外科重症监测治疗PPT.pptVIP

MPM—Mortlity probability model MPM-Ⅰ 1985 MPM-Ⅱ 1993 MPM0，MPM24，MPM48 The MPM can be used to calculate a direct probability of death in patients admitted to the ICU Severity-of-illness scoring systems suffer from the problem of inability to predict survival in individual patients. These tools should be used as important data to complement clinical bedside decision-making. MPM (Mortality Prediction Models) Developed by Stanley Lemeshow Uses data collected during first hour of ICU admission; 24 hours; 72 hours Series of true/false questions Weighted according to their individual contribution to mortality Monitoring of Respiratory function 床旁观察既简单又实用。 general: Consciousness Respiratory movements， Respiratory rate、apnea 呼吸音。 mucous 呼吸运动的观察 呼吸频率(RR) Adult RR 10-18 beat/min 每分钟肺泡通气量(minute ventilation,MV MV)=[tidal volume(VT)－dead volume(VD)]×RR 呼吸功能测定 肺容量监测—反映静态通气功能 潮气量(tidal volume,VT) 补吸气量(inspiratory reserve volume,IRV) 深吸气量(inspiratory capacity,IC) 补呼气量(expiratory reserve volume,ERV) 残气量(residual volume,RV) 功能残气量(functional residual capacity,FRC) 肺活量(vital capacity,VC) 肺总量(total lung capacity,TLC) Normal--- 80% predicted value Oxygen therapy 氧治疗 Oxygen therapy is the administration of oxygen as a medical intervention, which can be for a variety of purposes in both chronic and acute patient care. 氧治疗是通过吸入不同浓度的氧，使吸入氧浓度(F1O2)和肺泡气的氧分压(PAO2)升高，以升高动脉血氧分压(PaO2)，达到缓解或纠正低氧血症的目的。 Indication: Cardiac and resp arrest Resp failure typeⅠ,typeⅡ Cardiac failure or MI Shock Increase metabolic demands Post-operative states Carbon monoxide poisoning Oxygen therapy 氧疗方法:高流量系统，如文图里(Venturi)面罩(F1O2稳定)。低流量系统，如鼻导管吸氧、面罩吸氧、带贮气囊面罩吸氧等(F1O2不稳定) 。 氧疗护理:加强监测、预防交叉感染、湿化吸入气体、注意防火和安全。 Mechanical Ventilation 机械通气:人工气道 In medicine, mechanical ventilation is a method to mechanically assist or replace spontaneous breathing Artificial airway: endotracheal intubation or tracheostomy气管插管或气管切开。 Indication of mechanical ventilation Acute lung injury (including ARDS, trauma) Apnea with