一种可调节呼气末正压的新型高流量气管接口在急性呼吸窘迫综合征体外肺模型中的验证

doi:10.3969/j.issn.1006-5725.2026.09.024

摘要/Abstract

摘要：

目的本研究旨在验证一种能解决经气管高流量氧疗（high-flow tracheal oxygen， HFTO）患者在气管切开后，因缺乏上气道阻力而难以产生有效呼气末正压（positive end-expiratory pressure， PEEP），从而导致急性呼吸窘迫综合征（acute respiratory distress syndrome， ARDS）的新型高流量气管接口，并分析其在ARDS体外肺模型中生成PEEP及改善肺力学的能力。方法采用随机交叉体外实验，构建HFTO-新型/传统接口-模拟肺系统，模拟ARDS（顺应性51 mL/cmH₂O，阻力5.1 cmH₂O·s/L）。设定流量10 ~ 80 L/min（间隔10 L/min），比较两种接口对PEEP、功能残气量（FRC）、潮气量（Vt）及吸入氧浓度（FiO₂）等参数的影响。结果在40 ~ 60 L/min流量下，新型接口显著提升PEEP（3.9 ~ 7.3 cmH₂O vs. 2.5 ~ 5.0 cmH₂O，P < 0.001）及FRC（P < 0.01），Vt轻微降低；FiO₂稳定性差异无统计学意义（P ? 0.05）。PEEP与流量呈良好幂函数关系（R2 = 0.987）。结论该新型接口可通过模拟上气道阻力有效生成临床相关水平的PEEP，有望改善ARDS气管切开患者的肺复张。

关键词: 经气管高流量氧疗, 新型高流量气管接口, 呼气末正压, 功能残气量, 潮气量, 急性呼吸窘迫综合征

Abstract:

Objective High-flow tracheal oxygen （HFTO） often fails to generate effective positive end-expiratory pressure （PEEP） in tracheostomized patients with acute respiratory distress syndrome （ARDS） due to bypassed upper airway resistance. This study evaluated whether a novel high-flow tracheal interface could generate therapeutic PEEP levels and improve pulmonary mechanics in a mechanical lung model of ARDS. Methods In this randomized crossover bench study， an integrated system comprising a high-flow oxygen device， tracheostomy tube， and ARDS-programmed mechanical lung simulator （compliance： 51 mL/cmH?O； resistance： 5.1 cmH?O·s/L） was connected via either the novel or conventional interface. Gas flow was incrementally titrated from 10 to 80 L/min. Primary outcomes included PEEP， functional residual capacity （FRC）， tidal volume （Vt）， and FiO? delivery stability. Results At clinically relevant flow rates （40 ? 60 L/min）， the novel interface generated significantly higher PEEP （3.9 ? 7.3 cmH?O vs. 2.5 ? 5.0 cmH?O， P < 0.001） and FRC （P < 0.01） compared with the conventional interface， with only a modest reduction in Vt. FiO? stability remained comparable between interfaces （P ? 0.05）. PEEP demonstrated a robust power-function relationship with flow rate （R2 = 0.987）， enabling predictable pressure titration. Conclusion By simulating upper airway resistance， the novel high-flow tracheal interface effectively generates therapeutic PEEP levels， potentially facilitating lung recruitment in tracheostomized patients with ARDS.

Key words: high-flow tracheal oxygen, novel high-flow tracheal interface, positive end-expiratory pressure, functional residual capacity, tidal volume, acute respiratory distress syndrome

中图分类号:

R563.8

侯安纳,徐若男,焦风伟,米崧,张黎明. 一种可调节呼气末正压的新型高流量气管接口在急性呼吸窘迫综合征体外肺模型中的验证[J]. 实用医学杂志, 2026, 42(9): 1670-1680.

Anna HOU,Ruonan XU,Fengwei JIAO,Song MI,Liming ZHANG. Validation of a novel high-flow tracheal interface with adjustable positive end-expiratory pressure in an ex vivo lung model of acute respiratory distress syndrome[J]. The Journal of Practical Medicine, 2026, 42(9): 1670-1680.

图/表 5

图1

图2

表1

实验研究中的主要和次要终点指标 (x ± s)"

