呼吸机相关基础知识

1、呼吸机相关基础知识相关呼吸生理基础The First Affiliated Hospital of Bengbu Medical College in intensive medicine鼻 咽 喉 气管 支气管 肺终末细支气管通气部分换气部分呼吸系统呼吸系统The First Affiliated Hospital of Bengbu Medical College in intensive medicine生命体和外界环境之间氧和二氧化碳的交换呼吸系统The First Affiliated Hospital of Bengbu Medical College in intensive m

2、edicine通气弥散灌注自主呼吸原理The First Affiliated Hospital of Bengbu Medical College in intensive medicine吸气肌收缩吸气肌舒张吸气呼气主动被动人工通气原理The First Affiliated Hospital of Bengbu Medical College in intensive medicine吸气呼气机械力弹性回缩力被动主动通气原理The First Affiliated Hospital of Bengbu Medical College in intensive medicine自主通气机械

3、通气压力变化容量变化机械通气(ventilation) 机械通气是患者自然通气或氧合功能出现障碍时运用器械使患者恢复有效通气并改善氧合的方法The First Affiliated Hospital of Bengbu Medical College in intensive medicine呼吸机的作用？The First Affiliated Hospital of Bengbu Medical College in intensive medicine外呼吸机械通气的目的？ 改善通气，纠正呼吸性酸中毒 改善换气，纠正低氧血症 减少呼吸肌作功，节约氧耗 保持呼吸道通畅 改善压力容积关系Th

4、e First Affiliated Hospital of Bengbu Medical College in intensive medicine人工气道 经鼻气管插管 经口气管插管 气管切开The First Affiliated Hospital of Bengbu Medical College in intensive medicine呼吸机的基本构造主机附加结构监测结构The First Affiliated Hospital of Bengbu Medical College in intensive medicinequestion给患者送气 一直送下去吗呼气.PS.要呼完吗

5、 who转换 how送.PS.呼多少 监测The First Affiliated Hospital of Bengbu Medical College in intensive medicine常用的通气概念潮气量（Vt）：患者在平静状态下，每次所能吸入或呼出的气体容量吸气压力（Pi）：辅助/控制通气时在吸气相叠加在PEEP之上的压力分钟通气量（MV）：每分钟吸入或呼出气体的总量，分钟通气量=呼吸频率*潮气量压力支持（PS）：患者自主呼吸时在PEEP压力之上呼吸机提供的一个帮助吸气的压力PEEP：呼吸机提供的在呼气末维持的压力The First Affiliated Hospital of

6、Bengbu Medical College in intensive medicine常用的通气概念吸气时间：呼吸机供气时间吸呼比：在每次呼吸中，吸气所用时间和呼气所用时间之间的比值呼吸频率：患者每分钟的呼吸的次数窒息通气：仅在自主呼吸模式中，如果在预先设定的时间后病人没有自主呼吸或触发呼吸机，呼吸机将启动后备通气程序吸气触发：流速、压力、时间呼气触发：患者由吸气项转化为呼气项的判断标准The First Affiliated Hospital of Bengbu Medical College in intensive medicine机械通气物理量-压力The First Affilia

7、ted Hospital of Bengbu Medical College in intensive medicineB平台压time(sec)机械通气物理量-流速、容量The First Affiliated Hospital of Bengbu Medical College in intensive medicine目标The First Affiliated Hospital of Bengbu Medical College in intensive medicine潮气量压力压力潮气量容量控制压力控制呼吸机模式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机械通气时相The First Affiliated Hospital of Bengbu Medical College in intensive medicineABCD触发阶段吸气阶段吸气转换呼气呼气阶段pressuretime触发阶段The First Affiliated Hospital of Bengbu Medical College in intensive medicineTime triggerPressure trigger Flow triggerTime trigger 呼吸机控制通气的启动，根据设定的频率，按一定时间间隔送气T

10、he First Affiliated Hospital of Bengbu Medical College in intensive medicineSensitivity 反应患者自主吸气触发呼吸机作功的大小，这个吸气引起管道系统内压力、流速的变化，变化被系统感知即触发呼吸机供气The First Affiliated Hospital of Bengbu Medical College in intensive medicinePressure trigger 患者引起管道内压力变化触发呼吸机启动 一般设置在-2-0.5cmH2OThe First Affiliated Hospital

11、 of Bengbu Medical College in intensive medicineFlow trigger 患者的吸气动作引起管道内气流速变化 一般设置13L/minThe First Affiliated Hospital of Bengbu Medical College in intensive medicineFlow trigger由于流速触发中背景气流的存在，患者吸气时即刻新鲜的气体流速触发比压力触发更敏感，呼吸机的反应时间(响应时间)较短The First Affiliated Hospital of Bengbu Medical College in intens

12、ive medicine吸气相 PS 定容The First Affiliated Hospital of Bengbu Medical College in intensive medicine吸气相 PS 定容潮气量：预设气流大小：预设气流形态：方波或减速波The First Affiliated Hospital of Bengbu Medical College in intensive medicine方波或减速波The First Affiliated Hospital of Bengbu Medical College in intensive medicineflowtime(

13、sec)flowtime(sec)00吸气吸气吸气吸气呼气呼气呼气呼气方波减速波吸气相 PS 定压The First Affiliated Hospital of Bengbu Medical College in intensive medicine吸气相 PS 定压The First Affiliated Hospital of Bengbu Medical College in intensive medicine“定压”是指吸气压力恒定气流大小不定气流形态：减速波吸气流速曲线下面积不定，无法“定容”影响因素：患者的吸气用力程度、气道阻力、肺的顺应性 吸气向呼气切换时间切换：通过预设的吸

14、气时间使吸气终止容量切换：吸气达到预设潮气量时,吸气终止压力切换：呼吸道达到设置压力时使吸气终止流速切换：当吸气流速降至预设的峰流速%以下The First Affiliated Hospital of Bengbu Medical College in intensive medicine呼气相 PS PEEP是指呼吸机在吸气时产生正压，将气体压入肺内，呼气相气道压始终保持在正压水平的通气模式防止肺泡萎缩，提高肺顺应性，降低呼吸功和耗氧量，增加肺泡和间质的压力，促进肺间质和肺泡水肿的消退，减少生理无效腔，增加肺泡通气量，改善通气-血流比值，降低肺内静-动脉分流，提高PaO2，改善组织供氧The First Affiliated Hospital of Bengbu Medical College in intensive medicine通气模式及机制The First Affiliated Hospital of Bengbu Medical College in intensive medicine自己学习目标参数设置The First Affiliated Hospital of Bengbu Medical College in intensiv