TheNeedsofThePatientsandTheTheNeedsofThePatientsandTheCustomersComeFirstCustomersComeFirstTheNeedsofThePatientsandTheTheNeedsofThePatientsandTheCustomersComeFirstCustomersComeFirst呼吸机的使用及撤机路伟娜TheNeedsofThePatientsandTheTheNeedsofThePatientsandTheCustomersComeFirstCustomersComeFirstTheNeedsofThePatientsandTheTheNeedsofThePatientsandTheCustomersComeFirstCustomersComeFirst呼吸机系统简图成立时间:2009年科室人员配置:主任:傅水桥护士长:徐珏华目前医生10人,护士28人,其中副主任医师2人,主治医师4人,住院医师4人。TheNeedsofThePatientsandTheTheNeedsofThePatientsandTheCustomersComeFirstCustomersComeFirstTheNeedsofThePatientsandTheTheNeedsofThePatientsandTheCustomersComeFirstCustomersComeFirst呼吸模式•辅助/控制型(A/C:Assist/Control;CMV)•半自主型:同步间歇指令呼吸SIMV•自主型(Spontaneous)TheNeedsofThePatientsandTheTheNeedsofThePatientsandTheCustomersComeFirstCustomersComeFirstTheNeedsofThePatientsandTheTheNeedsofThePatientsandTheCustomersComeFirstCustomersComeFirst辅助/控制模式(A/C):机控呼吸•临床应用:病人基本没有自主呼吸•呼吸机根据临床医生的设定参数供气:–潮气量或压力–流速和流速波形,或吸气时间–呼吸频率•由机器启动,也可由病人同步触发通气TimePressureTheNeedsofThePatientsandTheTheNeedsofThePatientsandTheCustomersComeFirstCustomersComeFirstTheNeedsofThePatientsandTheTheNeedsofThePatientsandTheCustomersComeFirstCustomersComeFirst辅助/控制模式(A/C):机控呼吸一.控制通气(controlledmechanicalventilation,CMV)呼吸机完全替代自主呼吸的通气方式1.容量控制通气(volumecontrolledmechanical,VCV)特点:能保证潮气量的供给,完全替代自主呼吸,有利于呼吸机休息;易发生人机对抗、通气不足或同期过度,不利于呼吸机锻炼2.压力控制通气(pressurecontrolledmechanical,PCV)特点:通气功能差、气道压力高的患者;用于ARDS有利于改善换气;新生儿、婴幼儿补偿漏气TheNeedsofThePatientsandTheTheNeedsofThePatientsandTheCustomersComeFirstCustomersComeFirstTheNeedsofThePatientsandTheTheNeedsofThePatientsandTheCustomersComeFirstCustomersComeFirst辅助/控制模式(A/C):机控呼吸二、辅助通气(Assistedventilation,AV)关键是预设触发灵敏度和潮气量或吸气压力要恰当三、辅助控制通气(A/C)病人有自主呼吸时,机器随呼吸启动,一旦自发呼吸在一段时间内不发生时,机械通气自动由辅助转为控制性通气。它属于间歇正压通气。TheNeedsofThePatientsandTheTheNeedsofThePatientsandTheCustomersComeFirstCustomersComeFirstTheNeedsofThePatientsandTheTheNeedsofThePatientsandTheCustomersComeFirstCustomersComeFirst半自主型:同步间隙指令通气(SIMV)•临床应用:病人有一定频率的自主呼吸•由呼吸机强制通气和自主呼吸组合而成•强制通气是由机器启动(IMV)或病人触发(SIMV)•在自主呼吸时,病人决定潮气量和呼吸频率机器启动的强制通气病人触发的强制通气自主呼吸病人触发TimePressureTheNeedsofThePatientsandTheTheNeedsofThePatientsandTheCustomersComeFirstCustomersComeFirstTheNeedsofThePatientsandTheTheNeedsofThePatientsandTheCustomersComeFirstCustomersComeFirst半自主型:同步间隙指令通气(SIMV)•属于辅助通气方式,呼吸机于一定的间歇时间自主呼吸导致气道内负压信号,同步送出气流,间歇进行辅助通气。即(可自主呼吸)若干次自主呼吸后给一次正压通气,保证每分钟通气量,IMV的呼吸频率承认一般小于10次/分。TheNeedsofThePatientsandTheTheNeedsofThePatientsandTheCustomersComeFirstCustomersComeFirstTheNeedsofThePatientsandTheTheNeedsofThePatientsandTheCustomersComeFirstCustomersComeFirst自主型(Spontaneous)•临床应用:病人有足够的自主呼吸频率•定义–要求有主动的自主呼吸驱动力–持续气道内正压通气(C...