CN102196837A - 利用开放的气道界面提供机械通气的方法和装置 - Google Patents

利用开放的气道界面提供机械通气的方法和装置 Download PDF

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CN102196837A
CN102196837A CN2009801419880A CN200980141988A CN102196837A CN 102196837 A CN102196837 A CN 102196837A CN 2009801419880 A CN2009801419880 A CN 2009801419880A CN 200980141988 A CN200980141988 A CN 200980141988A CN 102196837 A CN102196837 A CN 102196837A
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gas
patient interface
airway
gas delivery
delivery circuit
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CN102196837B (zh
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T·阿勒姆
A·翁德卡
J·西波隆
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Breathe Technologies Inc
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Abstract

本发明描述了使用一种开放式气道病人界面来向病人提供机械通气支持的方法、系统和设备。所述系统包括气体输送线路和病人界面，所述病人界面构造成优化通气系统的性能和效率。通气系统可包括用于提供通气气体的呼吸机。病人界面可包括与病人气道相连通的远侧端部、与环境空气相连通的近侧端部以及位于所述远侧端部和近侧端部之间的气流通道。气体输送线路可适于附接到所述病人界面而不闭塞所述病人界面，以便允许环境空气从所述病人界面外侧流到所述病人气道中。所述通气气体可携带来自环境的空气和来自所述病人气道的空气。

Description

利用开放的气道界面提供机械通气的方法和装置
优先权申请
本申请要求于2008年8月22日提交的美国临时专利申请序号No.61/091,198、2009年8月22日提交的美国临时专利申请序号No.61/136,269的优先权，它们所公开的内容以参引的方式合并于此。
相关申请的交叉引用
本申请还以全文参引的方式合并：于2004年2月4日提交的美国非临时专利申请序号No.10/771,803(美国印刷公布2005/0034721)，于2004年6月17日提交的美国非临时专利申请序号No.10/870,849(美国印刷公布2005/0005936)，于2008年9月26日提交的美国非临时专利申请序号No.12/239,723(美国印刷公布2009/0151724)。
技术领域
本发明涉及用于正在遭受呼吸机能障碍和呼吸失调的人的通气疗法，例如该人正在遭受慢性阻塞性肺疾病(COPD)，肺纤维化、急性呼吸窘迫综合症(ARDS)，神经肌肉损伤，睡眠呼吸暂停，流行性感冒，不同形式的集体事故，和军事用途，和/或其他呼吸和气道损伤。更具体地，本发明涉及使用开放的气道通气系统向病人提供机械呼吸支持。
背景技术
现在存在两种通用类型的机械通气控制模式。第一种类型基于与病人行为无关的、临床医生选择的频率将气体输送给病人。这种类型的通气称为受控机械通气，用于需要呼吸机使病人呼吸时，例如，当病人是非警觉的，病人是镇静的，反应迟钝的或者瘫痪的。第二类型的通气称为辅助机械通气或者辅助通气或者增强通气，其响应病人的吸气努力，将气体输送给病人。这种类型的通气帮助病人呼吸，例如病人呼吸机能不全，如COPD。还存在组合上述两种通气模式的通气模式和呼吸机。
在所有呼吸机的使用中，需要气体输送线路以将气体从呼吸机输送到病人。还需要与病人气道连通的通气病人界面。气体输送线路连接病人界面，从而呼吸机通过气体输送线路和通过病人界面能将气体输送到病人气道。这些界面可以是非侵害性的，例如位于鼻子和/或嘴上方的面罩或者鼻套管，或者是侵害性的，例如气管内导管，气管切开插管，或者插入病人气道的经气管的导管。
在呼吸支持通气的更具体的情形中，病人通过病人界面接收来自呼吸机的气体，所述病人界面称为“开放式气道”系统，意味着病人的呼吸道通过他们的正常上气道呼吸路径(嘴和鼻子)对大气是开放的。开放式气道通气(OAV)通常用于需要呼吸支持的自发呼吸病人；然而，OAV还可以用于不能呼吸的依赖呼吸机的病人。在前一种情形下，病人可以通过上气道“自发地”或者自然地呼吸，但是他们的呼吸通过“开放式”病人界面接收来自呼吸机的气体而得到增强。这种疗法的目的在于利用OAV系统帮助病人的呼吸工作，从而病人不受到封闭式气道正压通气的各种问题，限制，强迫和副作用的妨碍。在美国专利7,487,778(Freitag)和美国印刷公布2005/0005936(Wondka)中描述了这种系统。现有技术中描述的通气界面通常是经由皮肤通过病人颈部安置到气管腔中的经由气管的通气导管，或者安置到现存气道管道中，例如无气囊的(uncuffed)气管切开插管。可替代地，通气导管是安置到支架或者人造口导向装置中，例如Montgeomey T-Tube，或者气管内导管，或者气道假体。在OAV中，向肺部提供机械通气支持是明显不可能的，这是因为呼吸机输送的空气存在当气道是开放的时从上气道泄露出去的可能性，从而使系统无效，限制能够输送到肺部的添加量。因此，需要专门气流输送流体动力学以使系统有效和高效，还需要专门的输送系统和界面设计以实现上述动力学。
发明内容
本发明涉及用于提供在开放式气道通气系统中呼吸机械支持的方法和系统。在本发明的实施例中，通气系统可包括用于提供通气气体的呼吸机。病人界面可包括与病人气道相连通的远侧端部、与环境空气相连通的近侧端部以及位于所述远侧端部和近侧端部之间的气流通道。气体输送线路可适于附接到所述病人界面而不闭塞所述病人界面，以便允许环境空气从所述病人界面的外侧流到所述病人气道。通气气体可携带来自环境的空气和来自所述病人气道的空气。
在本发明的另一实施例中，通气系统可包括用于提供通气气体的呼吸机。病人界面可包括与病人气道相连通的远侧端部、与环境空气相连通的近侧端部和位于所述远侧端部和近侧端部之间的气流通道。气体输送线路可适于附接到所述病人界面而不闭塞所述病人界面，以便环境空气从所述病人界面外侧流到所述病人气道。所述气体输送线路可包括位于所述气体输送线路的远侧端部的喷嘴，其中，在供给通气气体时，所述喷嘴位于所述病人界面的外侧。
在本发明的又一实施例中，通气系统可包括用于提供通气气体的呼吸机。病人界面可包括与病人气道相连通的远侧端部、与环境空气相连通的近侧端部以及位于所述远侧端部和近侧端部之间的气流通道。所述远侧端部可包括一个或多个窗孔。气体输送线路可适于附接到所述病人界面而不闭塞所述病人界面，以便允许环境空气从所述病人界面外侧流到所述病人气道。所述气体输送线路可包括位于所述病人界面内部的喷嘴，其中，当供给通气气体时，所述喷嘴位于所述一个或多个窗孔的邻近。
