CN103124575A - 用于润湿呼吸道的方法、系统和装置 - Google Patents

用于润湿呼吸道的方法、系统和装置 Download PDF

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CN103124575A
CN103124575A CN2011800473137A CN201180047313A CN103124575A CN 103124575 A CN103124575 A CN 103124575A CN 2011800473137 A CN2011800473137 A CN 2011800473137A CN 201180047313 A CN201180047313 A CN 201180047313A CN 103124575 A CN103124575 A CN 103124575A
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ventilator
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CN103124575B (zh
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A·D·翁德卡
J·西波隆
G·A·卡萨尼斯
T·W·阿勒姆
E·布拉比拉
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Breathe Technologies Inc
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Abstract

提供了用于增湿通气气体的系统和方法。所述系统和方法可包括用于接收来自气体输送管系的通气气体和用于增湿通气气体的鼻接口设备。所述鼻接口设备可具有所述鼻接口内的一个或多个通道从而将气体从气体输送回路输送至患者的鼻子；与所述一个或多个通道流体连通从而将通气气体引导至患者的鼻子的一个或多个结构；以及在所述通气气体的流动路径上的鼻接口内的吸湿性材料。

Description

用于润湿呼吸道的方法、系统和装置
技术领域
本发明涉及对遭受呼吸失调（如呼吸功能不全和睡眠呼吸暂停）的人们进行通气疗法领域。更具体地说，本发明涉及为接受人工通气的患者提供增湿的方法和装置。
背景技术
许多临床综合症都需要某种形式的通气疗法。这些综合症可以包括低氧血、各种形式的呼吸功能不全和气道异常。还有非呼吸和非气道疾病也需要通气疗法，例如分别为充血性心力衰竭和神经肌肉疾病。典型地，接受穿过这些通气疗法系统的气体的患者需要对输送的气体进行增湿以防气体令气道干燥。此外，还已知用氧气疗法的话，如果在流速大于6lpm下输送氧气的时间延长，气道将干燥并且需要人工增湿。
在现有的系统中，通过令输送的气体穿过加湿器的汽相或令气体流经水来增湿。对于机械的通气机来说，在现有的系统中气体输送管系或患者回路流体地将可呼吸的气体从通气机传递至患者，其尺寸被调整为在通气机与患者之间提供低压降。这个管系的尺寸为15mm或22mm的内径。为防止蒸汽在管系内冷凝，通常应用加热所述气体输送管系或用保护套热绝缘它的辅助技术。
新一代的机械通气机出现了，它利用更小的管系来将可呼吸的气体运输至患者。与现有系统的15mm或22mm的内径相比，这种新一代通气机的气体输送管系的内径在2-14mm的范围内。相应地，在新型气体输送管系中实现的压力可比环境压力高0-80磅/平方英寸，同时来自现有通气机的管系内部的压力典型地为环境压力的1磅/平方英寸。由于新式的机械通气机系统的气体输送回路的更小直径和更高压力，相应的需要新型的增湿系统。
此外，一些新一代机械通气机利用打开气道技术（open airwaytechnology），其中通气机与患者之间的气道不密封，而在传统的机械通气机系统中是密封的。利用打开气道技术的系统除了从通气机输送的气体外提供了在患者接口附近经由文丘里管系统被输送的周围空气，其中输送至患者的气体是从通气机输送的气体加上输送空气的组合。由于新式的开放系统，利用常规方法对被输送的气体增湿是很困难和效率差的。因此，需要与所述打开气道技术兼容的新型增湿技术。
此外，新一代的机械通气机被设计为强调在行走期间的使用和灵活性，同时现有的通气系统趋向于限制应用的灵活性，例如当患者限制在轮椅上时。现有的增湿系统典型地使用水槽，其过于巨大且对方向很敏感，并且通过消耗比便携电池电源的实际功率更大的功率的系统被加热。由于这些原因，现有的系统典型地仅仅用于当患者静止时提供增湿。因此，存在对小型的、重量轻的和便携式的增湿技术的需求。
现有的增湿系统典型地不具有对引入所述系统的水量的准确控制，并且它们与患者的呼吸型不同步。典型地，现有的系统能提供90%相对湿度以上的增湿水平，即使一些研究表明患者典型地不能感知超过50%相对湿度以上的增湿水平的好处。此外，因为现有的系统具有连续的有意泄漏或呼气流，并且由于患者名义上呼气的时间是吸气的两倍，如果系统仅在患者吸气循环期间提供水的话，现有的增湿系统能够消耗期望水的三倍。此外，通过提供比患者需要更多的增湿，现有的增湿系统常常具有过分“冲洗（rainout）”或管系内冷凝的问题，导致需要在管系内进行除水以捕获多余水，防止患者和设备吸入收集在系统中的水。此外，当在睡眠期间使用时，一些患者抱怨因为提供了过量的湿度，现有的增湿系统把他们的枕头弄湿了。由于这些和其它原因，存在对能够精确控制增湿量和/或与患者呼吸型同步增湿的增湿系统的附加需求。
