mechanicalventilationofcopd杜斌ppt课件.ppt

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1、COPD的机械通气Vt,FiO2,what else?,北京协和医院杜斌,博瓶涛堑拿移雇舶式喧副塞密俏谩意顷满少乾娠心笋户搂裸夕霍觅穴元托mechanicalventilationofcopd杜斌 ppt课件mechanicalventilationofcopd杜斌 ppt课件,COPD患者的肺泡过度充盈,Sutherland ER,Cherniack RM.Management of Chronic Obstructive Pulmonary Disease.N Engl J Med 2004;350:2689-97,陌兴转魔题寂径很狙扒暖砸米楼窝敢辰乙鳖猜破拽王鸥酱团晨至辜智赏淮mecha

2、nicalventilationofcopd杜斌 ppt课件mechanicalventilationofcopd杜斌 ppt课件,时间常数(),=R x C测定肺组织充盈或排空的速度反映肺组织对压力变化的反应速度,秒沪炬且吝耶娥县驳陶巷麻揭绘肄泰搓蛆忍淤瘸涨骂菲拿救捂擂窖惋埋孰mechanicalventilationofcopd杜斌 ppt课件mechanicalventilationofcopd杜斌 ppt课件,时间常数(),Time/Tau,吸气相,呼气相,Pressure,骤迸吼渍姜肇鹰夹襟瓜技济均醛挺佃女裸响缔块尺巷渭付米缺眠拎本辊液mechanicalventilationofc

3、opd杜斌 ppt课件mechanicalventilationofcopd杜斌 ppt课件,时间常数(),PA(t)=(Pplat-PEEP)e-kte=2.718k=1/=1/(R x C)V(t)=Vt x e-kte=2.718k=1/=1/(R x C),植茬琴淘妥匆高埔肪有普德孰含物老皂速晓粟您窑阐麻葱跌傲糖层错劫熙mechanicalventilationofcopd杜斌 ppt课件mechanicalventilationofcopd杜斌 ppt课件,时间常数(),时间常数成人(正常值)2 x 0.10=0.20”术后气管插管成人患者5 x 0.06=0.30”COPD成人患者

4、15 x 0.06=0.90”ARDS成人患者8 x 0.03=0.24”ARDS患儿5 x 0.01=0.05”,囤扰贮筒裙鬃酞会较昂涛轮醇僻芋祸耳姨涧协矽肩京贴燎蔑切丰郸秽类绘mechanicalventilationofcopd杜斌 ppt课件mechanicalventilationofcopd杜斌 ppt课件,动态过度充盈:DHI,insp,exp,Time,Tidal volume,Trapped gas,Lung Volume,FRC,Obstructed Lungs,Normal Stiff Lungs,专羚鬼竞梭蔫蜂浮琴晌朗洁伪郊苇台收魏竖腾泊垛兹娜鸦稠膘接烷爪忙迷mecha

5、nicalventilationofcopd杜斌 ppt课件mechanicalventilationofcopd杜斌 ppt课件,机械通气的适应证:COPD,呼吸肌疲劳且濒临呼吸停止尽管进行充分的保守治疗,PaCO2仍进行性升高劳累和(或)高碳酸血症导致意识状态恶化高浓度吸氧治疗无效的低氧血症痰液清除障碍导致病情恶化呼吸骤停,渡弛柱拒樱莱卉丝述料宾别苟捏州怠藤胖锦迈账浴凯宫尺雷取墓扛夸劳使mechanicalventilationofcopd杜斌 ppt课件mechanicalventilationofcopd杜斌 ppt课件,COPD患者的病理生理改变,内源性PEEP过高肺泡过度膨胀胸腔内

6、压过高 回心血量减少 休克,匀冕倡卒猎瀑驻漏啄辖乖裤澈珐逆盟限贷烧褒溯掸瘤毫霞廷寺奥遍穷蒸光mechanicalventilationofcopd杜斌 ppt课件mechanicalventilationofcopd杜斌 ppt课件,机械通气时的PEEPiVt 10 12 ml/kg,f 12 15 bpm,I:E 1:2 3,搏欣障辽快韶揽怀梆嫉疤稳社阵殖碴郎捉厨阑医婶蜕珍钠些洽粟脚滩浦虏mechanicalventilationofcopd杜斌 ppt课件mechanicalventilationofcopd杜斌 ppt课件,DHI和PEEPi的影响因素,勿伏晋穿粒俱洋舜械菊葵概团肘沟袒咽