本发明的实施例可包括一种通气系统，所述通气系统包括呼吸机、气体输送管道和病人界面，所述病人界面包括与病人气道相连通的远侧端部、与环境空气相连通的近侧端部，其中，所述气体输送线路适于附接到所述病人界面而不闭塞所述病人界面，从而允许环境空气从界面外侧流到所述病人气道中，所述气体输送线路适于将呼吸机气体通过所述病人界面输送到所述病人气道中。本发明的实施例同样可包括通气系统，所述通气系统包括呼吸机、气体输送线路和病人界面，所述病人界面包括远侧端部和近侧端部以及从所述近侧端部延伸到所述远侧端部的气流通道，所述远侧端部与病人气道相连通，所述近侧端部与环境空气相连通，以及：(a)所述气体输送线路包括连接于所述呼吸机的第一端部和连接于所述病人界面的第二端部，其中，所述第二端部与所述病人界面的连接部不闭塞所述气流通道，从而环境空气可通过气流通道流入所述气道中；和(b)所述气体输送线路将气体从所述呼吸机输送到所述病人气道。本发明的实施例同样包括一种通气系统，所述通气系统包括呼吸机、气体输送线路和病人界面，其中，所述病人界面包括远侧端部和近侧端部以及从所述近侧端部延伸到所述远侧端部的气流通道，所述远侧端部与病人气道相连通，所述近侧端部与环境空气相连通，以及：(a)气体输送线路包括连接于所述呼吸机的第一端部和连接于所述病人界面的第二端部，所述第二端部与所述病人界面的连接部不闭塞所述气流通道，从而环境空气通过所述气流通道流入到所述气道中，肺部空气可流出所述气流通道，流到环境空气中；和(b)所述气体输送线路将气体从所述呼吸机输送到所述病人气道中。本发明的实施例同样包括一种通气系统，所述通气系统包括呼吸机和气体输送线路，所述气体输送线路包括适于连接所述呼吸机的第一端部和包括适于连接通气病人界面的连接器的第二端部，其中，所述第二端部连接器适于连接所述通气病人界面，从而所述通气病人界面保持开放式通道，这样，所述开放式通道允许环境空气从环境通过所述病人界面输送到气道中。
本发明的实施例同样包括当使用者所选择的容量与病人吸气周期同步时，所述呼吸机气体被输送。所述呼吸机气体可以连续地、以所述呼吸机确定的速率周期地输送，当容量与病人呼吸并且与在一段时间内输送强制次数呼吸的后备速率(back up rate)周期性地同步时，或者当容量周期性地在吸气周期中减小呼吸工作，和周期性地在呼气周期中构建PEEP时。所述系统可用来治疗肺部疾病，呼吸紊乱或者神经肌肉紊乱。所述系统可使用便携气体供给和用于提高移动性。病人界面可以是气道导管、气管切开插管，T-管和气孔支架、细孔，气管内插管，经环甲膜管，环喉部切除管，面罩，鼻罩，口罩，鼻-口罩，套管，经气管的套管，鼻套管，口部套管或者鼻-咽喉套管。
本发明的实施例可包括下述这些位置，即在此处，所述气体输送线路的第二端部包括两个气体输送排出口，其中，所述通气病人界面包括左和右鼻套管；所述气体输送线路的第二端部包括远侧顶端，其中，所述远侧顶端包括气体输送喷嘴，并且适于将所述气体输送喷嘴设置在所述通气病人界面的远侧端部和近侧端部之间；所述气体输送线路的远侧顶端与所述气道导管的入口共面；所述气体输送线路的远侧顶端与从直部分到弯部分的过渡部分共面；所述气体输送线路连接所述病人界面的连接装置包括一个调整装置以调整所述喷嘴的远侧顶端的位置。
在某实施例中，所述病人界面可以是气道导管，所述气道导管包括窗孔，所述气体输送线路的远侧顶端设置在所述窗孔附近；所述气体输送线路的远侧顶端是小外形的，喷嘴是气体输送线路的远侧顶端的侧孔；所述气体输送线路的远侧顶端是有角度的，以便指向气道导管的远侧开口；所述气体输送线路的远侧端部使用肘形连接器附接于病人界面；所述气体输送线路的远侧端部使用T形连接器附接到病人界面；所述气体输送线路的远侧端部使用L形连接器附接到病人界面；所述气体输送线路的远侧端部使用旋转连接器附接到病人界面；所述气体输送线路的远侧端部使用包括允许空气沿吸入方向流动的单向吸气阀的连接器附接到病人界面；所述气体输送线路的远侧端部使用包括允许空气沿呼出方向流动的单向呼气阀的连接器附接到病人界面；连接于所述病人界面的所述气体输送线路的远侧端部连接装置包括PEEP阀；连接于所述病人界面的所述气体输送线路的远侧端部连接装置包括PEEP阀，其中，所述PEEP阀包括调整装置；连接于所述病人界面的所述气体输送线路的远侧端部连接装置包括PEEP阀，其中，所述PEEP阀的设定值受到所述呼吸机提供的压力信号的控制；连接于所述病人界面的所述气体输送线路的远侧端部连接装置包括吸气阀和呼气阀；连接于所述病人界面的所述气体输送线路的远侧端部连接装置包括吸气和PEEP阀；连接于所述病人界面的所述气体输送线路的远侧端部连接装置包括隔板连接装置；连接于所述病人界面的所述气体输送线路的远侧端部连接装置包括加热增湿器；连接于所述病人界面的气体输送线路的远侧端部连接装置包括具有ME、吸气阀和PEEP阀的连接器；连接于所述病人界面的气体输送线路的远侧端部连接装置包括具有侧连接器的连接器；连接于所述病人界面的气体输送线路的远侧端部连接装置包括具有两个侧连接器的连接器；所述气体输送线路远侧端部连接装置连接于所述病人界面的内侧；或者所述气体输送线路远侧喷嘴包括锥形内径ID，其中，所述锥形内径ID限制自较大尺寸到所述喷嘴远侧顶端处的较小尺寸的内径ID。
在某实施例中，所述呼吸机气体作为喷气排出所述气体输送线路的远侧端部，排出速度为50-530m/s；所述呼吸机气体作为喷气排出所述气体输送线路的远侧端部，这携带(entrain)了来自所述连接器外侧的环境空气，其中，携带量是所述呼吸机气体的25-300％。
在某实施例中，所述系统包括用来测量气体携带量的传感器，和用来调整和校准携带量的控制单元。所述系统可包括湿气输送、加湿管腔或者湿润气体输送配件。气体输送线路的远侧端部可包括呼吸传感器，所述呼吸传感器可以是包括检测管腔和检测口的压力检测线的呼吸传感器；一个检测口垂直于面向远侧方向的气流路径；一个检测口垂直于面向近侧方向的气流路径；检测口与气体流动路径平行；热量流动传感器；气道压力检测延伸线，其适于延伸到所述气道导管中一定距离；气道压力检测通道，以及其中所述气体输送线路包括检测连接器以连接所述病人界面检测通道；或者通气气体输送通道，压力检测通道，加湿输送通道，氧气流出输送通道，氧气和二氧化碳检测通道，和热量传感器线通道。
实施例可包括下述位置，在这些位置中，所述通气气体是空气，氧气渗入(bleed into)所述气道导管；所述通气气体是氧气；所述通气气体是空气和氧气的混合气体；或者氧气检测机构；二氧化碳检测机构。在某实施例中，所述呼吸机适于改变气体输出参数，以达到希望的FIO2；所述呼吸机适于改变气体输出参数以达到希望的气道压力；所述呼吸机适于改变气体输出参数，以达到希望的吸气流速；治疗气体渗入所述病人界面，例如氦气、NO、HeliOx；输出滴定算法，以使用生物反馈技术基于病人活动水平来调整输送量，例如呼吸速率，吸气强度，I∶E比，呼气成分；输出触发算法，以使用生物反馈技术基于病人舒适和活动水平来调整容量的输送的时间，例如呼吸速率，吸气强度，I∶E比，呼气成分；输送混合的空气和氧气，以及其中，所述呼吸机包括混合器，外侧氧气和空气供给，以及外部压缩机；输送混合的空气和氧气以及其中，所述呼吸机包括混合器，外部氧气和空气供给，以及内部压缩机；或者输送混合的空气和氧气以及其中，所述呼吸机包括混合器，外部氧气供给，其中，所述外部氧气供给是选自包括压缩氧气气体，液态氧气或者氧气浓缩机，和内部压缩机，气体分析器，增湿器单元，微处理器控制系统，以及肺部容量传感器。
考虑到下述详细描述，本发明的附加的特征、优点和实施例进行了阐明或者是明显的。此外，应当理解的是，本发明的前述概要和下面的详细描述时示例性的，意图是提供进一步的解释，而非限制所主张的本发明的范围。
附图说明
附图例示了本发明的优选实施例，并与详细说明一起用来解释本发明的原理，这里所包括的附图用来进一步理解本发明，并且作为说明书的一部分合并在说明书中。在附图中：
图1示出了现有技术的常规封闭式气道通气系统，使用了带有气囊(cuffed)的气管内导管。
图2示出了使用密封鼻罩的常规非侵害性通气系统。
图3示出了具有开放式气道病人界面的本发明的开放式气道通气系统的概略图。
