无创呼吸机患者安全使用指南

无创呼吸机患者安全使用指南规范操作·风险防控·应急处置·安全闭环汇报人护理部日期2026年09月内容导览01认识无创通气基础原理与安全共识url("data:image/svg+xml,%3Csvgxmlns='/2000/svg'width='160'height='160'viewBox='00160160'fill='none'%3E%3Ccirclecx='140'cy='20'r='60'fill='%233E8DC4'fill-opacity='0.03'/%3E%3Ccirclecx='20'cy='140'r='40'fill='%2363B87A'fill-opacity='0.02'/%3E%3C/svg%3E")02规范操作流程上机全流程要点url("data:image/svg+xml,%3Csvgxmlns='/2000/svg'width='160'height='160'viewBox='00160160'fill='none'%3E%3Ccirclecx='140'cy='20'r='60'fill='%233E8DC4'fill-opacity='0.03'/%3E%3Ccirclecx='20'cy='140'r='40'fill='%2363B87A'fill-opacity='0.02'/%3E%3C/svg%3E")03风险防控要点并发症与安全隐患识别url("data:image/svg+xml,%3Csvgxmlns='/2000/svg'width='160'height='160'viewBox='00160160'fill='none'%3E%3Ccirclecx='140'cy='20'r='60'fill='%233E8DC4'fill-opacity='0.03'/%3E%3Ccirclecx='20'cy='140'r='40'fill='%2363B87A'fill-opacity='0.02'/%3E%3C/svg%3E")04故障应急处理报警应对与突发状况url("data:image/svg+xml,%3Csvgxmlns='/2000/svg'width='160'height='160'viewBox='00160160'fill='none'%3E%3Ccirclecx='140'cy='20'r='60'fill='%233E8DC4'fill-opacity='0.03'/%3E%3Ccirclecx='20'cy='140'r='40'fill='%2363B87A'fill-opacity='0.02'/%3E%3C/svg%3E")05质量持续改进安全管理闭环url("data:image/svg+xml,%3Csvgxmlns='/2000/svg'width='160'height='160'viewBox='00160160'fill='none'%3E%3Ccirclecx='140'cy='20'r='60'fill='%233E8DC4'fill-opacity='0.03'/%3E%3Ccirclecx='20'cy='140'r='40'fill='%2363B87A'fill-opacity='0.02'/%3E%3C/svg%3E")认识无创通气知其然，更知其所以然理解原理，是安全使用的第一步01无创通气原理与临床价值以正压支持替代或辅助自主呼吸，减少插管创伤无创通气以正压支持为核心，是呼吸支持的重要方式，规范操作与密切监测决定其成败。url("data:image/svg+xml,%3Csvgxmlns='/2000/svg'width='160'height='160'viewBox='00160160'fill='none'%3E%3Ccirclecx='140'cy='20'r='60'fill='%233E8DC4'fill-opacity='0.03'/%3E%3Ccirclecx='20'cy='140'r='40'fill='%2363B87A'fill-opacity='0.02'/%3E%3C/svg%3E")工作原理4项正压气流通过面罩或鼻罩提供正压气流辅助呼吸辅助患者自主呼吸改善通气改善通气与氧合减少做功减少呼吸肌做功url("data:image/svg+xml,%3Csvgxmlns='/2000/svg'width='160'height='160'viewBox='00160160'fill='none'%3E%3Ccirclecx='140'cy='20'r='60'fill='%233E8DC4'fill-opacity='0.03'/%3E%3Ccirclecx='20'cy='140'r='40'fill='%2363B87A'fill-opacity='0.02'/%3E%3C/svg%3E")核心优势3项无创伤无创伤，保留气道防御功能患者可进食进食、咳痰、交流不受限降低肺炎风险降低呼吸机相关肺炎风险url("data:image/svg+xml,%3Csvgxmlns='