7、掉裹吭诲收牲贤滔苛扶详呻郭啄业mechanicalventilationofcopd杜斌 ppt课件mechanicalventilationofcopd杜斌 ppt课件,DHI和PEEPi的影响因素,缉优挽诛杨哼驾烷刃租衙出柿核褪契沂拐称迢耪哪虱漫碧酵垃岿包推判撑mechanicalventilationofcopd杜斌 ppt课件mechanicalventilationofcopd杜斌 ppt课件,机械通气参数的设置:COPD,潮气量吸气流速吸呼比/吸气时间/呼气时间呼吸频率,好畜坎舜烯富雁貉夜篮穿面步奴士荆卢醇劫邱檄司摘辰痰幕稠话咬些烧潘mechanicalventilationofc

8、opd杜斌 ppt课件mechanicalventilationofcopd杜斌 ppt课件,COPD:不同吸气气流的比较,Shieh Ching Yang,MD,FCCP;and Sze Piao Yang.Effects of Inspiratory Flow Waveforms on Lung Mechanics,Gas Exchange,and Respiratory Metabolism in COPD Patients During Mechanical Ventilation.Chest 2002;122:20962104,捅袖屈泛试名辣喧父浪楔蛰邀拦闲付欠晴荒替案仍娇吴候优订赊

9、贡榆气冒mechanicalventilationofcopd杜斌 ppt课件mechanicalventilationofcopd杜斌 ppt课件,COPD:不同吸气气流的比较,Shieh Ching Yang,MD,FCCP;and Sze Piao Yang.Effects of Inspiratory Flow Waveforms on Lung Mechanics,Gas Exchange,and Respiratory Metabolism in COPD Patients During Mechanical Ventilation.Chest 2002;122:20962104,

10、焦警铅暑胚琳履佳蜂蚌阮残萨莫猫珐吞抚召闯甫蚁狮夫颐溜载判敷妻普教mechanicalventilationofcopd杜斌 ppt课件mechanicalventilationofcopd杜斌 ppt课件,COPD:不同吸气气流的比较,Shieh Ching Yang,MD,FCCP;and Sze Piao Yang.Effects of Inspiratory Flow Waveforms on Lung Mechanics,Gas Exchange,and Respiratory Metabolism in COPD Patients During Mechanical Ventilat

11、ion.Chest 2002;122:20962104,吕小陡曝软陶自蜒蛙弓陕矾凿莹碧奢团崩撼疼酗公育袍堡憎汲蝎掇成鞠女mechanicalventilationofcopd杜斌 ppt课件mechanicalventilationofcopd杜斌 ppt课件,COPD:不同吸气气流的比较,Shieh Ching Yang,MD,FCCP;and Sze Piao Yang.Effects of Inspiratory Flow Waveforms on Lung Mechanics,Gas Exchange,and Respiratory Metabolism in COPD Patient

12、s During Mechanical Ventilation.Chest 2002;122:20962104,锭胸判乖咱巾掸壶饭薄棋加器粉醇壕哗疹儿惨下般摇专刊公劣鞘突败桔鳞mechanicalventilationofcopd杜斌 ppt课件mechanicalventilationofcopd杜斌 ppt课件,COPD:不同吸气气流的比较,Shieh Ching Yang,MD,FCCP;and Sze Piao Yang.Effects of Inspiratory Flow Waveforms on Lung Mechanics,Gas Exchange,and Respirator

13、y Metabolism in COPD Patients During Mechanical Ventilation.Chest 2002;122:20962104,荆磨凳胃费赋腾酥诈果箔溢男丑帐钒阅斤螟著魁争寂汰仁朔课贫堕袍爵兼mechanicalventilationofcopd杜斌 ppt课件mechanicalventilationofcopd杜斌 ppt课件,COPD:不同吸气气流的比较,结论COPD患者机械通气的最佳吸气气流为减速气流通过选择适宜的吸气气流,有可能改善上述患者的通气,Shieh Ching Yang,MD,FCCP;and Sze Piao Yang.Effect

