基于模拟人类自然咳嗽的智能吸痰技术研究
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摘要
咳嗽是人体的一种保护性呼吸道反射。当呼吸道受到刺激后,通过咳嗽动作以排出呼吸道分泌物或异物,来保持呼吸道的清洁和通畅。然而对于重症监护室(ICU)中机械通气的患者来说,由于建立人工气道,不能产生有效咳嗽,痰液会淤积在呼吸道内进而危及生命。吸痰是机械通气病人保持呼吸道通畅,改善肺泡通气和换气功能的一种重要方法。然而现有的吸痰技术在效率、安全性及自动化方面存在严重缺陷。针对目前吸痰技术存在的问题,提出一种基于模拟人类自然咳嗽的智能吸痰技术,该技术采用压力-时间自适应控制算法,取代目前技术的开关控制,在安全性和效率方面有所提升。通过实验研究,该技术的数学模型和控制算法得到有效地验证。结果表明该技术对气道分泌物清除技术的发展具有很好的参考价值。
Cough is a protective respiratory airway reflex of human. When the respiratory airway is irritated, the secretions and foreign bodies can be excreted through a cough maneuver to keep the airway clean. However the ventilated patients in intensive care unit(ICU)cannot produce an effective cough because of the establishing of artificial airway. Along with the impaired cough, secretions can accumulate in airways which may threat life. As one of the most important nursing interventions of ventilated patients' respiratory tract, secretion clearance is usually used to keep the respiratory tract clear, improve alveolar ventilation and patients' breathe function. However, the existing secretion clearance technologies have serious defects in efficiency, safety and automation. Considering the defeats in current secretion clearance technologies, an intelligent secretion clearance technology based on simulation of the human natural cough is proposed. The pressure-time adaptive algorithm used in this technology has replaced the current open-loop control and improved the safety and efficiency. Through the experiment study, the mathematical model and control algorithm have been verified. The results show that this technology provides a constructive suggestion for the development of airway clearance technologies.
Cough is a protective respiratory airway reflex of human. When the respiratory airway is irritated, the secretions and foreign bodies can be excreted through a cough maneuver to keep the airway clean. However the ventilated patients in intensive care unit(ICU)cannot produce an effective cough because of the establishing of artificial airway. Along with the impaired cough, secretions can accumulate in airways which may threat life. As one of the most important nursing interventions of ventilated patients' respiratory tract, secretion clearance is usually used to keep the respiratory tract clear, improve alveolar ventilation and patients' breathe function. However, the existing secretion clearance technologies have serious defects in efficiency, safety and automation. Considering the defeats in current secretion clearance technologies, an intelligent secretion clearance technology based on simulation of the human natural cough is proposed. The pressure-time adaptive algorithm used in this technology has replaced the current open-loop control and improved the safety and efficiency. Through the experiment study, the mathematical model and control algorithm have been verified. The results show that this technology provides a constructive suggestion for the development of airway clearance technologies.
引文
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[14]TEHRANI F T.A control system for mechanical ventilation of passive and active subjects[J].Computer methods and programs in biomedicine,2013,110(3):511-518.
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[17]李晓芳,高敏,程青虹,等.两种吸痰负压对急性呼吸窘迫综合征病人血流动力学及血氧饱和度的影响[J].护理研究,2010,24(10):873-875.LI Xiaofang,GAO Min,CHENG Qinghong,et al.Influence of two different ways of negative pressure sputum aspiration on hemodynamics and blood oxygen saturation of patients with acute respiratory distress syndrome[J].Respiratory care,2010,24(10):873-875.
[18]BE’ERI E.Automated airway secretion clearance in the ICU by in-line inexsufflation:clinical implications and technology[M]//Humidification in the Intensive Care Unit.Springer Berlin Heidelberg,2012:237-243.
[19]CHATBURN R L.Computer control of mechanical ventilation[J].Respiratory care,2004,49(5):507-517.
[20]BRUNNER J X.History and principles of closed-loop control applied to mechanical ventilation[J].Nederlandse Vereniging voor Intensive Care,2002,6(4):6-9.
[21]REN S,CAI M,SHI Y,et al.Influence of bronchial diameter change on the airflow dynamics based on a pressure‐controlled ventilation system[J].International Journal for Numerical Methods in Biomedical Engineering,2017,34(3):2929.
[22]SHI Y,REN S,CAI M,et al.Modelling and simulation of volume controlled mechanical ventilation system[J].Mathematical Problems in Engineering,2014(1):271053-271060.
[23]SHI Y,REN S,NIU J,et al.An intelligent secretion clearance system based on pneumatics[C]//Fluid Power and Mechatronics(FPM),2015 International Conference on.IEEE,2015:355-359.
[24]JAIMCHARIYATAM N,DWEIK R A,KAW R,et al.Polysomnographic determinants of nocturnal hypercapnia in patients with sleep apnea[J].Journal of clinical sleep medicine:JCSM:official publication of the American Academy of Sleep Medicine,2013,9(3):209-215.
