呼吸機(jī)相關(guān)基礎(chǔ)知識(shí)

1、呼吸機(jī)相關(guān)基礎(chǔ)知識(shí)相關(guān)呼吸生理基礎(chǔ)The First Affiliated Hospital of Bengbu Medical College in intensive medicine鼻 咽 喉 氣管 支氣管 肺終末細(xì)支氣管通氣部分換氣部分呼吸系統(tǒng)呼吸系統(tǒng)The First Affiliated Hospital of Bengbu Medical College in intensive medicine生命體和外界環(huán)境之間氧和二氧化碳的交換呼吸系統(tǒng)The First Affiliated Hospital of Bengbu Medical College in intensive m

2、edicine通氣彌散灌注自主呼吸原理The First Affiliated Hospital of Bengbu Medical College in intensive medicine吸氣肌收縮吸氣肌舒張吸氣呼氣主動(dòng)被動(dòng)人工通氣原理The First Affiliated Hospital of Bengbu Medical College in intensive medicine吸氣呼氣機(jī)械力彈性回縮力被動(dòng)主動(dòng)通氣原理The First Affiliated Hospital of Bengbu Medical College in intensive medicine自主通氣機(jī)械

3、通氣壓力變化容量變化機(jī)械通氣(ventilation) 機(jī)械通氣是患者自然通氣或氧合功能出現(xiàn)障礙時(shí)運(yùn)用器械使患者恢復(fù)有效通氣并改善氧合的方法The First Affiliated Hospital of Bengbu Medical College in intensive medicine呼吸機(jī)的作用？The First Affiliated Hospital of Bengbu Medical College in intensive medicine外呼吸機(jī)械通氣的目的？ 改善通氣，糾正呼吸性酸中毒 改善換氣，糾正低氧血癥 減少呼吸肌作功，節(jié)約氧耗 保持呼吸道通暢 改善壓力容積關(guān)系Th

4、e First Affiliated Hospital of Bengbu Medical College in intensive medicine人工氣道 經(jīng)鼻氣管插管 經(jīng)口氣管插管 氣管切開The First Affiliated Hospital of Bengbu Medical College in intensive medicine呼吸機(jī)的基本構(gòu)造主機(jī)附加結(jié)構(gòu)監(jiān)測結(jié)構(gòu)The First Affiliated Hospital of Bengbu Medical College in intensive medicinequestion給患者送氣 一直送下去嗎呼氣.PS.要呼完嗎

5、 who轉(zhuǎn)換 how送.PS.呼多少 監(jiān)測The First Affiliated Hospital of Bengbu Medical College in intensive medicine常用的通氣概念潮氣量（Vt）：患者在平靜狀態(tài)下，每次所能吸入或呼出的氣體容量吸氣壓力（Pi）：輔助/控制通氣時(shí)在吸氣相疊加在PEEP之上的壓力分鐘通氣量（MV）：每分鐘吸入或呼出氣體的總量，分鐘通氣量=呼吸頻率*潮氣量壓力支持（PS）：患者自主呼吸時(shí)在PEEP壓力之上呼吸機(jī)提供的一個(gè)幫助吸氣的壓力PEEP：呼吸機(jī)提供的在呼氣末維持的壓力The First Affiliated Hospital of

6、Bengbu Medical College in intensive medicine常用的通氣概念吸氣時(shí)間：呼吸機(jī)供氣時(shí)間吸呼比：在每次呼吸中，吸氣所用時(shí)間和呼氣所用時(shí)間之間的比值呼吸頻率：患者每分鐘的呼吸的次數(shù)窒息通氣：僅在自主呼吸模式中，如果在預(yù)先設(shè)定的時(shí)間后病人沒有自主呼吸或觸發(fā)呼吸機(jī)，呼吸機(jī)將啟動(dòng)后備通氣程序吸氣觸發(fā)：流速、壓力、時(shí)間呼氣觸發(fā)：患者由吸氣項(xiàng)轉(zhuǎn)化為呼氣項(xiàng)的判斷標(biāo)準(zhǔn)The First Affiliated Hospital of Bengbu Medical College in intensive medicine機(jī)械通氣物理量-壓力The First Affilia

7、ted Hospital of Bengbu Medical College in intensive medicineB平臺(tái)壓time(sec)機(jī)械通氣物理量-流速、容量The First Affiliated Hospital of Bengbu Medical College in intensive medicine目標(biāo)The First Affiliated Hospital of Bengbu Medical College in intensive medicine潮氣量壓力壓力潮氣量容量控制壓力控制呼吸機(jī)模式V/PCV(volume/pressure controlled ve