图4示出了具有通气导管的气体输送线路，其中，通气导管安置到带有开放式连接的气管导管病人界面中，通气导管部分地延伸到气管导管中。
图5示出了具有通气导管的气体输送线路，其中，通气导管安置到具有开放式连接的气管导管病人界面中，通气导管延伸到远侧顶端突出气管导管的顶端。
图6示出了使用旋转肘形连接装置而连接到有窗孔的带气囊的气管导管病人界面的气体输送线路和通气导管，其中，通气导管的远侧顶端安置在窗孔附近，并且由旋转肘形连接器罩盖。
图7示出了使用旋转肘形连接装置而连接于具有窗孔的气管导管病人界面的气体输送线路和通气导管，通气导管的远侧端部位于窗孔附近。
图8示出了使用隔板连接装置而连接于气道导管的气体输送线路，喷嘴顶端设置在所述气道导管近侧端部一定距离处的外侧。
图9示出了使用开放式适配器连接于气道导管的气体输送线路，并且示出了输送到气道的气体源，还示出了呼吸检测延伸管。
图10示出了使用开放式肘形连接器连接于气道导管的气体输送线路。
图11示出了使用开放式T连接器连接于气道导管的气体输送线路。
图12示出了使用开放式旋转肘形连接装置而连接于气道导管的气体输送线路。
图13示出了使用具有滑动喷嘴调整装置的开放式适配连接器连接于气道导管的气体输送线路。
图14示出了使用开放式适配器连接装置而连接于气道导管的气体输送线路，其中，气体输送喷嘴设置于所述气道导管近侧端部的稍微内侧。
图15示出了使用开放式适配连接器连接于气道导管的气体输送线路，其中，气体输送喷嘴设置于所述气道导管内侧的一定距离处。
图16示出了使用小外形连接装置而直接连接于气道导管近侧端部的气体输送线路。
图17示出了使用小外形开放式连接装置而连接于气道导管的气体输送线路，其中，所述连接装置位于气道导管的近侧端部的内侧。
图18示出了使用开放式适配器连接装置而连接于气道导管的气体输送线路，其中，所述开放式适配器连接装置具有位于吸气阀的近侧端部上的吸气阀。
图19示出了使用具有侧连接器的开放式肘形适配器连接于气道导管的气体输送线路，其中，所述开放式肘形适配器具有附接于侧连接器的HME和吸气阀。
图20示出了使用开放式肘形连接装置连接于气道导管的气体输送线路，其中，所述开放式肘形连接装置具有附接于侧连接装置的PEEP或呼气阀和吸气阀。
图21示出了使用开放式适配器连接于气道导管并且具有用于气道呼吸检测和压力检测的延伸管的气体输送线路。
图22示出了使用开放式适配器连接于气道导管的气体输送线路，其中，所述气道导管具有气道检测通道，并且所述线路具有附接于所述检测通道的连接装置。
图23示出了使用具有湿气输送配件的开放式适配器连接于气道导管的气体输送线路。
图24示出了使用附接有湿气导管的开放式适配器连接于气道导管的气体输送线路。
图25示出了使用开放式适配器连接于气道导管的气体输送线路，其中，在气体输送线路中具有整体式的呼吸检测和加湿输送通道。
图26示出了图25所示喷嘴构造的近视图。
图27示出了图25所示气体输送线路的剖视侧视图。
图28示出了连接于具有一个或多个检测口的气道导管的气体输送线路。
图29示出了沿图28的A-A剖面的截面图。
图30示出了图28的喷嘴的放大图，所述喷嘴具有面向呼气气流的呼吸检测口。
图31示出了图28的喷嘴的放大图，所述喷嘴具有面向吸气气流的呼吸检测口。
图32示出了图28的喷嘴的放大图，所述喷嘴具有面向呼气气流和吸气气流的呼吸检测口。
图33示出了使用开放式适配器连接于气道导管的气体输送线路，并且具有附接于所述开放式适配器以转换成封闭或者部分封闭的系统的阀。
图34示出了图33所示的阀的放大图。
图35示出了可替代图33所示的阀的可调整的阀。
图36示出了连接于病人界面面罩的气体输送线路。
图37示出了具有位于病人界面面罩外侧的喷嘴的、连接于病人界面面罩的气体输送线路。
图38示出了使用外部气体供给时开放式气道通气系统的系统示意图。
图39示出了使用内部压缩机、混合器、可选外部气体源和可选加湿单元时开放式气道通气系统的系统示意图。
图40示出了转换成封闭或部分封闭系统的开放式气道通气系统的系统示意图，其具有气体成分分析器、整体式混合器、外部氧气供给和肺的容量传感器。
具体实施方式
在一些情形下，专门气流输送流体动力学能够由通气气体的专门驱动压力和泄露速度构建，而在另一些情形下，专门气流输送流体动力学可由专门病人界面构造进行构建。本发明的实施例可包括专门病人界面构造和几何结构，这优化了开放式系统增强的通气的功效。
图1描述了常规通气系统，称为受控机械通气(CMV)，其中，呼吸机1用两肢式气体输送线路2连接于病人Pt，将气体经由吸入肢3输送给病人Pt，气体自肺部呼出通过呼出肢4回到呼吸机1。通常病人通气界面是位于气管T内的具有气囊7的气管内导管6，从而病人的肺部L与外界气体是封闭的，只通过呼吸机气体输送线路2连接于空气源。空气受迫进入肺部L，由于是不对环境开放的封闭式系统，呼吸机1能够增大肺部的容量。
图2描述了常规通气系统，一般称为持续气道正压通气(CPAP)系统。在这种情形中具有单肢式气体输送线路8，病人通过它进行呼气和吸气。这个系统也是封闭式的，因为病人通气界面通常是非侵害性的通气面罩9(称为非侵害性通气(NIV)面罩)，它密封病人的脸部，从而呼吸系统与环境大气封闭。非侵害性通气面罩可包括一个或多个面罩排气口10。在这个系统中，病人自发呼吸，但是自发呼吸由呼吸机1供给的气体供给。气体受迫进入肺部，呼吸机1能够增大肺部的容量，这是因为系统是封闭系统，不与环境相连接。气流可通过上气道UA和/或口咽导气管PA。
图3描述了本发明的典型开放式通气系统的概略图，其中，病人通过上气道自然地吸气和呼气。病人通气界面可以是气管切开插管或者气管内导管，一般用单肢式气体输送线路21连接于呼吸机20。单肢式气体输送线路21可联接于气道导管60。气道导管60可以是各种类型的结构，包括但不限于气管导管、面罩、套管等。这种情形中的呼吸机20可以提供通气辅助，或者增强病人的通气。如果呼吸管道足够大，使得病人能够通过呼吸管道部分地呼气，或者如果不是足够大，病人完全通过上气道呼出。
Freitag在美国专利申请No.2005/0003472中和Wondka在美国专利申请No.2005/0005936中描述了开放式通气系统。在这些参考文献中，呼吸管道是很小的，这是为了方便使用者，使使用者不引人注目，或者因为其他性能因素，例如气体输送动力学，因而病人完全通过自然呼吸路径(上气道)呼气，通过呼吸路径只接收增强的通气。由于专门呼吸机驱动压力和排出导管的排出气的流体动力学，尽管是开放式上气道系统，呼吸机仍具有增大肺部容量或者压力的可能性。标准气体输送技术，例如有氧疗法，肺部容量和压力不受影响。
图4描述了气管切开插管23和通气导管40组合的侧视图，其中，通气导管40和气管导管23之间的连接在气管导管近侧端部是开放的，导管远侧顶端45放置在气管导管23的一半长度附近的位置。这个构造可以通过气管导管开口增加来自环境空气的携带气流。这个构造可通过喷射泵的类似特征增强弥散效果。气管导管的远离导管顶端的区段称为喷射泵的喷嘴，靠近气管顶端的区段(包括气管导管近侧连接器的内部容量和气管导管连接器正外侧的环境空气容量)可认为是喷射泵的真空室，导管排出气从这里被携带进入到所述容量内。通气导管40可以是预成形的，以匹配气管导管23的曲率，或者可以成形为与气管导管的内侧的上表面接触，或者可以成形为与气管导管的内侧的下表面接触。通气导管40的远侧顶端可以是成角度的，以引导喷气通过气管导管气流通道24离开喷嘴，流向气管导管23的远侧顶端27开口，这对优化系统的喷射性能是必要的。通气导管40还可以成形为与气管导管23的侧壁中的一个接触。单肢式气体输送通道21可以联接于气管导管23，气管导管23使用气道导管连接器42而与连接器44相连通，优选是15mm连接器，气管导管23还与气管导管法兰43相连通。