因为现有的系统典型地加热水从而蒸发它，它们可能经历由其它包含溶解固体的水源例如自来水留下的固体所导致的性能下降，并且出于这种原因，它们的系统典型地需要蒸馏水。但是，增湿系统的使用者不想应付获得用于他们系统的蒸馏水的花费和不便。因此，存在对不需要蒸馏或其它专用水的增湿系统的附加需求。
发明内容
本发明以独特特性解决了现有技术系统的限制，其能够将增湿输送至小直径、高压和打开气道气体输送回路。
本发明的实施例包括用于接收来自于气体输送管系的通气气体（ventilation gas）和用于增湿通气气体的鼻接口设备，所述设备可包括所述鼻接口内的一个或多个通道以便将来自于气体输送回路的气体输送至一个或多个结构，其中所述一个或多个结构可与所述一个或多个通道流体连通以便将通气气体引导至患者的鼻子，以及在所述通气气体的流动路径中在鼻接口内的吸湿性材料。
在一些实施例中，所述一个或多个结构是一个或多个鼻枕，并且其中所述吸湿性材料可位于所述一个或多个鼻枕内或位于附接于所述一个或多个鼻枕的垫层内。可设置至少一个压力传感器装置，其中所述至少一个压力传感器位于所述吸湿性材料的患者侧上。所述气体输送回路可具有大约2-14mm的内径。所述系统与便携式通气系统一同使用。所述增湿通气气体的输送被伺服机构控制，其中所述伺服机构基于患者的需求来控制增湿水平，并且其中所述伺服机构以预先确定的方式（predictively）控制增湿水平。所述伺服机构可考虑被输送至患者的气流、环境温度、环境湿度及它们的组合。所述增湿通气气体与患者的呼吸循环同步地被输送。在患者的吸气阶段比在患者的呼气阶段可输送更多的增湿通气气体。可设置加热的管系。能量被与患者需求和患者的呼吸循环同步地施加于所述加热管系。
本发明的实施例可包括用于输送增湿通气气体的方法，所述方法包括设置鼻接口，所述鼻接口包括：所述鼻接口内的一个或多个通道以便将来自于气体输送回路的气体输送至一个或多个结构，其中所述一个或多个结构可与所述一个或多个通道流体连通以便将通气气体引导至患者的鼻子；以及在所述通气气体的流动路径中在鼻接口内的吸湿性材料；以及将增湿通气气体输送至患者。
在一些实施例中，所述一个或多个结构是一个或多个鼻枕，并且其中所述吸湿性材料可位于所述一个或多个鼻枕内或位于附接于所述一个或多个鼻枕的垫层内。可设置至少一个压力传感器，其中所述至少一个压力传感器可位于所述吸湿性材料的患者侧上。所述气体输送回路可具有大约2-14mm的内径。所述增湿通气气体的输送可利用伺服机构控制。所述增湿通气气体可与患者的呼吸循环同步地被输送。
本发明的实施例可包括一种用于增湿通气气体的系统，所述系统包括：通气机；患者回路，所述患者回路在近端处与所述通气机流体连通并且在远端处流体地连接于患者气道，其中所述患者回路具有大约2-14mm的内径；流体贮存器；增湿装置；以及所述增湿装置与所述患者回路的远端之间的通道。
在本发明的一些实施例中，可设置患者接口，其中所述患者接口是鼻接口、口部接口或经气管的接口。所述流体可以是水、药液或它们的组合。药物与增湿可替换地输送。所述通气机可以是便携式的。所述通道的近端终止于所述患者回路的末端，使得患者回路内由气体产生的射流文丘里管（jet venturi）输送来自所述通道的蒸汽。所述流体贮存器可被来自所述通气机的气体所增压。可在所述通道的远端处设置气雾网栅。可设置用于输送气体从而在所述气雾网栅之前产生射流的第二通道。可在所述通道内设置亲水介质盒。可设置毛细作用力蒸发器。可设置振动网孔喷雾器（vibrating mesh nebulizer）。可设置雾化导管。可设置包围所述通道的气流通道。所述通道可包围气流通道。可设置用于将热气供至加湿器和将冷气供至通气机的涡旋热分离机。所述增湿通气气体的输送可受到伺服机构的控制。所述增湿通气气体可与患者的呼吸循环同步地被输送。所述通气机所输送的气体的平均流量可大于约6lpm。所述增湿气体的输送可被控制在50-95%的相对湿度以防止患者回路内的冲洗。
本发明的实施例可包括一种用于治疗呼吸失调的方法，所述方法包括：设置通气系统，所述通气系统包括：通气机；在近端处与所述通气机流体连通并且在远端处流体地连接于患者气道的患者回路，其中所述患者回路具有大约2-14mm的内径；流体贮存器；增湿装置；以及所述增湿装置与所述患者回路的远端之间的通道。
一些实施例可包括利用伺服机构控制所述增湿通气气体的输送。所述增湿通气气体可与患者的呼吸循环同步地被输送。所述药液可交替地与增湿通气气体一起输送。所述通气机所输送的气体的平均流量可在约6lpm以上。
本发明的实施例可包括一种用于输送增湿通气气体的设备，所述设备包括:内径约2-14mm的一个或多个管子；以及沿所述一个或多个管子的长度的一个或多个加热器，其中所述一个或多个管子适于将增湿通气气体输送至患者。
一些实施例可包括通过控制器控制所述一个或多个加热器从而与患者需求和患者的呼吸循环同步地输送热量。通过控制器控制所述一个或多个加热器从而基于环境条件来输送热量。
其它特征、优点和本发明的实施例根据以下的详细说明、附图和权利要求得以阐述或更为清楚。此外，要了解上面对本发明的总结和下面的详细说明都是示例性的并且意图提供进一步解释而非对所声称的本发明范围的限制。
附图说明
所包括的附图提供对本发明的进一步理解并且并入和构成本说明书的一部分，示出本发明的优选实施例并且与详细说明一同用来解释本发明的原理。附图中：.