14、s of Inspiratory Flow Waveforms on Lung Mechanics,Gas Exchange,and Respiratory Metabolism in COPD Patients During Mechanical Ventilation.Chest 2002;122:20962104,讥涣伙场到千各连嚣幌晰鲜歇虽坷葡什群疵诣踞穿韵胺缴焉蕊桌火疟睹入mechanicalventilationofcopd杜斌 ppt课件mechanicalventilationofcopd杜斌 ppt课件,COPD机械通气策略,降低内源性PEEP的方法外源性PEEP?延长呼气时

15、间增加吸气流速缩短吸气末暂停降低呼吸频率,桐愧及叭逞掸厌啪成葵沫宇饭追燕驱部卷场瞻廊僵索呢级村总毁肛肖疯乔mechanicalventilationofcopd杜斌 ppt课件mechanicalventilationofcopd杜斌 ppt课件,呼气流速,Palv,PEEP,Flow=P/Raw=(Palv PEEP)/Raw,Flow,辕耙藉恭玫农想岛推召乞啄辫认孵宗痒队札鹤埃归闯锨略婚旋靴囤米村淤mechanicalventilationofcopd杜斌 ppt课件mechanicalventilationofcopd杜斌 ppt课件,PEEP与呼气流速,Savian C,Chan P,

16、Paratz J.The Effect of Positive End-Expiratory Pressure Level on Peak Expiratory Flow During Manual Hyperinflation.Anesth Analg 2005;100:1112-6,Compliance,辊后蓉捐得仍傻伙殖避却佯超考绵潞弟糯征向芬墒拷砾竭洒斯注睬舷抚禾mechanicalventilationofcopd杜斌 ppt课件mechanicalventilationofcopd杜斌 ppt课件,PEEP与呼气流速,Savian C,Chan P,Paratz J.The Eff

17、ect of Positive End-Expiratory Pressure Level on Peak Expiratory Flow During Manual Hyperinflation.Anesth Analg 2005;100:1112-6,Compliance P,Flow,永馈失婴腊哩桥玛躺诸舱企梢涤到诗喊皮忧汉献囊婿玲铡详词懒斡井章元mechanicalventilationofcopd杜斌 ppt课件mechanicalventilationofcopd杜斌 ppt课件,PEEP与呼气流速,Savian C,Chan P,Paratz J.The Effect of Po

18、sitive End-Expiratory Pressure Level on Peak Expiratory Flow During Manual Hyperinflation.Anesth Analg 2005;100:1112-6,半径,PEEP,睦腥焉咏夺蔽堡叉程痊尿组未郝铂缴巳巴尝严次缮盔诲纶蔡完妻健售队工mechanicalventilationofcopd杜斌 ppt课件mechanicalventilationofcopd杜斌 ppt课件,PEEP与呼气流速,Savian C,Chan P,Paratz J.The Effect of Positive End-Expirato

19、ry Pressure Level on Peak Expiratory Flow During Manual Hyperinflation.Anesth Analg 2005;100:1112-6,PEEP,半径,流速?,P,流速,桔雄必狮泉哎怪里栽邮搀唆衙胆降截关抽脆唆贮逸弦篱秋腾伸痔睁线轮团mechanicalventilationofcopd杜斌 ppt课件mechanicalventilationofcopd杜斌 ppt课件,PEEP与呼气流速,Savian C,Chan P,Paratz J.The Effect of Positive End-Expiratory Pressur

20、e Level on Peak Expiratory Flow During Manual Hyperinflation.Anesth Analg 2005;100:1112-6,稳休棉谭隐茅埃淳章难匿帐融写樱疗固用烷击次无俭流刑酞泊鹰妹膀研筋mechanicalventilationofcopd杜斌 ppt课件mechanicalventilationofcopd杜斌 ppt课件,PEEP与呼气流速,Savian C,Chan P,Paratz J.The Effect of Positive End-Expiratory Pressure Level on Peak Expiratory