[2]BATEMAN J R,NEWMAN S P,DAUNT K M,et al.Is cough as effective as chest physiotherapy in the removal of excessive tracheobronchial secretions?[J].Thorax,1981,36(9):683-687.
[3]De B C,ZINMAN R.Cough versus chest physiotherapy.A comparison of the acute effects on pulmonary function in patients with cystic fibrosis.[J].American Review of Respiratory Disease,1984,129(1):182-184.
[4]KING M,BROCK G,LUNDELL C.Clearance of mucus by simulated cough[J].Journal of Applied Physiology,1985,58(6):1776-1782.
[5]LEINER G C,ABRAMOWITZ S O L,SMALL M J,et al.Expiratory peak flow rate 1:standard values for normal Subjects.Use as a clinical test of ventilatory function[J].American Review of Respiratory Disease,1963,88(5):644-651.
[6]SROUR N,LEBLANC C,KING J,et al.Lung volume recruitment in multiple sclerosis[J].PloS one,2013,8(1):e56676.
[7]BACH J R.Amyotrophic lateral sclerosis:predictors for prolongation of life by noninvasive respiratory aids[J].Archives of physical medicine and rehabilitation,1995,76(9):828-832.
[8]BACH J R,ISHIKAWA Y,KIM H.Prevention of pulmonary morbidity for patients with Duchenne muscular dystrophy[J].Chest,1997,112(4):1024-1028.
[9]BACH J R,GONCALVES M R,HAMDANI I,et al.Extubation of patients with neuromuscular weakness:Anew management paradigm[J].CHEST Journal,2010,137(5):1033-1039.
[10]DYHR T,BONDE J,LARSSON A.Lung recruitment manoeuvres are effective in regaining lung volume and oxygenation after open endotracheal suctioning in acute respiratory distress syndrome[J].Critical Care,2002,7(1):55.
[11]MUNNUR U,BANDI V D,GROPPER M A.Airway management and mechanical ventilation in pregnancy[M]//Pulmonary Problems in Pregnancy.Humana Press,2009:385-403.
[12]TSOUMAKIDOU M,SIAFAKAS N M.Novel insights into the aetiology and pathophysiology of increased airway inflammation during COPD exacerbations[J].Respiratory research,2006,7(1):80.
[13]MORRISSEY B M.Pathogenesis of bronchiectasis[J].Clinics in chest medicine,2007,28(2):289-296.
[14]TEHRANI F T.A control system for mechanical ventilation of passive and active subjects[J].Computer methods and programs in biomedicine,2013,110(3):511-518.
[15]GUGLIELMINOTTI J,DESMONTS J M,DUREUIL B.Effects of tracheal suctioning on respiratory resistances in mechanically ventilated patients[J].Chest,1998,113(5):1335-1338.
[16]LUCCHINI A,ZANELLA A,BELLANI G,et al.Tracheal secretion management in the mechanically ventilated patient:comparison of standard assessment and an acoustic secretion detector[J].Respiratory care,2011,56(5):596-603.
[17]李晓芳,高敏,程青虹,等.两种吸痰负压对急性呼吸窘迫综合征病人血流动力学及血氧饱和度的影响[J].护理研究,2010,24(10):873-875.LI Xiaofang,GAO Min,CHENG Qinghong,et al.Influence of two different ways of negative pressure sputum aspiration on hemodynamics and blood oxygen saturation of patients with acute respiratory distress syndrome[J].Respiratory care,2010,24(10):873-875.
[18]BE’ERI E.Automated airway secretion clearance in the ICU by in-line inexsufflation:clinical implications and technology[M]//Humidification in the Intensive Care Unit.Springer Berlin Heidelberg,2012:237-243.
[19]CHATBURN R L.Computer control of mechanical ventilation[J].Respiratory care,2004,49(5):507-517.
[20]BRUNNER J X.History and principles of closed-loop control applied to mechanical ventilation[J].Nederlandse Vereniging voor Intensive Care,2002,6(4):6-9.
[21]REN S,CAI M,SHI Y,et al.Influence of bronchial diameter change on the airflow dynamics based on a pressure‐controlled ventilation system[J].International Journal for Numerical Methods in Biomedical Engineering,2017,34(3):2929.
[22]SHI Y,REN S,CAI M,et al.Modelling and simulation of volume controlled mechanical ventilation system[J].Mathematical Problems in Engineering,2014(1):271053-271060.
[23]SHI Y,REN S,NIU J,et al.An intelligent secretion clearance system based on pneumatics[C]//Fluid Power and Mechatronics(FPM),2015 International Conference on.IEEE,2015:355-359.
[24]JAIMCHARIYATAM N,DWEIK R A,KAW R,et al.Polysomnographic determinants of nocturnal hypercapnia in patients with sleep apnea[J].Journal of clinical sleep medicine:JCSM:official publication of the American Academy of Sleep Medicine,2013,9(3):209-215.