图1示出根据示例性实施例的本发明系统的示意图。
图2A示出现有技术的通过或穿过气泡系统。
图2B示出图2A的现有技术的通过或穿过气泡系统的放大图。
图2C示出图2A的所述湿度系统的改进形式。
图3A示出根据示例性实施例的蒸汽夹带系统。
图3B示出图3A的所述蒸汽夹带系统的放大图。
图4示出根据示例性实施例的雾化系统。
图5示出根据示例性实施例的湿气输入系统。
图6A示出根据示例性实施例的湿气输入气雾化系统（mistingsystem）。
图6B示出图6A的所述湿气输入气雾化系统的放大图。
图7示出根据示例性实施例的湿气夹带系统（moisture entrainmentsystem）。
图8示出根据示例性实施例的盒夹带系统（cartridge entrainmentsystem）。
图9示出根据示例性实施例的盒穿过系统(cartridge pass-throughsystem)。
图10示出根据示例性实施例的带有毛细作用力蒸发器的实施例。
图11A示出根据示例性实施例的带有喷雾器的实施例。
图11B示出可与图11A的喷雾器系统一同使用的示例性增湿系统。
图11C是图11B所示的增湿系统的示意图。
图12示出根据示例性实施例的带有喷雾器的实施例。
图13A示出根据示例性实施例的带有雾气通道的实施例。
图13B示出根据示例性实施例的替换气体输送回路远端的细节。
图14A示出根据示例性实施例利用附加气流通道输送增湿气体的实施例。
图14B示出根据示例性实施例的图14A的替换实施例的细节。
图15示出根据示例性实施例用于通气机的增湿系统。
图16示出根据示例性实施例用于加热的增湿气体的系统。
图17示出根据示例性实施例的其内并入吸湿性材料的鼻接口。
具体实施方式
描述了与通气治疗系统结合使用的增湿系统。所述增湿系统可适于整合在小口径、高压的通气气体输送系统中。可以理解，当本发明应用于上述应用时，本发明与常规的人工增湿系统相比具有固有优点，并且因此还可应用于常规的通气系统和氧疗系统以及药物输送系统。
所述增湿系统可用于连接患者接口，患者接口可包括全脸、鼻、口部或经气管的患者接口。
湿气（humidity）和/或气雾（aerosol）可被添加于所述患者接口（如鼻罩或经气管的管子），或可直接施加于气道，或可施加于将通气气体引导至所述患者的气体输送回路。所述湿气或气雾可与所述通气气体并行地被输送，或可与所述通气气体合起来被输送。理论上，如果被远距离地产生并输送，则所述湿气颗粒小于15微米，如果接近所述患者气道入口处产生则小于20微米，以便不将细菌引导至气道。由所述通气机输送的气体的平均流量可在约6lpm以上。
通过主动加热增湿或使湿气颗粒雾化进入所述气体输送系统——典型地进入或来自所述患者接口面罩或连接、或热湿气交换（HME）或它们的组合，可对所述气体输送回路进行增湿。
为防止在接口面罩或连接内发生冲洗，所述面罩或连接可具有排出管线以清除收集的任何湿气。
本发明的实施例可改进增湿以降低耗水量并且提高患者的灵活性。适用于所有主动增湿系统的一般概念也包括湿气的输送与患者的呼吸型合拍。可提供加热的管系的使用。加热的管系可被固定、受环境条件控制、与呼吸型合拍和/或适合于呼吸型。
本发明的实施例也可在通常小于15mm内径的小型管子内进行增湿。小内径管子典型地的特征是通过吹风机/通气机输送的高压，以及沿所述管子的高压降。
在小型管系中，此处描述传统的增湿系统。传统的可指不依赖于夹带而产生穿过所述系统的流体流的系统。根据本发明的实施例，沿管子的压降使得相对湿度百分数降低。该作用可抵消由于气体沿所述管子的长度冷却导致的相对湿度百分数的增加。结果可能是防止了冲洗并且相对湿度百分数在大约50-大约99之间相对湿度百分数的气体被输送至患者。在优选实施例中，增湿气体的输送被控制在50-95%相对湿度的范围内从而防止在所述患者回路内的冲洗。
在小型管子中，此处描述夹带系统。通常，至患者的可呼吸气流（Qp）是由（1）来自通气机的形成夹带作用的流（Qjet）以及（2）被夹带的流（Qent）构成的。被夹带气体（Qent）的增湿可直接增湿。可替换地或附加地，来自所述通气机的流（Qjet）如空气、氧气等可被增湿。增湿所述可呼吸气流（Qjet）的好处可包括增加输送至患者的气体的密度，这可增大夹带作用。增湿装置或系统可位于沿所述可呼吸气体（Qet）流动路径的任何位置，从通气机前面至夹带喷嘴自身。所述增湿液体可或可不被加热。如果被所述增湿系统所加热，所述增湿系统可使用毛细作用力的蒸发器。如果不被所述增湿系统所加热，所述可呼吸气流（Qet）可或可不被独立的加热器所加热。在这些构造中，所述增湿系统可使用带有补给水输入管线的亲水介质盒、超声喷雾器、气刷式气雾发生器（其中高速气流夹带液体并且雾化液体）、振动网孔喷雾器等等。
在本发明的实施例中，可利用直接湿气输送技术、湿气再利用技术和/或它们的组合来提供增湿。