8、ntilation)V/P-A/C(volume/pressure-assisted/controlled) V/P-SIMV(volume/pressure-synchronized intermittent mandatory ventilation)PSV(pressure support ventilation)CPAP(continuous positive airway pressure)BIPAP(bi-level positive airway pressure)The First Affiliated Hospital of Bengbu Medical College in

9、 intensive medicine機(jī)械通氣時(shí)相The First Affiliated Hospital of Bengbu Medical College in intensive medicineABCD觸發(fā)階段吸氣階段吸氣轉(zhuǎn)換呼氣呼氣階段pressuretime觸發(fā)階段The First Affiliated Hospital of Bengbu Medical College in intensive medicineTime triggerPressure trigger Flow triggerTime trigger 呼吸機(jī)控制通氣的啟動(dòng)，根據(jù)設(shè)定的頻率，按一定時(shí)間間隔送氣T

10、he First Affiliated Hospital of Bengbu Medical College in intensive medicineSensitivity 反應(yīng)患者自主吸氣觸發(fā)呼吸機(jī)作功的大小，這個(gè)吸氣引起管道系統(tǒng)內(nèi)壓力、流速的變化，變化被系統(tǒng)感知即觸發(fā)呼吸機(jī)供氣The First Affiliated Hospital of Bengbu Medical College in intensive medicinePressure trigger 患者引起管道內(nèi)壓力變化觸發(fā)呼吸機(jī)啟動(dòng) 一般設(shè)置在-2-0.5cmH2OThe First Affiliated Hospital

11、 of Bengbu Medical College in intensive medicineFlow trigger 患者的吸氣動(dòng)作引起管道內(nèi)氣流速變化 一般設(shè)置13L/minThe First Affiliated Hospital of Bengbu Medical College in intensive medicineFlow trigger由于流速觸發(fā)中背景氣流的存在，患者吸氣時(shí)即刻新鮮的氣體流速觸發(fā)比壓力觸發(fā)更敏感，呼吸機(jī)的反應(yīng)時(shí)間(響應(yīng)時(shí)間)較短The First Affiliated Hospital of Bengbu Medical College in intens

12、ive medicine吸氣相 PS 定容The First Affiliated Hospital of Bengbu Medical College in intensive medicine吸氣相 PS 定容潮氣量：預(yù)設(shè)氣流大?。侯A(yù)設(shè)氣流形態(tài)：方波或減速波The First Affiliated Hospital of Bengbu Medical College in intensive medicine方波或減速波The First Affiliated Hospital of Bengbu Medical College in intensive medicineflowtime(

13、sec)flowtime(sec)00吸氣吸氣吸氣吸氣呼氣呼氣呼氣呼氣方波減速波吸氣相 PS 定壓The First Affiliated Hospital of Bengbu Medical College in intensive medicine吸氣相 PS 定壓The First Affiliated Hospital of Bengbu Medical College in intensive medicine“定壓”是指吸氣壓力恒定氣流大小不定氣流形態(tài)：減速波吸氣流速曲線下面積不定，無法“定容”影響因素：患者的吸氣用力程度、氣道阻力、肺的順應(yīng)性 吸氣向呼氣切換時(shí)間切換：通過預(yù)設(shè)的吸

14、氣時(shí)間使吸氣終止容量切換：吸氣達(dá)到預(yù)設(shè)潮氣量時(shí),吸氣終止壓力切換：呼吸道達(dá)到設(shè)置壓力時(shí)使吸氣終止流速切換：當(dāng)吸氣流速降至預(yù)設(shè)的峰流速%以下The First Affiliated Hospital of Bengbu Medical College in intensive medicine呼氣相 PS PEEP是指呼吸機(jī)在吸氣時(shí)產(chǎn)生正壓，將氣體壓入肺內(nèi)，呼氣相氣道壓始終保持在正壓水平的通氣模式防止肺泡萎縮，提高肺順應(yīng)性，降低呼吸功和耗氧量，增加肺泡和間質(zhì)的壓力，促進(jìn)肺間質(zhì)和肺泡水腫的消退，減少生理無效腔，增加肺泡通氣量，改善通氣-血流比值，降低肺內(nèi)靜-動(dòng)脈分流，提高PaO2，改善組織供氧The First Affiliated Hospital of Bengbu Medical College in intensive medicine通氣模式及機(jī)制The First Affiliated Hospital of Bengbu Medical College in intensive medicine自己學(xué)習(xí)目標(biāo)參數(shù)設(shè)置The First Affiliated Hospital of Bengbu Medical College in intensiv