呼吸机波形分析-中文剖析.ppt

触发的选择 压力触发 呼吸肌等长度收缩 流速触发 呼吸肌等张力收缩 波形触发 比流速触发节省触发所需呼吸功50%以上 T P Eur Respir J 2002; 20: S603 触发不同步 Kondili et al. patient with severe COPD ventilated with PSV 触发不同步 误触发（Autotriggering） 管路积水 心搏干扰 无效触发（ineffective triggering） 肌力不足 呼气不完全 呼吸系统弹性差 通气量高 呼气阻力高（病人、回路阻力） 呼气时间短 损伤肌纤维超微结构 降低肌力 流量不同步 Eur Respir J 1999; 13: 873±82 PSV V-ACV 切换不同步 Br J Anaesth 2003; 91:106–119 吸气过早切换为呼气 切换不同步 无论采取何种切换模式，呼吸机的Ti和呼吸中枢的Ti之间总是存在差异 压力切换 1 时间切换 2 容量切换 3 流速切换 4 Ti固定不变 Ti取决于预设和病人 Am J Respir Crit Care Med 2002;165: 972±7 人机不同步 原因 流速设置不当 神经系统损伤 触发设置不当 波形特征 吸气和呼气过程中病人的呼吸努力造成吸气和呼气波形的“波动” V P F V 人机不同步-流速设置过低 因为吸气流速设置过低，压力时间曲线的吸气支下移 Time(sec) Time(sec) Paw cmH2O L/min Flow 增加流速，减少吸气时间，增加设定的呼吸频率 调整触发敏感度，改成以支持通气为主的通气模式，如PSV 对于神经系统损伤病人给予充分镇静 测试题 Time (sec) Raw↑ Paw cmH2O Question: An increase in airway resistance causes _____to increase and _____ to remain the same? Answer: PIP increases, Pplat remains the same 测试题 Question: This flow pattern indicates what? Answer: Air trapping (auto-PEEP) Time (sec) L/min 1 2 3 4 5 6 120 -120 Flow Normal 测试题 120 -120 Flow L/min Pre-Bronchodilator Post-Bronchodilator Question: To assess improvement after a breathing treatment you should see what? Time (sec) Answer: Improved peak flow and shorter expiratory time 测试题 T P T V F T The flow waveform doesnt return to baseline Interpret the mode: Is it a Volume or Pressure mode? Is it a Control (rate) or Support mode? The pressure waveform has a plateau 测试题 Question: What does this loop indicate? Answer: Decreased lung compliance. (ARDS, CHF, Atelectasis) LITERS Paw cmH2O VT 测试题 Paw cmH2O VT Paw rises With little or no change in VT “beaking” LITERS Question: What is occurring when there is a bird beak appearance on the P/V loop? Answer: Lung overdistention. Pressure continues to increase, while volume remains the same. 测试题 Question: When the expiratory side of the loop doesn’t return to baseline, this indicates what? Answer: There is a leak. (ETT cuff, vent circuit) I