可在所述患者接口内提供直接湿气输送技术。所述增湿液体可或可不被加热。如果被所述增湿系统所加热，所述增湿系统可使用毛细作用力的蒸发器。如果不被所述增湿系统所加热，所述可呼吸气流（Qet）可或可不被独立的加热器所加热。在这些构造中，所述增湿系统可使用带有补给水输入管线的亲水介质盒、超声喷雾器、气刷式气雾发生器、振动网孔喷雾器等等。
可在所述患者接口内提供湿气的再利用。这种类型的系统不需要外部湿气。湿气再利用系统可位于歧管内、鼻枕内、或它们的组合。特别地，可在一个或多个鼻枕内使用热和湿气交换器。为了精确的传感器读数，压力传感器装置可被定位在接近所述患者的位置，所述患者与热和湿气交换器之间。湿气再利用系统的额外好处可包括空气流的扩散排出和/或可导致更小噪音的消声。
增湿技术的组合也可用于提高水效率。例如，热和湿气交换器可与被供以水的亲水性盒组合，水可被预加热或不被预加热。
图1是描述利用本发明实施例的通气系统101的简图。所述通气系统101典型地可向患者提供空气、氧气或其一些组合，但也能额外地提供替换的治疗气体。所述通气系统101可自带电池和气源以使它可被患者携带，使得所述患者能够行走和参加日常活动。通气机115可提供通气气体。所述通气系统101的其它可选特性可以包括发送器/接收器、计步表、活动记录仪传感器、脉搏血氧仪（pulse oximeter）、CO2监控器、搅拌器、增压空气供应或产生器、液态氧（LOX）系统、呼吸传感器等等。
加湿器105可与通气系统101一体或位于所述系统外部。然而，与现有技术的系统不同，可穿过气体输送回路的气体输送通道、穿过气体输送回路内的另一内腔或穿过独立的套管或管系来输送增湿气体。为延长使用期限，当所述患者很可能静止时，所述增湿系统可为固定系统并且能够输送相对较高量的湿气，而在活动期间，由于尺寸和能量消耗的限制，患者可不接收增湿或使用能够输送相对较少量湿气的便携式增湿系统。也与现有技术的系统不同，本发明公开的一些增湿技术可与患者的呼吸同时发生并且导入所述系统的湿气可被精确地控制，从而减少所述系统需要的水量，减少系统中的冷凝量并且减少驱动所述系统期望的功率。
所述通气系统101可以是便携式的例如约10磅以下，并且可具有小口径的管系如内径在15mm以下。传统的增湿系统不是便携式的并且使用大口径管系（典型地15mm或22mm内径）。当输送增湿时，轻便性和小口径管系建立唯一的输出流（issues）。
输药模块127可选地内置于或外接于通气机系统101。由于对现有的雾化输药吸入器的质疑，本发明可用于推动并在呼吸系统深处沉积药物颗粒而无需载体推进物。因为使用所述疗法的患者常常也需要处方药物，这是一种便利和有效的给药方法。所述输药模块127可将药物与增湿一起输送，可选择地增湿，或它们的组合。控制器可以确定和/或定制何时通过所述输药模块127来输送药物。
本发明的实施例可用于产生夹带作用的系统中。图2A-2C示出夹带增湿气体和/或周围空气的通过或穿过系统。图3-10示出本发明的实施例是如何并入夹带系统中的。
图2A-2C示出现有技术的通过（pass-over）或穿过（pass-through）气泡系统（bubble systems）。在图2A中，通气机201穿过患者回路205输送气体203至患者207。通过209和/或穿过211可提供气体至加湿器/蒸发器/雾化器213。所述加湿器/蒸发器/雾化器213可具有水、水溶液等215和蒸汽相（vapor phase）217。对于通过209，气体可仅穿过所述汽相217。对于穿过211，气体可穿过所述液相215和/或所述蒸汽相217。气体可收集所述加湿器/蒸发器/雾化器213内的蒸汽或湿气。可利用加热的加湿器或雾化器来产生湿气。一些雾化器可自己产生流动源。由于膨胀，蒸汽可到达患者而不需流动源。在离开所述加湿器/蒸发器/雾化器213后，所述增湿气体可穿过蒸汽通道219。
如图2B所示，所述蒸汽通道219可位于所述通气气体输送通道221附近。一个或多个感应线223可位于所述患者回路205附近从而检测各种参数如压力、温度、湿度、流动、呼吸等等。在图2B的特定实施例中，所述患者回路205的远端可终止于所述患者气道225外部。所述气体输送203可将周围空气227夹带到患者气道225中。可替换地，所述患者回路205可终止于所述患者气道225处或内部。
图2C示出通过209，其中所述加湿器/蒸发器/雾化器213与所述通气机201分离。所述加湿器/蒸发器/雾化器213和所述通气机201可以是分离装置和/或一体的。
图3A-3B示出蒸汽夹带系统。在图3A中，通气机301经由射流文丘里管将气体303穿过患者回路305输送至患者307。加湿器/蒸发器/雾化器309可具有水、水溶液等311和蒸汽相313。可利用加热了的加湿器或雾化器325产生湿气。加热或雾化元件可位于贮存器内或至患者的管系中。在离开加湿器/蒸发器/雾化器309后，增湿气体可以穿过蒸汽通道315。
