呼吸机波形应用-课件.ppt
Company Confidential For internal use only,呼吸机波形应用,Company Confidential For internal use only,机械通气的目的,提供合适的肺泡通气量，达到合适的动脉血PH和二氧化碳分压在尽量安全的氧浓度下达到合适的动脉血氧分压避免产生各种由于机械通气造成的肺部损伤达到良好的人机同步，使病人尽量舒适合理的呼吸肌负荷，避免呼吸肌疲劳及萎缩,Company Confidential For internal use only,潮气量的设置,VA=（VTVTD）f=VEVTDfVA：肺泡分钟通气量VT：潮气量VTD：死腔量VE：分钟通气量,Company Confidential For internal use only,潮气量在通气量上升的同时，根据呼吸系统顺应性的特点，肺泡扩张压以指数级别上升,Company Confidential For internal use only,Company Confidential For internal use only,潮气量通常根据理想体重来设置,Company Confidential For internal use only,上拐点,临床设置时，潮气量应低于UIP较为合适。,Company Confidential For internal use only,要想得到更精确的上拐点，需要在肌松状态下采用静态PV曲线描记。需要注意的是，一部分病人，尤其是肺部不均质变的（如ARDS）病人，可能测不到上拐点。,Company Confidential For internal use only,呼吸频率（RR）,Company Confidential For internal use only,吸气流量（Flow）,Company Confidential For internal use only,Company Confidential For internal use only,Company Confidential For internal use only,Company Confidential For internal use only,Company Confidential For internal use only,吸气暂停(Ins.Pause),吸气暂停可以延长气体交换时间，有利于改善氧合，一般不超过整个呼吸周期的25%,Company Confidential For internal use only,呼气末正压（PEEP）,动态肺泡陷闭（RACE）,Company Confidential For internal use only,PEEP改善RACE,Company Confidential For internal use only,要准确测量下拐点必须描记静态PV曲线，最好使用肌松剂 临床上部分病例无法检测到第一拐点,尤其是ALI/ARDS之类肺不均质变的病人,Company Confidential For internal use only,Company Confidential For internal use only,延长吸气时间,Company Confidential For internal use only,内源性PEEP（PEEPi）的测量,容控模式下，呼气不完全情况下，比较气道峰压的改变,Company Confidential For internal use only,压控模式下，呼气不完全情况下，比较潮气量改变，估计陷闭气体量,Company Confidential For internal use only,呼气保持是现代呼吸机测算PEEPi最常用的方法。,Company Confidential For internal use only,触发灵敏度和系统响应时间,Company Confidential For internal use only,Company Confidential For internal use only,Company Confidential For internal use only,气管导管阻力影响,Company Confidential For internal use only,持续气流的设置,最理想的持续气流水平，就是作最小的吸气功，同时呼气压增加最小。,Company Confidential For internal use only,压力上升梯度,Company Confidential For internal use only,Company Confidential For internal use only,过高的压力上升时间,Company Confidential For internal use only,泄漏,Company Confidential For internal use only,Company Confidential For internal use only,Company Confidential For internal use only,评估支气管扩张剂效果,呼气峰流量下降，呼气流量速度下降缓慢，使得呼气支变得平坦，而使用支扩剂以后则明显改善，则说明支扩剂有效。,Company Confidential For internal use only,Company Confidential For internal use only,顺应性改变,顺应性下降时，容控模式下压力曲线的主要变化是峰压和平台压同时上升,Company Confidential For internal use only,PV环的变化则是整个环斜率下降，环呈“倾倒”的趋势，容控下表现为压力增加，压控模式下则表现为潮气量下降,Company Confidential For internal use only,动态的PV环包含了气流阻力的因素，要想更精确地评估顺应性，则需要描记静态PV环。结合气管内测压和食道内测压，则在监测上去除了胸壁对波形的一些影响，可以更准确地评估肺顺应性，而单纯使用管路内普通测压，所得到的是整个呼吸系统的顺应性（包括胸壁、肺和气管导管）,Company Confidential For internal use only,阻力改变,Company Confidential For internal use only,Company Confidential For internal use only,管路积水,Company Confidential For internal use only,Company Confidential For internal use only,双重控制模式PRVC,Company Confidential For internal use only,双重控制模式Machine Volume,Company Confidential For internal use only,撤机时的波形,SIMV过渡撤机通常都加用一定水平的PS，并给予较低频率的辅助通气,Company Confidential For internal use only,Company Confidential For internal use only,PSV撤机往往开始予以高水平的压力（PS MAX,能保证10-12ml/kg的潮气量并且病人呼吸做功少。）随后，PS水平逐步下降，将负担渐渐转由病人承担。,Company Confidential For internal use only,Company Confidential For internal use only,Company Confidential For internal use only,Company Confidential For internal use only,