参数	接口类型	气体流量/(L/min)
参数	接口类型	10	20	30	40	50	60	70	80	P值^※
PEEP/cmH₂O	传统接口	0.4 ± 0.2	0.8 ± 0.2	1.6 ± 0.2	2.5 ± 0.3	3.2 ± 0.3	5.0 ± 0.3	6.1 ± 0.5	7.9 ± 0.6	< 0.001
	新型接口	0.5 ± 0.2	1.0 ± 0.3	2.5 ± 0.2	3.9 ± 0.5	5.1 ± 0.5	7.3 ± 0.5	10.1 ± 0.6	13.4 ± 0.6	< 0.001
	P值^*	0.605	0.233	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001
FRC/mL	传统接口	1 502.8 ± 16.3	1 511.7 ± 16.6	1 522.4 ± 16.5	1 537.5 ± 11.6	1 553.4 ± 15.0	1 578.4 ± 19.3	1 604.3 ± 17.9	1 650.7 ± 19.3	< 0.001
	新型接口	1 509.7 ± 14.8	1 519.7 ± 19.9	1 534.6 ± 14.6	1 559.3 ± 13.4	1 588.5 ± 17.4	1 670.5 ± 17.4	1 781.6 ± 15.1	1 963.7 ± 13.2	< 0.001
	P值^*	0.335	0.337	0.096	0.001	< 0.001	< 0.001	< 0.001	< 0.001
Vt/mL	传统接口	235.7 ± 6.3	229.2 ± 6.9	221.3 ± 12.6	216.7 ± 16.8	212.6 ± 7.0	209.1 ± 24.5	208.2 ± 8.5	205.2 ± 7.8	< 0.001
	新型接口	239.3 ± 9.2	227.3 ± 10.2	216.0 ± 21.3	208.6 ± 10.7	198.6 ± 5.9	189.9 ± 10.4	182.9 ± 11.1	178.3 ± 14.9	< 0.001
	P值^*	0.323	0.623	0.514	0.218	< 0.001	0.034	< 0.001	< 0.001
Ptp-EI/cmH₂O	传统接口	8.1 ± 1.0	8.3 ± 1.1	8.6 ± 1.2	9.0 ± 0.9	9.3 ± 0.8	9.7 ± 0.4	10.2 ± 0.9	11.0 ± 0.6	< 0.001
	新型接口	8.3 ± 1.1	8.5 ± 1.1	9.4 ± 0.8	9.8 ± 0.9	10.1 ± 1.4	10.5 ± 0.9	11.9 ± 1.1	14.0 ± 0.8	< 0.001
	P值^*	0.680	0.695	0.110	0.078	0.130	0.031	0.001	< 0.001
Ptp-EE/cmH₂O	传统接口	0.0 ± 0.1	0.1 ± 0.1	0.6 ± 0.1	1.3 ± 0.2	2.2 ± 0.2	3.4 ± 0.3	4.9 ± 0.2	5.7 ± 0.3	< 0.001
	新型接口	0.1 ± 0.1	0.5 ± 0.1	1.4 ± 0.2	2.6 ± 0.2	4.1 ± 0.3	6.2 ± 0.2	7.3 ± 0.3	9.5 ± 0.3	< 0.001
	P值^*	0.003	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001
PIP/ cmH₂O	传统接口	-3.5 ± 0.5	-3.1 ± 0.4	-3.0 ± 0.5	-2.6 ± 0.5	-2.3 ± 0.6	-2.2 ± 0.7	-1.9 ± 0.6	-1.6 ± 0.4	< 0.001
	新型接口	-3.6 ± 0.7	-3.0 ± 0.4	-2.5 ± 0.5	-2.2 ± 0.6	-1.9 ± 0.5	-1.3 ± 0.5	-0.9 ± 0.4	-0.5 ± 0.4	< 0.001
	P值^*	0.710	0.497	0.063	0.128	0.154	0.003	< 0.001	< 0.001
PEP/cmH₂O	传统接口	3.4 ± 0.8	3.9 ± 0.6	4.9 ± 0.5	5.3 ± 0.8	6.3 ± 0.5	7.5 ± 0.7	9.0 ± 0.4	10.2 ± 0.8	< 0.001
	新型接口	3.8 ± 0.5	4.9 ± 0.4	6.1 ± 0.4	7.5 ± 0.5	8.3 ± 0.4	10.4 ± 0.6	12.4 ± 0.5	14.8 ± 0.6	< 0.001
	P值^*	0.213	0.001	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001
PEIC/cmH₂O	传统接口	-5.0 ± 0.1	-4.9 ± 0.5	-4.8 ± 0.3	-4.8 ± 0.4	-4.7 ± 0.5	-4.7 ± 0.3	-4.6 ± 0.3	-4.2 ± 0.3	< 0.001
	新型接口	-4.8 ± 0.3	-4.7 ± 0.3	-4.7 ± 0.4	-4.6 ± 0.4	-4.4 ± 0.3	-4.0 ± 0.3	-3.7 ± 0.3	-2.6 ± 0.3	< 0.001
	P值^*	0.060	0.353	0.323	0.304	0.043	< 0.001	< 0.001	< 0.001
PEEC/cmH₂O	传统接口	-0.1 ± 0.1	-0.1 ± 0.1	0.0 ± 0.0	0.1 ± 0.1	0.2 ± 0.1	0.3 ± 0.1	0.5 ± 0.1	0.8 ± 0.1	< 0.001
	新型接口	-0.1 ± 0.1	0.0 ± 0.2	0.1 ± 0.1	0.2 ± 0.1	0.4 ± 0.1	0.9 ± 0.1	1.5 ± 0.1	2.3 ± 0.1	< 0.001
	P值^*	0.809	0.308	< 0.001	0.001	< 0.001	< 0.001	< 0.001	< 0.001
FiO₂/%	传统接口	34.8 ± 1.1	37.7 ± 1.3	42.7 ± 1.7	45.0 ± 2.2	47.2 ± 1.7	47.8 ± 2.2	48.3 ± 2.5	48.2 ± 1.9	< 0.001
	新型接口	35.4 ± 1.2	38.7 ± 3.0	43.7 ± 2.1	46.2 ± 2.1	47.8 ± 2.4	48.1 ± 2.5	48.6 ± 2.1	49.0 ± 2.5	< 0.001
	P值^*	0.277	0.349	0.231	0.237	0.545	0.760	0.763	0.469

表1

图3

图4

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