图3B是所述装置的患者端的细节。所述蒸汽通道315可位于通气气体输送通道317附近。一个或多个感应线319可位于所述患者回路305附近以检测各种参数如压力、温度、湿度、流动、呼吸等等。在图3B的特定实施例中，所述患者回路305的远端可终止于所述患者气道321的外部。所述气体输送303可将周围空气323夹带至患者气道321中。可替换地，所述患者回路305可终止于所述患者气道321处或内部。湿气可通过通气机射流文丘里管被吸入患者气道321中。
图4示出雾化系统。通气机401可将气体403穿过患者回路405输送至患者407。液体可从贮存器413穿过管道411被输入雾化器/蒸发器409。液体可以从所述雾化器/蒸发器409产生蒸汽和将蒸汽推动至患者407的自产生（self-generate）的流动源。
图5示出湿气输入系统。通气机501可将气体503穿过患者回路505输送至患者507。通气机501可经由输入压力管道511对贮存器509增压。液滴可经由蒸汽通道513被离开患者回路505的气体503形成的射流文丘里管从贮存器509抽吸至患者气道内。所述液体可在到达患者之前被雾化。可用患者回路505内的元件加热或雾化液体。
图6A-6B示出湿气输入气雾化系统。如图6A所示，通气机601可将气体603穿过患者回路605输送至患者607。所述通气机601可经由输入压力管道611给贮存器609增压。液滴可被由离开患者回路605的气体603所形成的射流文丘里管从贮存器609经由液体输送通道613抽吸至患者气道内。所述液体可在到达患者之前被雾化（aerosolized）。可用患者回路605内的元件加热或雾化液体。图6B是所述装置的患者端的细节。所述液体输送通道613的位置可接近所述通气气体输送通道615。二级气体输送通道623和/或射流625可在气雾网栅（misting screen）627处形成气雾。一个或多个感应线617可位于所述患者回路605附近从而检测各种参数如压力、温度、湿度、流动、呼吸等等。在图6B的特定实施例中，所述患者回路605的远端可终止于所述患者气道619的外部。输送气体603可夹带着周围空气621输送至患者气道621中。可替换地，所述患者回路605可终止于所述患者气道621处或内部。湿气可通过所述通气机射流文丘里管被吸入患者气道621中。
图7示出湿气夹带系统。通气机701可将气体703穿过患者回路705输送至患者707。液体可从贮存器713穿过管道711被输入至雾化器/蒸发器709。利用由通气机701形成的射流文丘里管，所述液体可从雾化器/蒸发器709吸至患者707。所述液体可在到达患者707之前例如使用不需要气流源的毛细作用力蒸发器（CFV）被雾化。
图8示出盒夹带系统。通气机801可将气体803通过患者回路805输送至患者807。液体可从贮存器813穿过管道811被抽吸或压力输入至亲水介质盒809。利用通气机801形成的射流文丘里管，液体可从亲水介质盒809抽吸至患者回路805内。
图9示出盒穿过系统。通气机901可将气体903穿过患者回路905输送至患者907。液体可从贮存器913穿过管道911被抽吸或压力输入至亲水介质盒909。流动源（优选来自通气机901）可穿过亲水介质盒909被输入穿过管道915。液体可从亲水介质盒909经由与所述患者回路905分离的输送管道917被输送至患者907。
图13A-13B示出带有雾气通道的实施例。图13A示出在离开装置之前进入雾气通道1303的流道1301。气体与流体的交会可产生湿气。图13B示出带有将流体从所述流道1301传送至雾气通道1303的两个管道1305、1307的可替换实施例。流体可从经由与通气机1313流体连通的管道1311被增压的贮存器1309被抽吸或压力输入。通气输送回路1311可通过患者回路1317输送气体。
本发明的实施例也可集成入基于非夹带系统（non-entrainment-based systems）或与基于非夹带系统一同使用。
图10示出带有将蒸发气体输入至患者接口1005的毛细作用力蒸发器1003的通气机1001的实施例。毛细作用力蒸发器1003是将液体从液体贮存器通过毛细作用带入将液体转换成加热的蒸汽的小型化加热元件的子系统。所述毛细作用力蒸发器可位于患者接口内或患者回路内接近通气机的位置。在优选实施例中，毛细作用力蒸发器位于通气机附近并且蒸汽经由患者回路随着来自所述通气机的气流被输送至患者接口。为防止蒸汽在管系内冷凝，管系可被加热或患者回路可具有将患者回路的壁与环境温度隔离的特征。
图11A示出带有喷雾器1103的通气机1101的实施例，喷雾器1103例如是振动网孔喷雾器或超声喷雾器，将雾状增湿输入至患者接口1105。所述喷雾器1103可位于患者接口内或患者回路内接近通气机的位置。在优选实施例中，喷雾器位于通气机内并且蒸汽经由所述患者回路随着来自所述通气机的气流被输送至患者接口。如果喷雾器位于通气机附近，所述管系可被加热从而有助于雾状液体转换为蒸汽并且为患者提供舒适温度的气体。图11B和11C示出位于所述患者接口处用于打开气道通气系统的振动网孔喷雾器的实施例。