图5描述了气管切开导管构造的侧视图，其中，通气导管40延伸超过气管导管23的顶端。自通气导管40排出的气体可携带来自导管T的上气道流和来自气管导管气流通道24的内部及来自气管导管23的邻近外侧的一些气体。如果通气导管40和气管导管23之间的连接在气管导管23的近侧端部是封闭的，不存在环境空气通过气管导管气流通道24的额外携带，病人不能通过该路径呼吸。然而，如果气管导管23/通气导管40连接是开放的，可能存在环境空气的额外携带，这取决于导管的顶端的实际位置，进而病人能通过该路径及上气道路径呼吸。
图6描述了一种构造的侧视图，其中，气管导管23包括沿其长度的一个或多个窗孔25。通气导管远侧顶端45喷嘴可以设置在窗孔25附近，以便携带空气通过窗孔25。在这种情形下，系统的真空或者携带室可以是(a)窗孔25上方的导管气道隔室和(b)气管导管23和旋转肘形连接器47及气管导管23外侧的环境空气。气管切开插管气囊26可以阻止上气道的空气流过气管通气导管40。通过调整构造的精确细节尺寸，例如窗孔的尺寸和位置，导管顶端的尺寸和位置，气管导管喷嘴部分的尺寸等，对于导管携带的空气和环境携带的空气，携带的气体的量能够增加或者减少。来自导管的携带气体是优选的，因为其携带的空气包括自然润湿的空气。有时，来自环境的通过气管导管的携带空气是优选的，例如，在上气道阻塞的情形下或者病人上气道变干而且不希望附加携带的情形下。通气气体输送线路21和通气导管40可以利用旋转肘形连接器47附接到气管导管连接器44，旋转肘形连接器47可以具有凹形15mm远侧连接器48和凸形15mm近侧连接器49。可选择地，气管导管或旋转肘形连接器的近侧连接器可包括附接下面将要描述的其他特征。连接器盖29可密封旋转肘形连接器47。在图示情形下，连接器47的远侧端部由盖49覆盖，在这种情形下，可通过气管导管窗孔25进行喷气携带，当气囊26充气后，病人的自发呼吸通过上气道和通过窗孔25进行；如果气囊26泄气后，自发呼吸通过窗孔25以及环绕气管导管23的外侧进行。
图7描述了一种病人界面构造的侧视图，其中，气管导管23是具有窗孔的气管导管。在图示情形下，连接器47的远侧端部未用盖49罩盖。在这种情形下，病人可通过开放式连接器47自发呼吸。
图8描述了开放式界面的侧视图。气体输送线路21使用隔板附接装置附接到气道导管60。气道导管60可以是气管内导管，气管切开插管，喉头切除导管或者任何其他气道导管。气道导管60可包括气道导管法兰61。气道导管60还可包括气道导管远侧端部63，气道导管远侧端部63可具有气囊。气体输送线路的顶端可构造成气体输送喷嘴66，气体输送喷嘴66的顶端可安置在气道导管60入口的邻近或者气道导管60入口外侧一定距离处。隔板连接器64可以是开放的，从而环境空气可由呼吸机气体携带排出气体输送喷嘴66。在图8中显示隔板连接器64附接于气道导管近侧连接器62的外侧；然而，隔板连接器64可附接于气道导管60的内侧表面，或者连接于气道导管60的近侧边缘。气体输送喷嘴66和气道导管入口之间的理想距离根据例如气道导管60的类型和大小、期望的治疗效果和呼吸机驱动压力以及导管和喷嘴尺寸的条件而进行变化，然而，典型间隔范围是从2”到-2”，理想地凹进1.5”接近0.5”。气体输送喷嘴66利用隔板旋转连接器65附接到隔板连接器64，从而气体输送线路21可以旋转以为管件确定最方便的路径。气体输送线路21输送的气体可以是氧气、空气、空气-氧气混合气体、治疗用气体或者药物。可选择地，治疗用气体可渗入到系统中。关于气体输送系统的更多细节参见图28和图38-40。
本发明的实施例可能影响功效。通气导管的顶端相对于气管切开插管或者更一般地气道导管的位置对气体携带量进而对系统的物理效率是关键的根本贡献因素，以及对通气系统可在病人肺部形成的容量和压力的数量也是关键的根本贡献因素。病人肺部的压力或者容量的增大对系统在临床上的疗效是必要的。例如，吸气肺压从未辅助的值-5cmH2O增加到辅助的值-1cmH2O，这可减少吸气肌肉的工作量，使病人感到轻松，为病人提供支持。或者，肺压从未辅助的值-5cmH2O增加到辅助的值+5cmH2O，这可使病人感到轻松，为病人提供甚至更大的支持。对于自发呼吸的病人，这些压力增加可认为是势能增加，因为基于通气支持的检测，病人的努力可通过付出的或多或少的呼吸努力来补偿。对于依赖呼吸机的病人或者受控呼吸的病人，可适用压力增加。呼吸机系统引起的肺压增量越高，肺部容量的势能增量越大，这对于改善气体交换也是有功效的。同样，对于阻塞性肺部疾病的病人，通气系统增加的支持可缩短吸气时间，这可提供更长的呼气时间，降低动态过度膨胀。增加的肺压提供的呼吸辅助工作可以释放和放松呼吸肌肉，从而它们具有更高的强度和储备，而这可帮助重塑肺部力学，潜在地降低静态过度膨胀。对于限制性的肺部疾病病人，增加的肺压和肺部容量的势能可能有助于限制性气道和硬肺的补偿，给出呼吸容易的感觉。对于神经肌肉病人，增加的肺压和容量有助于补偿肢体无力以便充分地进行与神经有关的呼吸或者机械呼吸。对通气系统的物理效率和临床功效有贡献的因素还包括排出通气导管的气体的排出速度、气体的速度相对于气道导管或者气道管腔的调整、环绕通气导管喷嘴或者位于紧邻通气导管喷嘴处的气体容量。
对于通气导管的顶端相对于气道导管的位置可考虑三种情形。在情形A(图5)中，导管顶端可延伸到或者超过气道导管的远侧顶端。在情形B(图4、6和7)中，导管顶端可定位在气道导管的近侧和远侧端部的大概一半处。在情形C(图8)中，导管顶端可定位在气道导管的近侧的外侧。
在情形A中，喷气有机会将气体携带到气道中。在气道是导管或者另一更大的气道的情形中，气道柱内的气体容量是可观的。喷射泵设计领域的技术人员可能因此希望与情形B和情形C相比，情形A中的顶端位置是优化携带的优化构造。然而，以经验为依据的测试表明情形B和情形C产生了超过情形A的超优的携带效率。在情形B中，喷气携带来自气道导管的近侧端部外侧的空气，并且这种携带超过了情形A中的携带。情形C提供了最佳的携带效率，但这不是直观就可以得到的。本领域的技术人员可以想象排出气道导管的导管顶端外侧的气体将在气道导管的入口处产生涡流，进而显著地降低性能。然而，经验评估表明并不是这种情形，而是当它以及携带的环境空气进入入口到达气道导管时，速度流动剖面组织良好。返回参照情形B，如果气道导管在导管顶端位置附近具有孔隙，例如气管导管的窗孔，系统具有两个携带气体的潜在源：(1)气道外侧的环境空气；和(2)通过窗孔的气道空气。这种情况虽然可以改善情形B的效率，但是仍然不如情形C的效率。情形C的另一优点是不因导管顶端和气道导管顶端之间不对齐而较易于使性能降级。
然而，值得注意的是，情形A和情形B在向肺部输送湿润气体方面优于情形C。情形A输送最湿润的气体，这是因为携带的气体来自上气道，受到鼻部通道的润湿；与情形A相比，情形C输送最不湿润的气体，因为情形C携带了大量的环境空气。但是，情形B和情形C可通过人工湿润通气和携带的气体或者通过使用加热湿气交换器而进行改变。情形A、B和C的一些典型值列于下表1中。
表1
Figure BPA00001349512500131
上述值是基于呼吸机气体输送值为15lpm，15lpm接近本发明的呼吸机流速范围的低端值附近。本发明的呼吸机流速通常可以是15-40lpm平均流速，20-60lpm峰值流速。当流速增加时，携带百分比线性增加，压力势能以平方的方式增加。非直观地，情形A中携带的上气道空气的量小于通过气道导管近侧端部携带的环境空气。返回参照情形B，如果导管的远侧顶端的轴向中心线对齐气道导管的远侧顶端的轴向中心线，从而排出导管顶端的喷气不碰撞气道导管的内壁，这是有利的。这种对齐可以优选是大约10度以内的完美对齐。携带性能可能因为发生在导管顶端和气道导管顶端之间的涡流和杂乱的气流速度剖面而降级。
