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目的 探讨呼吸训练器对机械通气患者主动吹气或咳嗽所致气道高峰压的泄压作用.方法 选择2018年7-9月广州医科大学附属第一医院呼吸二区的15例机械通气治疗患者,采用自身对照方法,观察通气回路连接呼吸训练器前后患者主动用力吹气、轻轻咳嗽、用力咳嗽对气道峰压的影响.结果 机械通气呼吸回路连接呼吸训练器后,5例气管切开或气管插管机械通气患者深吸气末用力吹气、平静吸气末轻轻咳嗽、深吸气末用力咳嗽时的气道峰压分别从(30.0±4.5)、(31.4±5.0)和(34.9±5.0)cmH2O(1 cmH2O=0.098 kPa)降至(26.3±2.9)、(26.7±3.5)和(29.0±4.1)cmH2O,差异有统计学意义(均P＜0.01),而10例面罩无创机械通气患者分别从(17.7±1.9)、(16.6±2.5)和(18.9±2.5)cmH2O变为(18.9±2.5)、(16.3±1.9)和(18.8±2.0)cmH2O,差异无统计学意义(均P＞0.05).结论 呼吸训练器应用于气管切开或气管插管的机械通气回路中,可明显降低用力呼气和咳嗽所致的气道峰压,是机械通气患者预防气道高压的主动咳嗽辅助装置.“,”Objective To explore the effect of a breathing trainer on relieving the peak airway pressure caused by forced exhalation at the end of deep inspiration,gentle coughing at the end of calm inspiration and forced coughing at the end of deep inspiration in patients undergoing mechanical ventilation.Methods From July to September 2018,15 patients undergoing mechanical ventilation were selected from the First Affiliated Hospital of Guangzhou Medical University,including 5 patients with invasive ventilation (3 with tracheotomy and 2 with endotracheal intubation),and 10 patients with non-invasive ventilation through mask.The patients included 14 males and 1 female,aging 48-79 years,with an average age of (68± 10) years.A Breathing Trainer developed by both Dongguan Yongsheng Medical Products Co.,Ltd.and Guangzhou Institute of Respiratory Health was used to relieve the peak airway pressure.A one-way expiratory valve connected with a spring at the expiratory end of the Breathing Trainer was not opened until the pressure inside the airway was higher than 20 cmH2O (1 cmH2O=0.098 kPa),and opened completely when the pressure was higher than 35 cmH2O.Both before and after the Breathing Trainer was connected to the respiratory circuit,the patients were asked to exhale hard at the end of deep inspiration,to cough gently at the end of calm inspiration and to cough forcefully at the end of deep inspiration and the airway pressure were measured respectively.Each action was tested 3 times,and the interval time of each test was 1 min,and the interval of each action was 10 min.Results Among the patients with tracheotomy or endotracheal intubation for invasive mechanical ventilation,when the patients exhaled hard at the end of deep inspiration,coughed gently at the end of gentle inspiration and coughed forcefully at the end of deep inspiration,the peak airway pressure measured before the ventilation circuit was connected to the Breathing Trainer was (30.0±4.5),(31.4±5.0) and (34.9±5.0)cmH2O,respectively,which was significantly higher than that after fhe ventilation circuit was connected to the Breathing Trainer(26.3±2.9),(26.7±3.5) and (29.0±4.1)cnH2O (all P＜0.01).Among the patients with non-invasive mechanical ventilation wearing face masks,when the patients exhaled hard at the end of deep inspiration,coughed gently at the end of gentle inspiration and coughed forcefully at the end of deep inspiration,the peak airway pressure was (17.7± 1.9),(16.6±2.5) and (1 8.9±2.5) respectively,before the ventilation circuit was connected to the Breathing Trainer,and was (18.9± 2.5),(16.3± 1.9) and (18.8 ±2.0) cmH2O respectively,after the wentilation circuit was connected to the Breathing Trainer.There was no significant difference between them (P＞0.05).Conclusion The application of Breathing Trainer in the mechanical ventilation circuit of tracheotomy or endotracheal intubation could significantly reduce the peak airway pressure caused by hard exhalation and cough.It could be used as an active cough assist device for mechanical ventilation patients to prevent high airway pressure.