CompanyConfidential–Forinternaluseonly呼吸机基本波形Jay.DingCompanyConfidential–Forinternaluseonly机械通气四大变量•流量•压力•容量•时间•定流通气•变流通气CompanyConfidential–Forinternaluseonly吸气流量波—机控呼吸①呼吸机送气开始②吸气峰流量③吸呼切换④吸气时间⑤整个呼吸周期时间(TCT)CompanyConfidential–Forinternaluseonly漏气对切换的影响CompanyConfidential–Forinternaluseonly双重切换CompanyConfidential–Forinternaluseonly延迟时间效应CompanyConfidential–Forinternaluseonly管路回缩力CompanyConfidential–Forinternaluseonly不同的流量波型CompanyConfidential–Forinternaluseonly吸气流量波—自主呼吸①吸气开始②最大吸气流量③吸气结束④吸气时间CompanyConfidential–Forinternaluseonly•一次吸气过程中出现了病人吸气动作,通常在流量波形上会出现切迹,此时病人不会得到所需的流量CompanyConfidential–Forinternaluseonly按需流量补偿CompanyConfidential–Forinternaluseonly呼气流量波•呼气流量波的大小、持续时间、形状取决于顺应性和阻力①呼气开始②呼气峰流量③呼气结束④呼气流量的持续时间⑤有效呼气时间⑥TCT整个呼吸周期时间CompanyConfidential–Forinternaluseonly气道阻力增大CompanyConfidential–Forinternaluseonly被动呼气和主动呼气CompanyConfidential–Forinternaluseonly压力曲线CompanyConfidential–Forinternaluseonly吸气暂停CompanyConfidential–Forinternaluseonly阻力、流量、顺应性影响(固定潮气量)CompanyConfidential–ForinternaluseonlyPEEP/CPAPCompanyConfidential–Forinternaluseonly气道压和肺泡压CompanyConfidential–ForinternaluseonlyCompanyConfidential–Forinternaluseonly平均气道压CompanyConfidential–Forinternaluseonly自主触发CompanyConfidential–Forinternaluseonly未达到触发灵敏度CompanyConfidential–Forinternaluseonly•未能触发辅助通气的呼吸时,时间的测算也会受到影响。CompanyConfidential–Forinternaluseonly压力上升时间CompanyConfidential–ForinternaluseonlyPCV/PSVCompanyConfidential–Forinternaluseonly双水平正压通气下的压力曲线•两个不同水平的PEEP交替使用•Phigh,Plow,Thigh,Tlow•参数的不同组合和病人自主呼吸的情况,可衍生出几种不同的模式CompanyConfidential–ForinternaluseonlyAPRVCompanyConfidential–Forinternaluseonly食道压•测量食道压,需要放置测压管进入病人食道,由于食道内消化液的关系,最好采用带套囊的盲端测压管CompanyConfidential–Forinternaluseonly•食道测压管最好放置在右心房的后侧CompanyConfidential–ForinternaluseonlyCompanyConfidential–ForinternaluseonlyCompanyConfidential–Forinternaluseonly容量-时间曲线CompanyConfidential–Forinternaluseonly自动管路顺应性补偿CompanyConfidential–Forinternaluseonly压力—容量环CompanyConfidential–ForinternaluseonlyCompanyConfidential–Forinternaluseonly气道压和气管内压CompanyConfidential–Forinternaluseonly•Paw实线代表呼吸机端(气管插管远端)所反映的P-V环,包含了气管插管所导致的阻力。•Ptrach虚线代表总气管内(气管插管末端)所反映的P-V环,排除了气管插管所引起的阻力因素。•测Ptrach另需用2mm的细导管经气管插管插至气管导管外CompanyConfidential–Forinternaluseonly静态压力容量环CompanyConfidential–Forinternaluseonly流量-容量环CompanyConfidential–Forinternaluseonly方波和递减波CompanyConfidential–Forinternaluseonly压力-流量环临床使用较少CompanyConfidential–Forinternaluseonly