/2000/svg'width='160'height='160'viewBox='00160160'fill='none'%3E%3Ccirclecx='140'cy='20'r='60'fill='%233E8DC4'fill-opacity='0.03'/%3E%3Ccirclecx='20'cy='140'r='40'fill='%2363B87A'fill-opacity='0.02'/%3E%3C/svg%3E")安全意义2项操作规范是无创通气成功的关键密切监测任一环节疏忽均可能导致治疗失败url("data:image/svg+xml,%3Csvgxmlns='/2000/svg'width='160'height='160'viewBox='00160160'fill='none'%3E%3Ccirclecx='140'cy='20'r='60'fill='%233E8DC4'fill-opacity='0.03'/%3E%3Ccirclecx='20'cy='140'r='40'fill='%2363B87A'fill-opacity='0.02'/%3E%3C/svg%3E")适应证与禁忌证辨明适用边界，是安全上机的前提类别具体情形适应证慢阻肺急性加重、心源性肺水肿、术后呼吸支持、睡眠呼吸暂停相对禁忌气道分泌物多难排出、面部畸形、意识障碍、严重腹胀绝对禁忌心跳呼吸停止、误吸风险极高、上气道梗阻、面部创伤无法佩戴规范操作流程规范每一步，安全每一程流程标准化，是患者安全的保障02上机前评估与准备充分准备，是顺利上机的第一步患者评估评估先行评估意识状态与呼吸形态评估氧合情况与配合程度排除禁忌证url("data:image/svg+xml,%3Csvgxmlns='/2000/svg'width='160'height='160'viewBox='00160160'fill='none'%3E%3Ccirclecx='140'cy='20'r='60'fill='%233E8DC4'fill-opacity='0.03'/%3E%3Ccirclecx='20'cy='140'r='40'fill='%2363B87A'fill-opacity='0.02'/%3E%3C/svg%3E")物品准备设备就绪检查呼吸机性能与管路连接确认电源、氧源、湿化装置完好备好面罩与固定带url("data:image/svg+xml,%3Csvgxmlns='/2000/svg'width='160'height='160'viewBox='00160160'fill='none'%3E%3Ccirclecx='140'cy='20'r='60'fill='%233E8DC4'fill-opacity='0.03'/%3E%3Ccirclecx='20'cy='140'r='40'fill='%2363B87A'fill-opacity='0.02'/%3E%3C/svg%3E")体位与沟通配合准备协助患者取半卧位或坐位，头颈保持通畅向患者说明治疗目的与配合方法缓解紧张情绪url("data:image/svg+xml,%3Csvgxmlns='/2000/svg'width='160'height='160'viewBox='00160160'fill='none'%3E%3Ccirclecx='140'cy='20'r='60'fill='%233E8DC4'fill-opacity='0.03'/%3E%3Ccirclecx='20'cy='140'r='40'fill='%2363B87A'fill-opacity='0.02'/%3E%3C/svg%3E")面罩选择与佩戴要点面罩贴合度，直接影响治疗效果与舒适度型号不当是漏气与压疮的常见诱因，佩戴后须逐一确认贴合与舒适度选择合适的型号根据患者面部大小选择面罩类型与尺寸，避免过大导致漏气、过小压迫面部。url("data:image/svg+xml,%3Csvgxmlns='/2000/svg'width='160'height='160'viewBox='00160160'fill='none'%3E%3Ccirclecx='140'cy='20'r='60'fill='%233E8DC4'fill-opacity='0.03'/%3E%3Ccirclecx='20'cy='140'r='40'fill='%2363B87A'fill-opacity='0.02'/%3E%3C/svg%3E")规范佩戴手法先固定鼻梁处，再依次收紧两侧固定带，避免过度牵拉造成局部压迫。url("data:image/svg+xml,%3Csvgxmlns='/2000/svg'width='160'height='160'viewBox='00160160'fill='none'%3E%3Ccirclecx='140'cy='20'r='60'fill='%233E8DC4'fill-opacity='0.03'/%3E%3Ccirclecx='20'cy='140'r='40'fill='%2363B87A'fill-opacity='0.02'/%3E%3C/svg%3E")贴合度检查调整后检查有无明显漏气，以患者耐受为度，佩戴后询问其舒适感受。