图9描述了开放式界面的侧视图，图中描绘了气体从气体源流到气道A中。排出喷嘴的呼吸机气体Gv可包括来自气道导管60外侧的气体Ge。病人可自发地来自呼吸气道导管外侧的环境空气Gsi和上气道的环境空气Gsa。输送到肺部的所有气体Gt是这四个气体源的组合。图9中的气体输送线路21还显示有呼吸检测线80。呼吸检测线80的目的在于测量病人的呼吸压力、使呼吸机的功能和病人的呼吸同步以及追踪病人的呼吸参数。在气体输送线路21的远侧端部或者远侧端部附近，呼吸检测线可与导管分开，并且延伸到气道导管60中，超过气体输送喷嘴66。该深入延伸可允许更灵敏地检测气道呼吸压力。该延伸可延伸到气道导管远侧端部63或者超过气道导管远侧端部63。呼吸检测线80还可附接到气道导管60的壁内的管腔上或者与气道导管60的结构成为一体，以便检测气道压力。气道导管适配器81可将气体输送线路21和/或呼吸检测线80联接到气道导管60上。
图10描述了使用气道导管侧连接器82的开放式界面的局部剖视俯视图。气道导管侧连接器82可附接于气道导管60的近侧端部。气道导管侧连接器82的近侧端部与气道导管60相对，可以向环境空气开放，从而排出气体输送喷嘴66的气体携带环境空气通过气道导管侧连接器82。在图10中，从环境空气进入气道导管侧连接器82和气道导管60的路径是相对直的路径，没有或者极少需要气体陡转方向。气道导管侧连接器82的侧连接装置85可以用于附接呼吸用附件，例如氧气配件等。图示设计可替换成近侧侧部可以是图示的开放的或者封闭的。可使用任何合理构造的连接器，例如Y形，T形或者L形连接器。例如，图11描述了使用气道导管T适配器84的开放式界面，其具有两个开放侧连接装置85以允许气体通过和连接必要附件。气道导管T适配器84的近侧端部与气道导管60相对，并且在本实例中是封闭的，虽然它可以是封闭的或者开放的。同样，例如，图12描述了使用优选可旋转的气道导管肘形连接器83的开放式界面。如果附件附接到气道导管肘形连接器83，则旋转可有助于将其如所期望的那样地设置。
图13描述了具有可调整的气体输送喷嘴66的开放式界面。气体输送喷嘴66可在气道导管适配器81的导向或喷嘴调整槽86中相对于气道导管60近侧地和远侧地移动。能够调整位置的目的在于基于病人的需要，增加或者减少携带量和所产生的气道压力合力。来自压力检测端口87的信号可用于确定气体输送喷嘴66的适当位置。例如，如果希望携带量达到最大，可以移动气体输送线路21直到来自压力检测端口87的信号标示达到峰值幅值。呼吸机使用者界面可向使用者显示这一位置状态。或者，例如，如果希望得到特定的携带量，气体输送线路21的位置可以移动，直到近侧压力检测端口87标示达到期望携带量的希望特征信号。
图14描述了气体输送线路的喷嘴定位在气道导管60的近侧端部的稍微内侧而不是在气道导管60外侧一定距离处的开放式界面。气体输送喷嘴66可设置在具有直的轴向横截面的气道导管的一部分中，从而气体输送线路21和气道导管60之间的连接装置的转动不会改变气体输送喷嘴66相对于气道导管轴向中心线对齐。相反，如果喷嘴顶端定位在气道导管轴向中心线在该深度处是弧形的或者有角度的气道导管内的一定深度处，气体输送线路21和气道导管60之间的连接装置的转动将会导致喷气与气道导管60不对齐，以及产生对治疗效果不利的非常差的空气动力学。因此，这种布置可允许使用者附接两个零件而不用关心旋转对齐，和/或配件可包括可转动的转体，以安排气体输送线路离开病人的路径，如所希望的那样。
图15描述了气体输送喷嘴66的远侧端部定位在气道导管60近侧的直的部分到气道导管60的曲线部分的过渡区附近的一种开放式界面。
开放式气道界面的前述实例描述了从病人突出的病人界面的连接装置。图16和图17描述了小外形的替代连接装置。
图16描述了导管连接于气道导管60近侧端部中的喷嘴连接槽89的开放式界面。喷嘴连接槽89可以避免需要大体积的连接器。气体输送线路21可使用能够移动地附接和紧固的连接装置直接附接到喷嘴连接槽89。气道导管60的有槽的近侧端部可以是导管自身，15mm连接器，或者气道导管的外套管或内套管。
图17描述了一种开放式界面，其具有小外形气体输送喷嘴101和联接于气道导管60的小外形连接器100，以及与气道导管60的近侧端部的外侧和/或内侧接合的夹子99。当病人是自发呼吸和公开治疗时，这些小外形连接装置是具有优势的，气体输送线路21和界面可以更隐蔽。小外形连接装置的夹子99可以占据尽可能少的气道导管60的内直径，以便不限制气体流过气道导管60。夹子99可以沿径向扩张从而夹子99以足够大的力靠紧近侧端部附近的气道导管60的内壁，例如，使用2-10lbs的径向力，优选4-6lbs。夹子99可以用摩擦配合来保持。夹子99可以是塑料或者金属，例如分别是ULTEM或尼龙，或者不锈钢或NITANOL。小外形连接装置还包括一个或者多个外部夹子，该外部夹子附接于气道导管的近侧端部外侧，施加足够的力以夹紧气道导管的壁从而附接于气道导管60。为了便于小外形设计，气体输送线路21可包括小外形气体输送喷嘴101，小外形气体输送喷嘴101可包括形成于气体输送线路21的顶端处的气体输送喷嘴101侧壁上的通气气体输送口46。气体流动路径在顶端附近可以是弯曲的，而不是直角角度流动路径，以使气体的流动剖面在排出气体输送喷嘴101之间适当扩大。
图18和图19示出了一种开放式界面，其中，气体输送线路21利用开放式气道导管适配器81或者具有侧附接装置的气道导管连接器82附接到气道导管60。气道导管适配器81或者气道导管侧附接装置可包括吸气阀103。图18示出了吸气阀103作为直气道导管适配器81的一部分，图19描述了具有侧附接装置的气道导管连接器82，其联接于气道导管60。具有侧附接装置的气道导管连接器82可包括吸气阀103和呼吸附件，其中，吸气阀103位于与气道导管60相对的具有侧配件的气道导管连接器的端部，呼吸附件附接于具有侧附接装置的气道导管连接器82的侧连接器。在所示实例中，所述附件是热量和湿气交换器(HME)102，其阻止可在吸气过程中返回到病人的呼出的湿气。吸气阀103通常是低阻力、低开启压力的吸气阀，能够容易地打开以使环境空气由排出喷嘴的喷气携带。作为参考，吸气阀103显示了关闭状态108和打开状态107。吸气阀103可以包括阀座104、阀口105，和/或阀膜106。吸入的空气可抽吸通过吸气阀103，并且还可选地通过HME102。排出气体输送喷嘴66的喷气携带的空气可能有助于在吸气过程中将HME102阻止的湿润空气抽吸回到病人的气道中。吸气阀103的目的可能是在呼气过程中，一些呼出的空气受迫通过喉头流出上气道，因而能够发出声音。除HME102外的部件可像后面描述的那样使用。在已经描述的具有吸气阀103的各个实施例中，吸气阀103可包括允许呼出的气体流出的流动口，从而能够呼出足够的气体，同时维持反压以模拟撅起的嘴唇呼吸。吸气阀103的开启压力通常小于2cwp，优选0.3-0.8cwp。吸气阀103的气流阻力通常可小于10cwp/L/sec，优选小于5cwp/L/sec。
图20描述了一种开放式界面，其具有气体输送线路21和联接于气道导管60的带有侧连接装置的气道导管连接器82。在图20中，呼气PEEP阀109附接于具有侧连接装置的气道导管连接器的侧连接装置，并且与气道导管60相对的侧包括吸气阀103。因此，该构造是对环境空气在吸气过程中开放的，在呼气过程中是部分关闭的。在呼气过程中，呼气PEEP阀109允许一些呼出气流，但是具有一定的背压以产生期望的PEEP水平，例如5cwp。呼气PEEP阀109的阻力可以是例如5-20cwp/L/sec，以产生期望的PEEP水平。PEEP水平可以进行调整以产生期望的PEEP水平。在图20中，呼气PEEP阀109是具有弹簧的球笼阀。弹簧的拉力决定了呼气PEEP阀109的气流阻力。除呼气PEEP阀109外，该阀可以是呼气阀或者压力释放阀，或者上述阀的任意组合。
