机械通气原理PPT课件

.,1,机械通气工作原理,浙江大学医学院附属第一医院ICU蔡洪流,.,2,主要内容,概述,参数测量/计算,运动方程,.,3,概述,.,4,.,5,.,6,O2,AIR,ToPatient,50psig,50psig,BLENDER,RESERVOIR,10-15PSIG,AirandO2aremixedinablender,storedasamixedgasinareservoirthenpassthroughasingleproportionalvalve.,PROPORTIONALVALVE,SingleProportionalSystemHamiltonVeolar,Bird6400-8400st,.,7,O2,AIR,ToPatient,50psig,50psig,Eachgashasitsownsolenoid,flowsensorandpressureregulator.Bothvalvescontrolledbymicroprocessor.,FLOWSENSOR,FLOWSENSOR,TwoProportionalValveSystemNPB7200-840,DRAGERE2-4,SERVO300,.,8,O2,PulmoneticLTVTurbine/BlenderSystem,Blendedgastopatient,DeliveryControlValve,BlowerwithIntragralDigitalBlender,.,9,O2,AIR,50psig,50psig,AirandO2solenoidscombinedwithactiveexhalationvalve.,PATIENT,EXH,TwoProportionalValveSystemWithActiveExhalationValve,.,10,PB-840,.,11,.,12,.,13,双比例电磁阀：精确调整氧浓度、流速和波形,.,14,低阻力主动呼气阀,.,15,低阻力主动呼气阀,.,16,安全阀,.,17,.,18,.,19,.,20,学习目的,掌握常见呼吸机的工作原理：气路、电路、及计算机控制技术比较常见呼吸机的优缺点，了解未来呼吸机的发展方向及技术热点设计研发全球领先的新一代Ventilator，代号：协作一号,.,21,这显然是不可能的,学习目的,.,22,学习目的,对机械通气原理有一个大致的了解！,.,23,.,24,概念,呼吸外呼吸气体在血液中的运输内呼吸,.,25,概念,呼吸外呼吸通气弥散气体在血液中的运输内呼吸,.,26,概念,通气,.,27,.,28,压差是气体运动的动力,P1,P2,R,.,29,-5,0,0,NormalRespirationEnd-Expiration,.,30,-10,0,-5,NormalRespirationInspiration,.,31,-10to-5,0,NormalRespirationExpiration,.,32,吸气,Pb,Pa,PaPa机械通气,.,33,自主呼吸,胸廓容量改变,气流,压差,.,34,机械通气,压差,容量变化,气流,.,35,机械通气,机器产生压差,容量变化,气流,.,36,概念,通气机用来辅助或替代呼吸肌工作的机器,.,37,概念,机械通气使用通气机驱动气体进出呼吸系统,.,38,机械通气负压通气正压通气,概念,.,39,机械通气负压通气正压通气,概念,.,40,.,41,.,42,IronlungpoliowardatRanchoLosAmigosHospitalin1953.,.,43,.,44,.,45,机械通气负压通气正压通气,概念,.,46,机械通气负压通气正压通气,概念,.,47,.,48,.,49,.,50,概念,通气机械通气正压通气,.,51,.,52,.,53,.,54,.,55,.,56,概念,正压通气容量控制压力控制,.,57,Volume500ml,Volume500ml,.,58,Pressure20cmH2O,Pressure20cmH2O,.,59,.,60,Pressure3500cmH20,Pressure35cmH20Tidalvolume500ml,.,61,MicroprocessorControl,Pressure3500cmH20,solenoid,Microprocessor,exhalevalve,Tidalvolume500mlPressure35cmH20,.,62,描述气体运动参数,压力流速时间容量,.,63,参数测量/计算,.,64,监测参数,测量参数计算参数,.,65,测量参数,压力流速时间,.,66,计算参数,容量顺应性阻力,.,67,管道+气球模型,.,68,Tube+SpringModel,弹性阻力,摩擦阻力,.,69,Y型管通气机内部食道,压力测定部位,.,70,压力测定部位,.,71,压力测定部位,.,72,流速测定方法,压差传感器热线型传感器超声传感器,.,73,流速测定方法,压差传感器,.,74,流速测定方法,温差传感器,.,75,FlowSensor,.,76,.,77,HeatedWireAnemometer,.,78,Brokenwire,.,79,流速测定方法,温