图11B示出示例性增湿系统。连接器的特征可包括注射器提供动力（syringe-powered）的液体输入系统1701、功率和控制线路1703、振动网孔适配器1705、快速原型适配器（rapid prototyped adapter）1707、增加气雾流动的开口1709、改进的旋转连接器1711和/或通气机患者回路1713。
图11C是如图11B所示的增湿系统的示意图。通气机1801可包括图形用户接口1803、处理器1805、液体输入系统功率和导线装置1807、电源1809和/或液体贮存器1811。气体输送内腔1813可通向气管造口管1815。压力传感的内腔1817也可从通气机1801延伸至气管造口管（tracheostomy tube）1815。振动网孔喷雾器功率和控制线路1819可从通气机1801通向振动网孔喷雾器1821。所述振动网孔喷雾器1821可与所述液体贮存器1811流体连通1823。旋转或其它类型的连接器1825可将所述振动网孔喷雾器1821耦接于所述气管造口管1815。
图12示出带有将雾化气体输入至患者接口1205的雾化导管1203的通气机1201。雾化导管1203是将液体从液体贮存器运输至微型雾化端部的子系统，在此液体被转换成气雾。驱动压力用于穿过所述雾化导管输入液体并且产生气雾。在优选实施例中，来自通气机的压力用于产生驱动压力。所述雾化导管可被插入所述患者回路内或结合到所述患者回路内以使所述患者回路具有致力于将液体从所述液态源运输至所述雾化端部的内腔。所述雾化端部可位于患者接口内或患者回路内所述通气机附近。在所述优选实施例中，雾化端部位于患者接口附近或患者接口内，使得在气雾与患者接口壁之间的最小相互作用下将气雾传递至所述患者。为了优化患者的舒适度，将液体从液体贮存器运输至雾化端部的那部分雾化导管可被加热。
图14A-14B示出利用附加的气流通道输送增湿气体的实施例。在图14A中，流道1401可被气流通道1403所包围，气流通道1403与流道1401终止于基本相同位置处。在通道1401、1403的终点处，流体可被雾化并且被传送至患者接口或直接传送至气道。在图14B中，气流通道1405可被流道1407所包围，流道1407与所述气流通道1405终止于基本相同位置处。在通道1405、1407的终点处，流体可被雾化并且被传送至患者接口或直接传送至气道。在附加实施例中，由1403和1401或1405和1407构成的任何一个系统可在所述输送端口位置处与通气气体输送通道同心，或一般地说可为文丘里管泵的射流部分。在本实施例中，气流1403或1405将相应地雾化通道1401和1407中的流体。得到的流体和气体的雾化混合物将成为将空气夹带送入通气气体输送通道内的射流。气体/气雾混合物的密度增加将提供夹带性能的增加，有效地用相同气流夹带更多空气。
增湿源，例如毛细作用力蒸发器、振动网孔喷雾器和雾化导管，可被控制从而提供取决于患者需求的增湿水平。例如，一个或多个增湿传感器可位于所述增湿源与患者之间，并且这些子系统添加的增湿量可被伺服机构控制以提供满足患者需要但防止冲洗的目标增湿水平，例如75%的相对湿度。
可替换地，所述增湿子系统的特征使得控制系统能够基于已知的增湿子系统的特征预先地设定所述增湿源的输出或其它变量如传递至患者的气流、环境温度、环境湿度和它们的组合。用于增湿系统的控制器可为独立子系统，或在优选实施例中可与通气机一体。
优选地，所述增湿源可与患者的呼吸循环同步控制，这样在患者的吸气阶段添加更多湿气并且在患者的呼气阶段添加更少或不添加湿气。本领域技术人员将认识到，实际上当前使用的大口径管系包含很大的内容积（对于22mm的管系来说约为750ml），使得很难或不可能在管系的通气机末端处提供增湿的同时将湿度水平与患者连接端口处的患者的呼吸模式同步，因为管系引起非常显著的相位延迟。比较起来，本发明包含的小口径管系的内容积（对于6mm的管系来说约为50ml）仅会由于相位延迟引起极小的不精确度。
在输送管内“冲洗”或水冷凝的主要原因是因为流入输送管内的增湿可呼吸气体的冷却导致相对湿度增加超过饱和度。小口径管系的使用需要机械通气机产生的高压水平（40磅/平方英寸（psig）或更高）从而在患者接口处获得适当的治疗压力值。可采用沿小口径管子的高压降来抵消导致上述水冷凝的相对湿度的增加。当可呼吸气体的压力从患者远端至输送管近端部降低时，相对湿度相应地降低。该作用用于保持极高和恒定的相对湿度，确保输送管内不形成凝结水。该作用的大小取决于传递至患者的实际流量，因为期望的流量越高，沿输送管的压降就越高，由通气机产生的压力必须越高。沿管子的热损失还取决于气体的流率；特别是在更低流速下它可能更低。在低流速值下，由于可呼吸气体的温度降引起的相对湿度的增加可能更低，此外还有由于沿输送管的压降导致的相对湿度的降低。更高流速下则情况相反。在两个提及的作用的补偿方式与患者的呼吸循环自然地同时发生。当利用小口径管子时才能运用该作用，因为大口径管子（15mm内径或更大）不需要这种现象要很大值的压力水平。