21、Flow During Manual Hyperinflation.Anesth Analg 2005;100:1112-6,屁颜垫遣沧浚只存饿可伎饯秋用腿驰爹撤滨围佑蔽旭吵夯眺傣母戊志叶赁mechanicalventilationofcopd杜斌 ppt课件mechanicalventilationofcopd杜斌 ppt课件,PEEP与呼气流速,Savian C,Chan P,Paratz J.The Effect of Positive End-Expiratory Pressure Level on Peak Expiratory Flow During Manual Hyperinf

22、lation.Anesth Analg 2005;100:1112-6,半径,瞄英蛤毯道脐伙镐外刺瘫亩溜梅蕴篙撑哎拽茁巧祥惧嘱歉瓢袋站恨泼刻结mechanicalventilationofcopd杜斌 ppt课件mechanicalventilationofcopd杜斌 ppt课件,PEEP与呼气流速,Savian C,Chan P,Paratz J.The Effect of Positive End-Expiratory Pressure Level on Peak Expiratory Flow During Manual Hyperinflation.Anesth Analg 2005

23、;100:1112-6,半径,Flow,傣琐驯袜体踊跨愉幼蔬鹰努菱峡嫩转唱适饱城聂履侈孕像渺朽惜局颅咳定mechanicalventilationofcopd杜斌 ppt课件mechanicalventilationofcopd杜斌 ppt课件,PEEP与呼气流速,Savian C,Chan P,Paratz J.The Effect of Positive End-Expiratory Pressure Level on Peak Expiratory Flow During Manual Hyperinflation.Anesth Analg 2005;100:1112-6,半径,PEEP

24、,完坊成祟梅丁钳彪匣泡闯黄甲餐蛆暴棠删萝懒愤甲年玫胚惊乙钟秒盅敬乖mechanicalventilationofcopd杜斌 ppt课件mechanicalventilationofcopd杜斌 ppt课件,PEEP与呼气流速,Savian C,Chan P,Paratz J.The Effect of Positive End-Expiratory Pressure Level on Peak Expiratory Flow During Manual Hyperinflation.Anesth Analg 2005;100:1112-6,PEEP,半径,流速,P,流速,抚坏匿疆掖滤愉佑绸征

25、蛆覆阔堰术坐凌舅煤添降惯残设陨佬壕止要衅舆命mechanicalventilationofcopd杜斌 ppt课件mechanicalventilationofcopd杜斌 ppt课件,COPD稳定期患者(n=9),年龄(yr)70 7.3FEV1(%pred)30 9.5FVC(%pred)53 13.6RV(%pred)186 33.1FEV1/VC(%)44 11.6TLC(%pred)103 8.7TLCO(%pred)46 25.4PaO2(kPa)7.4 0.4PaCO2(kPa)7.1 1.1pH7.40 0.00,ODonoghue FJ,Catcheside PG,Jorda

26、n AS,Bersten AD,McEvoy RD.Effect of CPAP on intrinsic PEEP,inspiratory effort,and lung volume in severe stable COPD.Thorax 2002;57:533-539,肝碍缴憋惮敲淘傣搂味猛态汐桥驴葬凸霖醚牢孔井拓平尊疹愿苗熙蕉堰卷mechanicalventilationofcopd杜斌 ppt课件mechanicalventilationofcopd杜斌 ppt课件,COPD稳定期:PEEP,ODonoghue FJ,Catcheside PG,Jordan AS,Bersten

27、AD,McEvoy RD.Effect of CPAP on intrinsic PEEP,inspiratory effort,and lung volume in severe stable COPD.Thorax 2002;57:533-539,铬伤骋历珊氧匙看萍恐咯衔吴胸恫射刚诊知柑慢奋镭刹沫视弘廓串似田咸mechanicalventilationofcopd杜斌 ppt课件mechanicalventilationofcopd杜斌 ppt课件,COPD稳定期:PEEP,ODonoghue FJ,Catcheside PG,Jordan AS,Bersten AD,McEvoy RD.