url("data:image/svg+xml,%3Csvgxmlns='/2000/svg'width='160'height='160'viewBox='00160160'fill='none'%3E%3Ccirclecx='140'cy='20'r='60'fill='%233E8DC4'fill-opacity='0.03'/%3E%3Ccirclecx='20'cy='140'r='40'fill='%2363B87A'fill-opacity='0.02'/%3E%3C/svg%3E")参数设置与治疗监测参数个体化，监测动态化初始参数设置遵医嘱设置吸气压力、呼气压力与氧浓度从低水平开始逐步上调至患者耐受url("data:image/svg+xml,%3Csvgxmlns='/2000/svg'width='160'height='160'viewBox='00160160'fill='none'%3E%3Ccirclecx='140'cy='20'r='60'fill='%233E8DC4'fill-opacity='0.03'/%3E%3Ccirclecx='20'cy='140'r='40'fill='%2363B87A'fill-opacity='0.02'/%3E%3C/svg%3E")动态监测指标密切观察生命体征、血氧饱和度、呼吸频率及患者主观感受及时反馈医生调整参数url("data:image/svg+xml,%3Csvgxmlns='/2000/svg'width='160'height='160'viewBox='00160160'fill='none'%3E%3Ccirclecx='140'cy='20'r='60'fill='%233E8DC4'fill-opacity='0.03'/%3E%3Ccirclecx='20'cy='140'r='40'fill='%2363B87A'fill-opacity='0.02'/%3E%3C/svg%3E")治疗中护理定时检查管路连接与湿化情况鼓励并协助患者排痰观察有无并发症发生url("data:image/svg+xml,%3Csvgxmlns='/2000/svg'width='160'height='160'viewBox='00160160'fill='none'%3E%3Ccirclecx='140'cy='20'r='60'fill='%233E8DC4'fill-opacity='0.03'/%3E%3Ccirclecx='20'cy='140'r='40'fill='%2363B87A'fill-opacity='0.02'/%3E%3C/svg%3E")风险防控要点预防在先，风险可控识别隐患，才能防患于未然03常见并发症识别与预防识别在先，防范在前胃肠胀气气体潴留多因压力过高或吞咽气体所致，闭口呼吸，避免过度吸气指导患者

闭口呼吸，避免过度吸气url("data:image/svg+xml,%3Csvgxmlns='/2000/svg'width='160'height='160'viewBox='00160160'fill='none'%3E%3Ccirclecx='140'cy='20'r='60'fill='%233E8DC4'fill-opacity='0.03'/%3E%3Ccirclecx='20'cy='140'r='40'fill='%2363B87A'fill-opacity='0.02'/%3E%3C/svg%3E")误吸风险气道防护呕吐或分泌物增多时

及时清理必要时

暂停治疗，防止误吸url("data:image/svg+xml,%3Csvgxmlns='/2000/svg'width='160'height='160'viewBox='00160160'fill='none'%3E%3Ccirclecx='140'cy='20'r='60'fill='%233E8DC4'fill-opacity='0.03'/%3E%3Ccirclecx='20'cy='140'r='40'fill='%2363B87A'fill-opacity='0.02'/%3E%3C/svg%3E")气压伤与循环影响参数监测观察有无