此外，如果运用加热的管系，施加于加热器的能量可与患者的需要和呼吸循环同步被控制，提供了高度优化的系统。加热的管子优选是小口径的管子，带有大约2-14mm的内径。本领域技术人员将理解，加热的管子可使用电气元件来提供加热。供至加热器的电能可与呼吸循环期间的患者呼吸循环和/或湿度需要同步。小口径管子的使用可为系统提供较小的热惯性，有效地提供气体输送系统的快速响应和准确的温度/湿度控制。
图15示出用于通气机的增湿系统。通气机1501可包括氧气输入1503和患者回路输出1505。可包括利用重力输入的供水1507。所述患者回路输出1505可包括湿度适配器组件1509。进水口1511可通向偏压弹簧1513或类似装置，其又通向贮存器1515。贮存器约为5ml或任何其它适当的尺寸。来自通气机1501的增加物可被输入1517至贮存器1515内。可为患者回路1521提供输出1519。约2磅/平方英寸的弹簧1523可防止呼气期间的过量填注。
图16示出用于加热的增湿气体的系统。源1601（如汽缸或泵）可提供大约100磅/平方英寸或更多的气体。源1601可将气体供至调节器1603，调节器1603将气体压力调节至预定和/或期望水平。在一些实施例中，这可约为100磅/平方英寸。随后气体被供至涡旋热隔离器1605，其中热气可被供至第二调节器1607，其中气体压力被调节至预定和/或期望的水平。在一些实施例中，这可约为50磅/平方英寸。随后流量控制阀1609可将热气供至增湿器1611。冷气可从涡旋热隔离器1605被供至第三调节器1613，在第三调节器1613处气体压力被调节至预定和/或期望的水平。所述第三调节器1613可将冷气供至热交换器1619。在一些实施例中，这可约为50磅/平方英寸（PSIG）。冷气可被供至通气机1615。来自加湿器的暖湿气体可与来自患者接口1617之前、之内或与其分离的通气机的冷气结合。
图17示出带有并入其内的吸湿性材料1703的鼻接口1701。吸湿性材料俘获来自患者呼出的热量和湿气并且将热量和湿气返回所述患者的吸气中。这是一种无源技术，不需要其它复杂因素例如电力和湿气输入来产生用于患者的加热/增湿目标，藉此提供了用于通气的加热/湿气系统的简单实例。适宜吸湿性材料的示例包括可买到的热和湿气交换器（HME），以及吸水处理的热和湿气交换器（HHME）如用吸水化学制品（通常为氯化钙或氯化锂）处理过的纸张或聚丙烯插入物以提高保水性。所述吸湿性材料1703可为多孔的。在一些实施例中，所有或几乎所有患者的吸气和/或呼气可穿过吸湿性材料1703。在这些实施例中，鼻枕1705可密封患者的鼻子。优选患者呼出的所有流量以及被患者吸入的所有流量应当穿过所述吸湿性材料从而在呼气阶段优化加热和保水性并且最大化被患者吸入的可呼吸气体的加热和增湿。最佳尺寸通常取决于患者接口使用的材料、其厚度和流体动态设计。优选实施例中可能大多数吸水元件的表面暴露于患者呼出和吸入的气流中，并且可具有优选约2-20mm的厚度和约150-800mm2的表面积。
本发明的实施例在鼻接口内集成了吸湿性材料以提供加热和增湿患者气体的患者接口。吸湿性材料1703可位于鼻接口1701内气体流路的任何位置。在优选实施例中，吸湿性材料1703可位于鼻接口1701的枕状部分1705内或位于附接于枕状部分1705的垫层内。枕状部分1705可延伸至和/或接触患者的鼻子，并且可延伸至所述鼻接口的歧管部分1707。一个或多个通道1709可提供穿过鼻接口1701的从患者输送回路的进入1713至靠近患者鼻子或在鼻子内的出口1711的气体流路。一个或多个感应端口1715可检测压力、湿度或其它变量。优选地，一个或多个感应端口1715位于所述吸湿性材料1703的患者侧上以产生更准确的读数。
所述吸水元件可与前面公开的主动增湿系统结合使用以最小化通气系统的需水量。每当存在吸水元件时，增湿的输送将与患者的呼吸循环合拍并且在呼吸循环的一些阶段例如在呼气期间主动增湿的输送可降低乃至中止。这就提供了患者的最佳增湿，确保使用最少的水和能量，从而增加了通气设备的轻便性。
所述枕状部分1705内的位置可提供若干优点：
(1)通过紧邻患者鼻子处并入吸湿性材料1703，因为吸湿性材料与患者之间微不足道的热损失，得到了最大的效率。
(2)吸湿性材料1703和枕状接口1705均可由柔顺材料制成，并且因此这些材料的协同定位提供了实施所述患者接口而不牺牲任何一个材料的功能的最小可能性。
(3)枕状接口1705和吸湿性材料1703均可为使用者可更换的部件，即定期更换以维持系统性能和清洁的部件。因此，所述枕部1705和吸湿性材料1703的协同定位可为使用者提供最简单的保养经历。
(4)吸湿性材料1703的位置可最小化患者进气口处的声音。声音可穿过空气和患者而传播。吸湿性材料1703表现为在通气气体进入患者之前扩散气流并且因此减少了气流的噪音等级。此外，吸湿性材料1703可扩散患者呼出的气流至外界和或从患者接口向外界排出气流，因此减少了噪音。