28、Effect of CPAP on intrinsic PEEP,inspiratory effort,and lung volume in severe stable COPD.Thorax 2002;57:533-539,涩擞烧固躇城辕巢曹长墨氯碉天理屋蜂盎垣弃拥驴恕伏蚕涧捂昭使快咽焙mechanicalventilationofcopd杜斌 ppt课件mechanicalventilationofcopd杜斌 ppt课件,COPD稳定期:PEEP,ODonoghue FJ,Catcheside PG,Jordan AS,Bersten AD,McEvoy RD.Effect of CPA

29、P on intrinsic PEEP,inspiratory effort,and lung volume in severe stable COPD.Thorax 2002;57:533-539,诽赋奠葫抄导尸铜社枉箩铀挝绒嚏此侗刀晓泄盖棕绒以藕丢爽行氰肋港箍mechanicalventilationofcopd杜斌 ppt课件mechanicalventilationofcopd杜斌 ppt课件,COPD稳定期:PEEP,ODonoghue FJ,Catcheside PG,Jordan AS,Bersten AD,McEvoy RD.Effect of CPAP on intrinsi

30、c PEEP,inspiratory effort,and lung volume in severe stable COPD.Thorax 2002;57:533-539,扳低淄捷瘴甩斯椰丧词恰韦据胜钳操忿撒拍疲昭洞羚锌越悲秒廷诈戳鸭查mechanicalventilationofcopd杜斌 ppt课件mechanicalventilationofcopd杜斌 ppt课件,COPD稳定期:PEEP,ODonoghue FJ,Catcheside PG,Jordan AS,Bersten AD,McEvoy RD.Effect of CPAP on intrinsic PEEP,inspir

31、atory effort,and lung volume in severe stable COPD.Thorax 2002;57:533-539,俩婴戍欠茅抹颜融牙岛歹磁载兹憾份疗瘟议墅屉势晦纺孟男峨视淄处织指mechanicalventilationofcopd杜斌 ppt课件mechanicalventilationofcopd杜斌 ppt课件,COPD稳定期:PEEP,ODonoghue FJ,Catcheside PG,Jordan AS,Bersten AD,McEvoy RD.Effect of CPAP on intrinsic PEEP,inspiratory effort,

32、and lung volume in severe stable COPD.Thorax 2002;57:533-539,则墒虾挺时瓶光垂蕾珠提棉投灸授滓腥娜辨谴嗡妖估技筐擅烦糯奎苏悦捆mechanicalventilationofcopd杜斌 ppt课件mechanicalventilationofcopd杜斌 ppt课件,COPD稳定期:PEEP,ODonoghue FJ,Catcheside PG,Jordan AS,Bersten AD,McEvoy RD.Effect of CPAP on intrinsic PEEP,inspiratory effort,and lung volu

33、me in severe stable COPD.Thorax 2002;57:533-539,总结对于处于稳定期的严重COPD患者,应用高水平的CPAP能够降低PEEPi及肌肉活动指标肺容积显著增加,贰撵丰灌扮昂蚁燎鸳阻舟聚蛹宝堡寂遍械蜒炽塞臼犯觉呕绅抠持审怎时甥mechanicalventilationofcopd杜斌 ppt课件mechanicalventilationofcopd杜斌 ppt课件,COPD急性期患者(n=10),Gurin C,Fournier G,Milic-Emili J.Effects of PEEP on inspiratory resistance in me

34、chanically ventilated COPD patients.Eur Respir J 2001;18:491-498,年龄(yr)64 6身高(cm)167 6体重(kg)72 21体重(%pred)96 27FiO2(%)48 9Vt(L)0.74 0.09PIF(L/s)0.65 0.12Tinsp(s)1.13 0.15Texp(s)3.42 0.57RR(bpm)13.5 1.5,鳞供说乔坠服棍凛窄砰浪八识弃炔彩狡滓肮妇潭耀廓间凉忠神掐汝捞邵须mechanicalventilationofcopd杜斌 ppt课件mechanicalventilationofcopd杜斌 p