图21和图22示出了一种开放式气道系统，其中，所述开放式气道系统具有利用气道导管适配器81附接于气道导管60的气体输送线路21，和延伸到气道导管60和/或病人的气道中的气道检测延伸线120。在图21中，气道检测延伸线120从气道导管适配器81延伸到气道导管60的通道中。气道检测延伸线120能够如图所示部分地延伸到气道导管中，或者能够延伸到气道导管60的远侧端部或者超过气道导管60的远侧端部。气道检测延伸线120可包括位于气道检测延伸线120的远侧顶端或远侧顶端附近的远检测口121，和可包括位于气道检测延伸线120的近侧端部附近的近检测口122。当近检测口122和远检测口121一起使用时通过使用Hagen-Poiseuille方程可确定流过气道导管60的通道的气流。由于喷气通常在围绕气体输送喷嘴66的区域产生负压，可能不需要精确的压力测量装置；然而，呼吸机的微处理器可对测量值应用修正因子以得到衍生的压力测量。使用两个压力检测口以确定通过气道导管60的气流，使得系统确定通过气道导管的携带量和自发吸入的空气量。这个信息可以用来确定输送的总容量，并能用来调整呼吸机设置以产生期望的治疗水平。
图22描述了图21的替代构造，其中，气道导管检测线123集成于气道导管60。气体输送线路21可包括连接于气道导管60中的气道导管检测线123的检测线连接器126。气道导管检测线123可延伸到气道导管60的顶端，或者可替代地能终止于定位在沿气道导管60长度的某处的气道导管远检测口124，或者可替代地气道导管检测线123可包括多个检测口，包括气道导管近检测口125和/或气道导管远检测口124。可替代地，气道导管60或者气体输送线路21可包括多个检测线延长线。
图23描述了一种具有用于湿气输送软管129的湿气连接器128的开放式界面。在这个实施例中，加热的潮湿空气可经由湿气输送口127输送到气道导管适配器81，从而当病人吸气时或者当排出喷嘴的喷气携带环境空气时，空气被抽入界面和病人的气道，使肺部得到润湿。人工润湿的空气可以补偿气体输送导管21所供给的干空气或者氧气，还可补偿因通气气体的对流气流沿气道粘膜而产生的气道变干。湿气可由一般加热增湿器在呼吸机中产生，或者由喷雾器或烟雾器或喷雾系统产生。在开放式界面附近可以设置温度传感器(未示出)以向增湿器传回温度信号，从而调整或者限制蒸汽输出量，保持输送的蒸汽处于安全温度。潮湿的气体可以是空气，氧气或者混合气体。
图24描述了具有蒸汽或者雾气湿气导管140的开放式界面。在这个实施例中，除气体输送线路21外，湿气导管140也可以附接于气道导管适配器81。湿气导管140可以以蒸汽，雾气或者小水滴的形式向气道输送潮气。湿气可以经加压供给以便排出导管的远侧端部，或者通过通气导管喷气携带出导管的远侧端部，或者二者都进行实施。雾气导管可以是通气导管管件的一部分，或者是单独的管子。
图25描述了一种开放式界面，其具有与气体输送线路21成为一体的湿气通道141和湿气输送口127，以及气体输送喷嘴66，而不是如图24所示的雾气导管的单独配件。图26描述了图25中系统的B区的导管顶端的放大图。图27描述了沿图26中的A-A线的通气导管的截面图。潮气在湿气通道141中被引导到气体输送线路21的远侧端部。潮气源或者潮气的产生可以通过加热增湿或者烟雾化得到，并且潮气可以在压力下供给到导管的远侧端部，或者由通气导管喷气携带出远侧端部，或者二者都进行实施。可替代地，潮气可以在通气气体输送通道144中被带到导管的远侧端部，通过携带或者混合湿润气体在呼吸机和病人之间的某位置进入通气气体输送通道144。呼吸检测管腔143还可包括到通气气体输送线路21中。
图28描述了本发明的一个实施例，其中，因治疗而输送的氧气量是可以调整的，和/或监测的，和/或控制的。气体输送线路21可包括氧气输送口162或者流出口，氧气和/或二氧化碳检测口163和压力检测口87。在这个实施例中，经由气体输送喷嘴66输送的是空气而不是氧气，氧气经由氧气输送管腔164和氧气流出口提供。氧气可以由排出气体输送喷嘴66的喷气携带而输送到气道导管适配器81中。可选择地，氧气可以通过通气气体喷气携带而抽出氧气输送口162和氧气输送管腔164。氧气和/或二氧化碳检测口163和氧气和/或二氧化碳检测管腔165可用于将气体从气道导管适配器81抽吸回传感器，通常在呼吸机处进行以便确定在那个区域气体中氧气的浓度，在呼气过程中和呼吸周期的其他时间进行以便确定病人气道和肺部的氧气量。所检测的浓度可以用来增加或者减小渗入到系统中的氧气量，以便达到希望的吸入氧百分比(FIO2)。另外，可以改变喷气幅度和持续时间以便实现希望的FIO2。可替换地，喷气参数和氧气渗入参数可从预定的设置值中选择以便达到希望的FIO2水平。在所示实例中，氧气可使用气体输送线路中的管腔流入，然而，氧气也可从附接于连接器的单独的导管或者管件中渗入。图28还描述了一个可选的线形热传感器149和一个参考热传感器161，可用来通过温度变化测量呼吸。图中还显示了适配器转体147连接，其有助于将气道导管适配器81如所希望的那样向气道导管60定向。
图29描述了沿线A-A的图28中的系统的截面图，示出了通气气体输送通道144，氧气输送管腔164，氧气和/或二氧化碳检测管腔165，湿气通道141，呼吸检测管腔143和热传感器线160及相关管腔。
图30-32描述了位于气体输送线路21的远侧端部的气道压力检测口87的不同位置和构造。图30示出了位于气体输送线路21远侧顶端的前侧的检测口145，并且其沿垂直于呼出气流的方向进行定向。由于呼出的气体冲击端口而没有任何信号损失或者人为因素，因而在呼气过程中在这个位置进行检测特别灵敏。图31描述了具有面向吸气气流方向的压力检测口146的气体输送线路21。由于吸入的气体冲击端口而没有任何信号损失或者人为因素，因而在吸气过程中在这个位置进行检测特别灵敏。图32描述了具有两个压力检测口的气体输送线路21，其中，一个压力检测口面向吸气流146的方向，另一个压力检测口面向呼气流145的方向。这个构造可以改善吸气和呼气阶段的灵敏度。检测口还可定向成平行于呼吸气流并且设置在喷嘴的侧面、上表面或者内表面。
图33-35描述了本发明的一个实施例，其中，开放式界面可以转变成封闭或者部分封闭的界面。图33描述了一种开放式界面，其通过将阀组件附接到开放式界面的气道导管适配器81上而转变成部分封闭的界面。阀组件可包括吸气阀103和呼气PEEP阀109。呼气PEEP阀109可包括PEEP阀和PEEP/PIP安全阀180。吸气阀103可以是低开启压力低阻力阀，允许将吸气阀103的环境侧的环境气体携带到气道导管60和病人。图34描述了图33中所描述系统的阀组件的详图。在所示实例中，呼气阀109是球形止回阀，具有呼气阀座167，呼气阀球168，呼气阀弹簧169，使其成为一个通常封闭的阀。然而，可以使用任意类型的止回阀或单向阀，例如鸭嘴阀、隔膜阀或者叶式阀。呼气阀109可以包括阀调整装置181和/或阀导向压力线182。在自发呼吸过程中，该阀通常是一个被动阀，使用轻微压力打开，例如，1-10cmH2O，优选1-3cmH2O，这允许病人肺部和气道内的气体呼出。当病人不能自己呼吸而进行受控机械通气过程中，该阀可以转换成主动阀，在吸气阶段结束后由呼吸机控制进行周期性地打开。在这个情形中，呼气阀包括导向信号线，信号线从呼吸机传递压力信号以向阀提供开启或关闭控制。图35是图34所描述系统的可选吸气/呼气阀166的详图，其中，来自呼吸机的导向信号控制呼气阀109的开启和关闭和/或呼气阀109所产生的PEEP水平，并且具有PEEP调整装置以设定PEEP设置值和安全压力设定值。呼出的气体可从远侧端部D移动到近侧端部P。
