressure is to be measured whose values outside the device and inside the lungs are similar and virtually do not change if the frequency of HF FVL changes. The volume of dead space and internal elasticity of common FVL devices influence appreciably the created minute ventilation, particularly its alveolar component, and the probability of using such devices for HF FVL is doubtful. Requirements to the injector design for the most frequently used injection HF FVL are contradictory. A reasonable compromise on providing the needed consumption of inhaled gas and oxygen concentration in it within a sufficiently wide range of pressure may be attained by supplementing the device with a kit of special injectors. Estimations of gas movement in the airways do not validate the hypothesis on the turbulence in the transitory and respiratory zones of the tracheobronchial tree as a factor explaining the efficacy of HF FVL with low respiratory volumes.
作者分析了高频肺强制通气(HF FVL)的主要特征。估算表明,在高频肺强制通气期间不可避免地会出现呼气末肺正压;其值为30厘米水柱,且在高频肺强制通气开始后不迟于10秒就会出现。实验表明,在设备外部可测量的部位(出口处)测得的呼吸周期最大和最小压力与临床上无法测量但更有价值的肺内压力明显不同。为评估该值,需测量平均呼吸周期压力,其在设备外部和肺内的值相似,并且如果高频肺强制通气的频率改变,实际上不会变化。普通强制通气设备的死腔容积和内部弹性对产生的分钟通气量,特别是其肺泡部分,有明显影响,并且将此类设备用于高频肺强制通气的可能性存疑。对最常用的喷射式高频肺强制通气的喷射器设计要求相互矛盾。通过为设备配备一套特殊喷射器,可在足够宽的压力范围内合理地折中实现所需的吸入气体消耗量及其内的氧气浓度。对气道内气体运动的估算并未证实关于气管支气管树的过渡区和呼吸区内的湍流作为解释低呼吸量高频肺强制通气疗效的一个因素的假说。