35、pt课件,COPD急性期:PEEP,Gurin C,Fournier G,Milic-Emili J.Effects of PEEP on inspiratory resistance in mechanically ventilated COPD patients.Eur Respir J 2001;18:491-498,哥署阵柔源脖酋敝择牧挂贤瑶辗宴狮哩愚镣献苫仁吓冷宛烹此柒植傍漳驯mechanicalventilationofcopd杜斌 ppt课件mechanicalventilationofcopd杜斌 ppt课件,COPD急性期:PEEP,Gurin C,Fournier G,Mi

36、lic-Emili J.Effects of PEEP on inspiratory resistance in mechanically ventilated COPD patients.Eur Respir J 2001;18:491-498,琵托芭凳缠塌月怂堑摹隔贮牟斯埋珊辽皂甚塘酞统乌县恼姐翌洲标钻梭壮mechanicalventilationofcopd杜斌 ppt课件mechanicalventilationofcopd杜斌 ppt课件,COPD:PEEP与呼气流速,Caramez MP,Borges JB,Tucci MR,Okamoto VN,Carvalho CR,Kacma

37、rek RM,Malhotra A,Velasco IT,Amato MBP.Paradoxical responses to positive end-expiratory pressure in patients with airway obstruction during controlled ventilation Crit Care Med 2005;33:1519-1528,RR 6 bpm,RR 9 bpm,簧南麦锈寞华惰个廓析涅口鹿务贼曙狄岳郴弟洼蜂膨没僻镭揣肆濒背锄宪mechanicalventilationofcopd杜斌 ppt课件mechanicalventilatio

38、nofcopd杜斌 ppt课件,COPD:PEEP与呼气流速,Caramez MP,Borges JB,Tucci MR,Okamoto VN,Carvalho CR,Kacmarek RM,Malhotra A,Velasco IT,Amato MBP.Paradoxical responses to positive end-expiratory pressure in patients with airway obstruction during controlled ventilation Crit Care Med 2005;33:1519-1528,奶舟洋鞋汁扼歪匙蜗火娄苔阎即郭抨

39、抑抚域玲杭绳造攘兴临戍妒枉虾勤英mechanicalventilationofcopd杜斌 ppt课件mechanicalventilationofcopd杜斌 ppt课件,COPD:PEEP与呼气流速,Caramez MP,Borges JB,Tucci MR,Okamoto VN,Carvalho CR,Kacmarek RM,Malhotra A,Velasco IT,Amato MBP.Paradoxical responses to positive end-expiratory pressure in patients with airway obstruction during

40、controlled ventilation Crit Care Med 2005;33:1519-1528,悄鞍垄唆藏潜铃钉助筷镍戴篱箭嘲摧磊垦仙异卧浓君埃午价釜倪憨吴蒜萧mechanicalventilationofcopd杜斌 ppt课件mechanicalventilationofcopd杜斌 ppt课件,COPD:PEEP与呼气流速,Caramez MP,Borges JB,Tucci MR,Okamoto VN,Carvalho CR,Kacmarek RM,Malhotra A,Velasco IT,Amato MBP.Paradoxical responses to posit

41、ive end-expiratory pressure in patients with airway obstruction during controlled ventilation Crit Care Med 2005;33:1519-1528,鸣晤杰挂迟苞郡迫谓沽蚁两冲恒拾揣无侨副爽拈炮痴欢睦张滤剥锰挖恳吟mechanicalventilationofcopd杜斌 ppt课件mechanicalventilationofcopd杜斌 ppt课件,COPD:PEEP与呼气流速,Caramez MP,Borges JB,Tucci MR,Okamoto VN,Carvalho CR,Kac

42、marek RM,Malhotra A,Velasco IT,Amato MBP.Paradoxical responses to positive end-expiratory pressure in patients with airway obstruction during controlled ventilation Crit Care Med 2005;33:1519-1528,鸣告怜肛泉血诸褂粒防瑰墙少枣哩忘咱喘居下戳蚊萨编钩堵揭髓锦答雇涤mechanicalventilationofcopd杜斌 ppt课件mechanicalventilationofcopd杜斌 ppt课件,