图36描述了一种开放式气道通气系统，其中，气体输送线路21连接于面罩型病人界面，例如通气面罩183。面罩近侧连接器184可以打开以允许环境气流入和流出通气面罩183。气体输送线路21的远侧顶端和气体输送喷嘴66可以设置在通气面罩183的内侧和/或面罩近侧连接器184的内侧。系统然后通过喷气和携带的环境空气在通气面罩183内提供正压。病人可以通过通气面罩183自发呼吸通气面罩183内的正压源和环境空气。通气面罩183可以包括通气面罩密封件185和/或一个或多个面罩条带连接件186。
图37描述了一种开放式气道通气系统，其中，气体输送线路21连接于面罩型病人界面，例如，通气面罩183。面罩近侧连接器184可以打开以允许环境气流入和流出通气面罩183。气体输送线路21的远侧顶端和气体输送喷嘴66可以设置在通气面罩183的外侧和面罩近侧连接器184的外侧。气体输送线路21可以经由隔板连接器64和/或隔板旋转连接器65联接于通气面罩183和/或面罩近侧连接器184。系统然后可以经由喷气和携带的环境空气在通气面罩183内提供正压。病人可以通过通气面罩183自发呼吸通气面罩183内的正压源和环境空气。通气面罩183可以包括通气面罩密封件185和/或一个或多个面罩条带连接件186。
图38描述了整个发明的实施例的系统示意图，其中，呼吸机20由压缩氧气供给动力，向病人输送高浓度氧气，这在COPD或ARDS应用中是非常有用的，在COPD和ARDS应用中，病人经常需要输送加浓浓度的氧气。气体源可以是多种源；当在医院环境中，呼吸机20可以由压缩氧气供给200提供动力，例如，压缩氧气供给200为汽缸或者压缩氧气壁供给。在这种情况中，100％氧气从呼吸机20输送给病人，并且治疗的合成FIO2是100％氧气加上携带环境空气的结果。例如，如果输送了120ml的100％氧气，并且存在100％的携带的环境气体，即携带了120ml的环境空气，加上病人自发吸入的另外120ml环境空气，则肺部接收的气体总量是360ml，FIO2为47.33％。可选择地，压缩空气供给189的压缩空气可连接于呼吸机20，由联接于外部压缩机188的混合器187混合。压缩空气可以在进入呼吸机20以前与压缩的氧气混合，或者在呼吸机20内部混合以调整输送的通气气体的氧气浓度。
图39描述了整个发明的一个实施例的系统示意图，其中，呼吸机20可以由混合的压缩空气和氧气提供动力，并且向病人输送混合浓度的空气/氧气。在本实施例中，呼吸机20可包括在神经肌肉应用中非常有用的内部压缩机——涡轮202，其中，在神经肌肉应用中病人常常不需要高氧气浓度。可选择地，压缩机-涡轮可以是外部的。压缩的空气和氧气可以使用位于呼吸机20外部或者内部的混合器187混合，以选择和创建这种情形所需要的氧气浓度。图44还显示了经由湿气输送软管129从加湿器单元201混合进的湿气，如前面所描述的那样。
图40描述了整个发明的一个实施例的系统示意图，其中，呼吸机20由压缩空气提供动力，并且混合来自压缩氧气供给200的氧气以向病人输送空气/氧气的混合供给。压缩空气由内部压缩机或外部压缩空气源产生，或者由二者产生。在优选实施例中，来自氧气浓缩机206或者液态氧气源207的氧气混合到呼吸机气体输送线路21中，氧气浓缩机206或者液态氧气源207从环境空气中产生氧气。这在输送氧气的通路昂贵或者逻辑复杂的情形中是非常有用的。混合器187可以在呼吸机20的内侧或者外侧。由于气体输送线路21中输送的气体通常以大于50米/秒的速度进行输送，如果使用合适的阀，这个速度可以将氧气吸入气体输送线路21。在可选实施例中，该系统可包括气道气体清除系统，其中，一些气体从气道导管引导到通常位于呼吸机20内侧的氧气分析器203，二氧化碳分析器204或者一种组合仪器，用于测量氧气浓度和/或二氧化碳浓度。这个读数可使呼吸机20或者负责照顾人的人知道气道导管中的氧气浓度，气道导管中的氧气浓度和气道与肺部内的氧气浓度相关，进而知道FIO2。脉搏血氧定量法还可以用来确认输送的是否是适当的空气/氧气混合物以及需要做什么调整。图40还显示了一个可选实施例，其中，妨碍呼吸容量传感器209，例如胸廓阻抗传感器，用来确定吸气过程中进入肺部的容量的量。一个或多个传感器可以由微处理器控制系统209控制。在本实施例中，肺部容量信息用来确定开放式系统的治疗效果，即开放式通气系统中的呼吸容量。该信息可用来滴定和调整参数，例如通过调整喷气参数增加或减小携带量。呼吸容量信息可避免需要氧气或二氧化碳传感器，因为如果肺部容量和呼吸机氧气量输送已知，则可以计算呼吸容量中的氧气浓度百分比。
在本发明的各种实施例中，该治疗可包括21-100％氧气的呼吸机气体输出。或者补充氧气可在各种可选位置或者呼吸循环中的不同点(吸气，呼气，周期性的或者连续的)输送。呼吸机输出可以与吸气循环的所有可能备选方案同步，例如在吸气中尽早输送，延迟后输送，在吸气中间输送，在吸气结束时输送或者在吸气/呼气阶段过渡重叠时输送。
本发明的实施例可包括气道导管上的各种图案和构造的窗孔，以允许来自气道的气体携带到气道导管中，朝向肺部携带出气道导管远侧端部。窗孔的形状可以是圆形的、椭圆形的或者任何其他合理的形状，并且窗孔可以设置在气道导管上的任何位置。
呼吸传感器可以是通气导管的一部分，如典型地示出的那样，或者气道导管的一部分，或者是气道的内侧或者外侧，或者是不与导管或者气道导管结合的传感器。这些传感器可以测量病人的呼吸模式来如所希望的那样与呼吸机同步，并且还可测量携带气体，从而系统智能地知道携带水平。后一信息可用于改变构造以调整携带的源和幅度。一个或多个压力计界面可用来测量流过气道导管的气体。
虽然上述描述指向本发明的优选实施例，应当注意的是，其他变形和修改对本领域技术人员而言是显而易见的，并且可在不偏离本发明的精神或范围的情况下作出。此外，即使上面没有进行明确表述，与本发明的一个实施例相关的特征也可用于其他实施例。
附图标记
Pt.    病人
T.     气管
A.     气道
UA.    上气道
PA.    口咽导气管
L.     肺部
D.     远
P.     近
I.     吸气阀
E.     呼气阀
Gv.    呼吸机气体
Gsi.   通过界面吸入的空气
Gsa.   通过气道吸入的空气
Ge.    携带的空气
Gt.    所有吸入的气体
1.     现有技术的呼吸机
2.     两肢式气体输送线路
3.     吸入肢
4.     呼出肢
6.     气管内导管
7.     气囊
8.     现有技术的单肢式气体输送线路
9.     非侵害性的通气面罩
10.    非侵害性通气面罩排气口
20.    呼吸机
21.    单肢式气体输送线路
23.    气管切开插管
24.    气管切开插管气流通道
25.    气管切开插管窗孔
26.    气管切开插管气囊
27.    气管切开插管远侧顶端
29.    连接器盖
40.    通气导管
41.    通气导管喷嘴
42.    气道导管连接器
43.    气管切开插管法兰
44.    15mm连接器
45.    通气导管远侧顶端
46.    通气气体排放口
47.    旋转肘形连接器
48.    旋转连接器15mm凹形连接器
49.    旋转连接器15mm凸形连接器
60.    气道导管
61.    气道导管法兰
62.    气道导管近侧连接器
63.    气道导管远侧端部
64.    隔板连接器
65.    隔板旋转连接器
66.    气体输送喷嘴
80.    呼吸检测线
81.    气道导管适配器
82.    具有侧连接装置的气道导管适配器
83.    气道导管肘形连接器
84.    气道导管T连接器
85.    侧连接装置
86.    喷嘴调整槽
87.    压力检测线
89.    喷嘴连接槽
99.    夹子
100.   小外形连接器
101.   小外形气体输送喷嘴
102.   热量和潮气交换器