差传感器（热线型传感器）,晶体热膜式流量传感器,.,80,超声流量传感器,流速测定方法,.,81,流速测定方法,超声流量传感器,.,82,流速测定方法,超声流量传感器,.,83,流速测定部位,Y型管通气机内部,.,84,流速测定部位,Y型管,.,85,流速测定部位,通气机内部,.,86,测量参数,压力流速时间,.,87,计算参数,容量顺应性阻力,.,88,容量计算,.,89,容量,流速,时间,容量计算,容量=流速时间,.,90,容量计算,气体容量与压力、温度和水蒸气含量密切相关BTPSBodyTemperaturePressureSaturated(Inthelungsofthepatient),.,91,Someeasyprinciplesofphysics(i),WhathappensifyouheatacertaingasVolume?,Theinitialvolumeofgasincreases1Lofgasat20Cincreasesto1.058Lat37Cwhilethepressurelevelremainsthesame,.,92,Theinitialvolumeofgasincreasesuptothesaturationpointofwater1Lofdriedgasat20Cincreasesto1.023Lifhumidifiedto100%where2.3%ofthegasmixtureiswatervapor,Someeasyprinciplesofphysics(ii),Whathappensifyouhumidifydriedgas?,.,93,Theinitialvolumeofgasdecreasesproportionallytotheappliedpressure1Lofgasat1013mbarwilldecreaseto980mLifanadditionalpressureof20mbarisapplied,Someeasyprinciplesofphysics(iii),Whathappensifyouhumidifydriedgas?,.,94,Pressure,Saturated,1000,mL,37C,100%RH,Normal,Temperature,Pressure,Saturated,930,mL,20C,100%RH,容量测定,.,95,容量测定,.,96,C=,DV,DP,静态顺应性,.,97,静态顺应性,流速为零时测定（指令通气+吸气暂停）受患者体位和肌肉松弛程度等影响,.,98,静态顺应性,500,15-5,=50ml/cmH20,Compliance=,Vte,Plateau-PEEP,PlateauPressure15cm,PIP20cm,VTE500cc,PeakFlow=60L/min,PeakFlow=60L/min,PlateauPressure15cm,PIP20cm,VTE500cc,.,99,内源性PEEP的存在造成顺应性计算值偏低,VTE500cc,P,T,Plateau=20,PEEP=5,LungPEEP=10,静态顺应性,.,100,R=,DP,DF,气道阻力,.,101,PlateauPressure15cm,PIP20cm,VTE500cc,PeakFlow=60L/min,Resistance=,PIP-Plateau,PeakFlow,Resistance=,20-15,1L/sec,=5cmH20/L/sec,气道阻力,.,102,.,103,呼气,吸气,通气,概念,.,104,机械通气工作原理,吸气由什么触发Trigger吸气相通气机限制什么Limit吸气相什么时候结束Cycle呼气相预设压力Baseline,.,105,机械通气工作原理,ATriggerBLimitCCycleDBaseline,A,B,C,D,.,106,机械通气工作原理,吸气由什么触发（Trigger）？患者（压力/流速/容量/胸部阻抗/腹部活动）通气机（时间）操作者,.,107,吸气相通气机限制什么（Limit）？流速压力,机械通气工作原理,.,108,吸气相什么时候结束（Cycle）？流速压力时间容量,机械通气工作原理,.,109,机械通气工作原理,.,110,容量控制与压力控制通气,机械通气工作原理,.,111,Comparisonchart,.,112,运动方程,.,113,描述气体运动参数,压力流速时间容量,.,114,描述肺部情况基本参数,.,115,运动方程,压力、流速、容量、时间与顺应性、阻力之间的关系？,.,116,ventilationpressuretodelivertidalvolume,=,elasticpressuretoinflatelungsandchestwall,+,resistivepressuretomakeairflowthroughtheairways,PmusPvent=EVRf=1/CVRf,PmusPvent=PelasticPresistive,EquationofMotion,.,117,运动方程,通气驱动压=弹性回缩压流速阻力压=容量弹力流速阻力=容量/顺应性流速阻力,.,118,运动方程,容量控制方