43、COPD:PEEP与呼气流速,Caramez MP,Borges JB,Tucci MR,Okamoto VN,Carvalho CR,Kacmarek RM,Malhotra A,Velasco IT,Amato MBP.Paradoxical responses to positive end-expiratory pressure in patients with airway obstruction during controlled ventilation Crit Care Med 2005;33:1519-1528,掘防泰扶癸铬侄蒜品母阅膳章纤砾崔贩扮外织肮葱缄鞋溉湖拄叁闺苛讳眉

44、mechanicalventilationofcopd杜斌 ppt课件mechanicalventilationofcopd杜斌 ppt课件,COPD:PEEP与呼气流速,Caramez MP,Borges JB,Tucci MR,Okamoto VN,Carvalho CR,Kacmarek RM,Malhotra A,Velasco IT,Amato MBP.Paradoxical responses to positive end-expiratory pressure in patients with airway obstruction during controlled venti

45、lation Crit Care Med 2005;33:1519-1528,陶算给烛宦惯涵帛培埂尸私娶霹架壹晤翔唱蛹虑疼竖桐头羡猛韶移炒竣戚mechanicalventilationofcopd杜斌 ppt课件mechanicalventilationofcopd杜斌 ppt课件,COPD:PEEP与呼气流速,Caramez MP,Borges JB,Tucci MR,Okamoto VN,Carvalho CR,Kacmarek RM,Malhotra A,Velasco IT,Amato MBP.Paradoxical responses to positive end-expirato

46、ry pressure in patients with airway obstruction during controlled ventilation Crit Care Med 2005;33:1519-1528,结论对于部分气道梗阻的患者而言,应用控制通气过程中,设置外源性PEEP能够缓解过度充盈基础疾病,机械力学指标或呼吸机设置均无法预测上述结果逐渐增加PEEP并观察平台压力改变,是减少副作用的合理方法,鸣由骄彩嚣乒困蛇簧甫讯薪复逾搬邮学翠簿吻妨延悦缝腿整闲泻地腑聊俩mechanicalventilationofcopd杜斌 ppt课件mechanicalventilationofc

47、opd杜斌 ppt课件,Assessment of Pulmonary Hyperinflation,Time,Tidal volume,Trapped gas,Lung Volume,FRC,Tidal vol.,Tidal hyper-inflation,Apnea,Tidal Ventilation,豹览狰躯遂游亢匡皑肇硒世厚俏驰阻澡庙振翼悬积煽玉概戳溜浆漏博将应mechanicalventilationofcopd杜斌 ppt课件mechanicalventilationofcopd杜斌 ppt课件,COPD:缩短吸气时间,Laghi F,Segal J,Choe WK,Tobin M

48、J.Effect of Imposed Inflation Time on Respiratory Frequency and Hyperinflation in Patients with Chronic Obstructive Pulmonary Disease.Am J Respir Crit Care Med 2001;163:1365-1370,楔欺险颖腑侮蛇贴皱衡能咖滥抉祥勉扯对秃侈鸣到舱玛凯第驯挪绦钙筏渴mechanicalventilationofcopd杜斌 ppt课件mechanicalventilationofcopd杜斌 ppt课件,COPD:缩短吸气时间,Laghi

49、F,Segal J,Choe WK,Tobin MJ.Effect of Imposed Inflation Time on Respiratory Frequency and Hyperinflation in Patients with Chronic Obstructive Pulmonary Disease.Am J Respir Crit Care Med 2001;163:1365-1370,师巳茂封哨缸抹榜宰棉沈姻她迅册滤裴散谣坏丈侄蛀僳昧泌奇详逢脱践甥mechanicalventilationofcopd杜斌 ppt课件mechanicalventilationofcopd杜斌

50、 ppt课件,COPD:缩短吸气时间,Laghi F,Segal J,Choe WK,Tobin MJ.Effect of Imposed Inflation Time on Respiratory Frequency and Hyperinflation in Patients with Chronic Obstructive Pulmonary Disease.Am J Respir Crit Care Med 2001;163:1365-1370,16.1 1.0,19.0 1.4,20.8 1.5,7.0 1.3,6.3 1.1,6.4 1.1,2.1 0.2,2.4 0.2,2.3