103.   吸气阀
104.   阀座
105.   阀口
106.   阀膜
107.   打开状态
108.   关闭状态
109.   呼气PEEP阀
120.   气道检测延伸线
121.    远检测口
122.    近检测口
123.    气道导管气道检测线
124.    气道导管远检测口
125.    气道导管近检测口
126.    检测线连接器
127.    湿气输送口
128.    湿气连接器
129.    湿气输送软管
140.    湿气导管
141.    湿气通道
142.    湿气存储器
143.    呼吸检测管腔
144.    呼吸机气体输送通道
145.    面向远侧的检测口
146.    面向近侧的检测口
147.    适配器转体
149.    线形热传感器
160.    热传感器线
161.    参考热传感器
162.    氧气输送口
163.    氧气二氧化碳检测口
164.    氧气输送管腔
165.    氧气二氧化碳检测管腔
166.    吸气-呼气阀
167.    呼气阀座
168.    呼气阀球
169.    呼气阀弹簧
180.    PEEP/PIP安全阀
181.    阀调整装置
182.    阀导向压力线
183.    通气面罩
184.    面罩近侧连接器
185.    面罩面部密封件
186.    面罩条带连接件
187.    混合器
188.    外部压缩机
189.    压缩空气供给
200.    压缩氧气供给
201.    加湿器单元
202.    内部压缩机-涡轮
203.    氧气分析器
204.    二氧化碳分析器
206.    氧气加浓器
207.    液态氧气
208.    妨碍呼吸容量传感器
209.    微处理器控制系统

Claims (24)

1.一种通气系统，包括：
呼吸机，其用于供给通气气体；
病人界面，其中，所述病人界面包括与病人气道相连通的远侧端部，与环境空气相连通的近侧端部以及位于所述远侧端部和近侧端部之间的气流通道；
气体输送线路，其中，所述气体输送线路适于附接到所述病人界面且不闭塞所述病人界面，以便允许环境空气从所述病人界面外侧流入到所述病人气道中；以及
其中，所述通气气体携带来自环境的空气和来自所述病人气道的空气。
2.根据权利要求1所述的通气系统，其特征在于，至少在通气气体应用过程中，所述环境气流经所述病人界面。
3.根据权利要求1所述的通气系统，其特征在于，所述病人界面选自包括气道导管、面罩、套管及其组合的组。
4.根据权利要求1所述的通气系统，其特征在于，所述气体输送线路的远侧端部经由连接器连接于所述病人界面的内表面。
5.根据权利要求1所述的通气系统，其特征在于，所述气体输送线路的远侧端部经由连接器附接于所述病人界面，其中，所述连接器包括允许气体在所述病人气道和环境之间流动的一个或更多个阀。
6.根据权利要求1所述的通气系统，其特征在于，所述呼吸机气体以选自下组的周期进行输送，所述组包括：当容量与病人吸气周期同步时，其中所述容量由使用者选择；连续地；当容量以所述呼吸机确定的速率周期性地输送时；当容量与病人呼吸并且与在一段时间内输送强制次数呼吸的后备速率周期性地同步时；当容量周期性地在吸气循环中减少呼吸工作，和周期性地在呼气循环中构建PEEP时；以及它们的组合。
7.根据权利要求1所述的通气系统，其特征在于，所述通气系统还包括位于所述气体输送线路的远侧端部的喷嘴，其中，当供给通气气体时，所述喷嘴位于所述病人界面的外侧。
8.根据权利要求1所述的通气系统，其特征在于，所述通气系统还包括位于所述病人界面的远侧端部和近侧端部之间的一个或多个窗孔，和位于所述气体输送线路的远侧端部的喷嘴，其中，在供给通气气体时，所述喷嘴位于所述一个或多个窗孔的邻近。
9.根据权利要求1所述的通气系统，其特征在于，所述通气系统还位于所述气体输送线路远侧端部的喷嘴，和其中所述喷嘴是有角度的以将所述通气气体引导向所述病人界面远侧端部上的开口。
10.一种通气系统，包括：
呼吸机，其用于供给通气气体；
病人界面，其中，所述病人界面包括与病人气道相连通的远侧端部、与环境空气相连通的近侧端部以及位于所述远侧端部和近侧端部之间的气流通道；
气体输送线路，其中，所述气体输送线路适于附接到所述病人界面且不闭塞所述病人界面以便允许环境空气从所述病人界面外侧流到所述病人气道；以及
其中，所述气体输送线路包括位于所述气体输送线路的远侧端部的喷嘴，其中，当供给通气气体时，所述喷嘴位于所述病人界面的外侧。
11.根据权利要求10所述的通气系统，其特征在于，至少在通气气体应用过程中，所述环境气流经所述病人界面。
12.根据权利要求10所述的通气系统，其特征在于，所述病人界面选自包括气道导管；面罩；套管及其组合的组。
13.根据权利要求10所述的通气系统，其特征在于，所述气体输送线路的远侧端部经由连接器连接到所述病人界面的内表面。
14.根据权利要求10所述的通气系统，其特征在于，所述气体输送线路的远侧端部经由连接器附接于所述病人界面，其中，所述连接器包括允许气体在所述病人气道和环境之间流动的一个或多个阀。
15.根据权利要求10所述的通气系统，其特征在于，所述呼吸机气体以选自下述组的周期输送，所述组包括：当容量与病人吸气周期同步时，其中所述容量由使用者选择；连续地；当容量以所述呼吸机确定的速率周期性地输送时；当容量与病人呼吸并且与在一段时间内输送强制次数呼吸的后备速率周期性地同步时；当容量周期性地在吸气循环过程中减少呼吸工作，和周期性地在呼气循环中增加PEEP时；以及它们的组合。
16.根据权利要求10所述的通气系统，其特征在于，所述通气气体携带来自环境的空气和来自所述病人气道的空气。
17.一种通气系统，包括：
呼吸机，其用于供给通气气体；
病人界面，其中，所述病人界面包括与病人气道相连通的远侧端部、与环境空气相连通的近侧端部以及位于所述远侧端部和近侧端部之间的气流通道；
一个或多个窗孔，其位于所述病人界面的远侧端部和近侧端部之间；
气体输送线路，其中，所述气体输送线路适于附接到所述病人界面且不闭塞所述病人界面，以便允许环境空气从所述病人界面外侧流到所述病人气道中；以及
其中，所述气体输送线路包括设置于所述病人界面内的喷嘴，并且当供给通气气体时，所述喷嘴位于所述一个或多个窗孔的邻近。
18.根据权利要求17所述的通气系统，其特征在于，至少在通气气体应用过程中，所述环境气流经所述病人界面。
19.根据权利要求17所述的通气系统，其特征在于，所述病人界面选自包括气道导管；面罩；套管及其组合的组。
20.根据权利要求17所述的通气系统，其特征在于，所述气体输送线路的远侧端部经由连接器连接所述病人界面的内表面。
21.根据权利要求17所述的通气系统，其特征在于，所述气体输送线路的远侧端部经由连接器附接于所述病人界面，其中，所述连接器包括允许气体在所述病人气道和环境之间流动的一个或多个阀。
22.根据权利要求17所述的通气系统，其特征在于，所述呼吸机气体以选自下述组的周期输送，所述组包括：当容量与病人吸气周期同步时，其中所述容量由使用者选择；连续地；当容量以所述呼吸机确定的速率周期性地输送时；当容量与病人呼吸并且与在一段时间内输送强制次数呼吸的后备速率周期性地同步时；当容量周期性地在吸气循环过程中减少呼吸工作，和周期性地在呼气循环中增加PEEP时；以及它们的组合。
23.根据权利要求17所述的通气系统，其特征在于，所述通气气体携带来自环境的空气和来自所述病人气道的空气。
24.根据权利要求17所述的通气系统，其特征在于，所述喷嘴是有角度，以便将所述通气气体引导向所述病人界面远侧端部的开口。
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