胸闷气促加重、血压波动及时报告医生调整参数url("data:image/svg+xml,%3Csvgxmlns='/2000/svg'width='160'height='160'viewBox='00160160'fill='none'%3E%3Ccirclecx='140'cy='20'r='60'fill='%233E8DC4'fill-opacity='0.03'/%3E%3Ccirclecx='20'cy='140'r='40'fill='%2363B87A'fill-opacity='0.02'/%3E%3C/svg%3E")面部皮肤损伤与漏气管理皮肤防护与漏气管理，关系治疗能否持续皮肤防护与漏气管理，是保障治疗持续有效的关键环节url("data:image/svg+xml,%3Csvgxmlns='/2000/svg'width='160'height='160'viewBox='00160160'fill='none'%3E%3Ccirclecx='140'cy='20'r='60'fill='%233E8DC4'fill-opacity='0.03'/%3E%3Ccirclecx='20'cy='140'r='40'fill='%2363B87A'fill-opacity='0.02'/%3E%3C/svg%3E")皮肤损伤预防定时松解面罩减压使用皮肤保护敷料观察受压部位有无红疹破损url("data:image/svg+xml,%3Csvgxmlns='/2000/svg'width='160'height='160'viewBox='00160160'fill='none'%3E%3Ccirclecx='140'cy='20'r='60'fill='%233E8DC4'fill-opacity='0.03'/%3E%3Ccirclecx='20'cy='140'r='40'fill='%2363B87A'fill-opacity='0.02'/%3E%3C/svg%3E")漏气识别处理检查面罩位置与固定带松紧排查管路破损漏气明显时及时调整url("data:image/svg+xml,%3Csvgxmlns='/2000/svg'width='160'height='160'viewBox='00160160'fill='none'%3E%3Ccirclecx='140'cy='20'r='60'fill='%233E8DC4'fill-opacity='0.03'/%3E%3Ccirclecx='20'cy='140'r='40'fill='%2363B87A'fill-opacity='0.02'/%3E%3C/svg%3E")患者耐受管理出现明显不适或抗拒时评估原因调整治疗模式避免强行坚持url("data:image/svg+xml,%3Csvgxmlns='/2000/svg'width='160'height='160'viewBox='00160160'fill='none'%3E%3Ccirclecx='140'cy='20'r='60'fill='%233E8DC4'fill-opacity='0.03'/%3E%3Ccirclecx='20'cy='140'r='40'fill='%2363B87A'fill-opacity='0.02'/%3E%3C/svg%3E")故障与应急处理报警不慌，处置有方快速判断，是应急能力的核心04常见报警识别与处理读懂报警信号，快速定位原因报警类型识别总览报警类型常见原因处理要点压力过高气道阻塞、痰液潴留吸痰、检查管路压力过低漏气、面罩脱落调整面罩、检查连接潮气量异常漏气、参数不当排查漏气、联系医生调整氧浓度报警氧源故障或耗竭检查氧源与连接url("data:image/svg+xml,%3Csvgxmlns='/2000/svg'width='160'height='160'viewBox='00160160'fill='none'%3E%3Ccirclecx='140'cy='20'r='60'fill='%233E8DC4'fill-opacity='0.03'/%3E%3Ccirclecx='20'cy='140'r='40'fill='%2363B87A'fill-opacity='0.02'/%3E%3C/svg%3E")报警处理要点速览压力过高气道阻塞、痰液潴留→吸痰、检查管路压力过低漏气、面罩脱落→调整面罩、检查连接潮气量异常漏气、参数不当→排查漏气、联系医生调整氧浓度报警氧源故障或耗竭→检查氧源与连接url("data:image/svg+xml,%3Csvgxmlns='/2000/svg'width='160'height='160'viewBox='00160160'fill='none'%3E%3Ccirclecx='140'cy='20'r='60'fill='%233E8DC4'fill-opacity='0.03'/%3E%3Ccirclecx='20'cy='140'r='40'fill='%2363B87A'fill-opacity='0.02'/%3E%3C/svg%3E")突发状况应急处置分清轻重缓急，及时启动应急预案突发状况应急处置，立即响应、优先保障通气，防止病情恶化与窒息风险url("data:image/svg+xml,%3Csvgxmlns='/2000/svg'width='160'height='160'viewBox='00160160'fill='none'%3E%3Ccirclecx='140'cy='20'r='60'fill='%233E8DC4'fill-opacity='0.03'/%3E%3Ccirclecx='20'cy='140'r='40'fill='%2363B87A'fill-opacity='0.02'/%3E%3C/svg%3E")01▲