一个或多个控制器可调节本发明的系统和方法。一个或多个控制器可包括一个或多个处理器和一个或多个存储器。一个或多个控制器可控制通气机和/或增湿系统。一个或多个控制器可从一个或多个传感器接收信号并且处理那些信号以产生新信号送至通气机和/或加湿器以调整气体输送参数。
虽然上述说明书旨在本发明的优选实施例，要注意其它变化和改进对本领域技术人员是显而易见的，并且可能是脱离本发明的精神和范围而被做出的。此外，与本发明一个实施例有关的特征可与其它实施例结合使用，即使上面未明确指出亦是如此。本发明可体现在其它特定形式中而不脱离其精神或基本特征。所述实施例被认为是在各方面仅为示例性而非限制性的。

Claims (37)

1.一种用于接收来自气体输送管系的通气气体和用于增湿通气气体的鼻接口设备，所述设备包括：
所述鼻接口内的一个或多个通道，所述通道将来自气体输送回路的气体输送至一个或多个结构，其中所述一个或多个结构与所述一个或多个通道流体连通以便将通气气体引导至患者的鼻子；以及
在鼻接口内位于通气气体的流动路径中的吸湿性材料。
2.根据权利要求1的设备，其中所述一个或多个结构是一个或多个鼻枕，并且其中所述吸湿性材料位于所述一个或多个鼻枕内或位于附连至所述一个或多个鼻枕的垫层内。
3.根据权利要求1的设备，还包括至少一个压力传感器装置。
4.根据权利要求3的设备，其中所述至少一个压力传感器位于所述吸湿性材料的患者侧上。
5.根据权利要求1的设备，其中所述气体输送回路具有大约2-14mm的内径。
6.根据权利要求1的设备，其中所述系统与便携式通气系统一同使用。
7.根据权利要求1的设备，其中增湿通气气体的输送被伺服控制。
8.根据权利要求7的设备，其中伺服控制基于患者的需求来控制增湿水平。
9.根据权利要求7的设备，其中所述伺服控制以预先确定的方式控制增湿水平。
10.根据权利要求9的设备，其中所述伺服控制考虑了被输送至患者的气流、环境温度、环境湿度以及它们的组合。
11.根据权利要求1的设备，其中所述增湿通气气体被与患者的呼吸循环同步地输送。
12.根据权利要求11的设备，其中在患者的吸气阶段比在患者的呼气阶段输送更多增湿通气气体。
13.根据权利要求1的设备，还包括被加热的管系。
14.根据权利要求13的设备，其中能量被与患者需求和患者的呼吸循环同步地施加于所述加热管系。
15.一种用于增湿通气气体的系统，所述系统包括:
通气机；
在近端处与所述通气机流体连通并且在远端处流体地连接于患者气道的患者回路，其中所述患者回路具有大约2-14mm的内径；
流体贮存器；
增湿装置；以及
所述增湿装置与所述患者回路的远端之间的通道。
16.根据权利要求15的系统，还包括患者接口，其中所述患者接口是鼻接口、口部接口或经气管的接口。
17.根据权利要求15的系统，其中所述流体是水、药液或它们的组合。
18.根据权利要求15的系统，其中药物可选地与增湿一起输送。
19.根据权利要求15的系统，其中所述通气机是便携式的。
20.根据权利要求15的系统，其中所述通道终止于所述患者回路的一端附近，使得患者回路内由气体产生的射流文丘里效应夹带来自所述通道的蒸汽。
21.根据权利要求15的系统，其中所述流体贮存器被来自所述通气机的气体所增压。
22.根据权利要求15的系统，进一步包括在所述通道的远端处的气雾网栅。
23.根据权利要求22的系统，还包括用于输送气体从而在所述气雾网栅之前产生射流的第二通道。
24.根据权利要求15的系统，还包括在所述通道内的亲水介质盒。
25.根据权利要求15的系统，还包括毛细作用力蒸发器。
26.根据权利要求15的系统，还包括振动网孔喷雾器。
27.根据权利要求15的系统，还包括雾化导管。
28.根据权利要求15的系统，还包括包围所述通道的气流通道。
29.根据权利要求15的系统，其中所述通道包围气流通道。
30.根据权利要求15的系统，还包括用于将热气供至增湿器和将冷气供至通气机的涡旋热分离机。
31.根据权利要求15的系统，其中所述增湿通气气体的输送被伺服控制。
32.根据权利要求15的设备，其中所述增湿通气气体被与患者的呼吸循环同步地输送。
33.根据权利要求15的系统，其中所述通气机所输送的气体的平均流量在约6lpm以上。
34.根据权利要求15的系统，其中所述增湿气体的输送被控制在50-95%的相对湿度以防止患者回路内的冲洗。
35.一种用于输送增湿通气气体的设备，所述设备包括:
内径约2-14mm的一个或多个管子；以及
沿所述一个或多个管子的长度的一个或多个加热器，
其中所述一个或多个管子适于将增湿通气气体输送至患者。
36.根据权利要求35的设备，其中通过控制器控制所述一个或多个加热器从而与患者需求和患者的呼吸循环同步地输送热量。
37.根据权利要求35的设备，其中通过控制器控制所述一个或多个加热器以基于环境条件输送热量。
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