病情恶化意识改变·呼吸加重·血氧下降出现意识改变、呼吸困难加重或血氧持续下降时，立即通知医生。做好气管插管准备，随时应对抢救。url("data:image/svg+xml,%3Csvgxmlns='/2000/svg'width='160'height='160'viewBox='00160160'fill='none'%3E%3Ccirclecx='140'cy='20'r='60'fill='%233E8DC4'fill-opacity='0.03'/%3E%3Ccirclecx='20'cy='140'r='40'fill='%2363B87A'fill-opacity='0.02'/%3E%3C/svg%3E")02▲

设备故障断电或机器故障突然断电或机器故障时，立即断开面罩。改用简易呼吸器辅助通气，同时排查故障。url("data:image/svg+xml,%3Csvgxmlns='/2000/svg'width='160'height='160'viewBox='00160160'fill='none'%3E%3Ccirclecx='140'cy='20'r='60'fill='%233E8DC4'fill-opacity='0.03'/%3E%3Ccirclecx='20'cy='140'r='40'fill='%2363B87A'fill-opacity='0.02'/%3E%3C/svg%3E")03▲

呕吐误吸清理气道·防止窒息立即停止治疗，防止病情加重。头偏向一侧清理气道，防止窒息。url("data:image/svg+xml,%3Csvgxmlns='/2000/svg'width='160'height='160'viewBox='00160160'fill='none'%3E%3Ccirclecx='140'cy='20'r='60'fill='%233E8DC4'fill-opacity='0.03'/%3E%3Ccirclecx='20'cy='140'r='40'fill='%2363B87A'fill-opacity='0.02'/%3E%3C/svg%3E")质量与持续改进安全无终点，改进无止境闭环管理，让安全成为习惯05护理记录与培训考核记录留痕，培训固本护理记录与培训考核双轨并进，让每一次照护都有据可查、人人过关url("data:image/svg+xml,%3Csvgxmlns='/2000/svg'width='160'height='160'viewBox='00160160'fill='none'%3E%3Ccirclecx='140'cy='20'r='60'fill='%233E8DC4'fill-opacity='0.03'/%3E%3Ccirclecx='20'cy='140'r='40'fill='%2363B87A'fill-opacity='0.02'/%3E%3C/svg%3E")规范护理记录完整记录上机时间、参数设置、生命体征变化及处理措施做到可追溯url("data:image/svg+xml,%3Csvgxmlns='/2000/svg'width='160'height='160'viewBox='00160160'fill='none'%3E%3Ccirclecx='140'cy='20'r='60'fill='%233E8DC4'fill-opacity='0.03'/%3E%3Ccirclecx='20'cy='140'r='40'fill='%2363B87A'fill-opacity='0.02'/%3E%3C/svg%3E")落实培训考核定期开展操作规范与应急处置培训通过考核确保人人过关url("data:image/svg+xml,%3Csvgxmlns='/2000/svg'width='160'height='160'viewBox='00160160'fill='none'%3E%3Ccirclecx='140'cy='20'r='60'fill='%233E8DC4'fill-opacity='0.03'/%3E%3Ccirclecx='20'cy='140'r='40'fill='%2363B87A'fill-opacity='0.02'/%3E%3C/svg%3E")强化风险意识将安全使用要点纳入日常交接班内容形成常态化提醒机制url("data:image/svg+xml,%3Csvgxmlns='/2000/svg'width='160'height='160'viewBox='00160160'fill='none'%3E%3Ccirclecx='140'cy='20'r='60'fill='%233E8DC4'fill-opacity='0.03'/%3E%3Ccirclecx='20'cy='140'r='40'fill='%2363B87A'fill-opacity='0.02'/%3E%3C/svg%3E")安全管理闭环让安全成