机械通气地变化.ppt

机械通气的历史与变化Epidemiology of MV 首都医科大学附属复兴医院 席修明 讨论的问题 历史回顾 机械通气的流行病学调查 循证医学与机械通气的变化 总结 人工呼吸器的历史 Artificial Respiration in Pre-Physiology 最古老的人工呼吸器的描述来自古埃及神话，Isis 用呼吸拯救Osiris的生命 圣经-创世纪(Genesis)和国王(Kings) 中的描写; 历史回顾-Negative Pressure Ventilation (Iron Lung) that was wildly used during the polio epidemics 历史回顾-The first ICU in the world 历史回顾-The first ICU in the world 历史回顾 Patient no. 1 December 21st,1953 6.00 p.m: A 43 year-old-man was admitted from the medical ward to the Observation Room, three days after he had attempted to hang himself. He was agitated, confused and cyanotic with laboured respiration. T 38.6C, pulse 136. An X-ray showed bilateral infiltrated and oedema of the lung. Oxygen via facemask and when the SaO2 decreased, with positive pressure ventilation from bag and mask, was started. 历史回顾 December 22nd 7.15 a.m: The condition of the patient had deteriorated. A tube with cuff was passed into his trachea and manual positive ventilation with 60% oxygen in N2O was started. 00.45 p.m: SaO2 80%, Increases to 86% when 100% oxygen was used instead of the O2/N2O mixture 3.00 p.m: ABG pH 7.51, pCO2 31mmHg, SaO2100%. Clinically the patient was much improved. The respiration was sufficient and he was extubated. 历史回顾 Bjorn Ibsen第一次使用正压通气治疗呼吸衰竭的医生 （In the first ICU in the world） 这项新技术的应用使脊髓灰质炎的病死率从1952.7的87%下降到1953.3的15% 因此1953年3月是机械通气的生日 历史回顾 机械通的流行病学 第一个机械通气流行病学的报告是Rogers 1972 发表的 Impact of the Respiratory Intensive Care Unit on Survival of Patients with Acute Respiratory Failure 持续机械通气患者病死率的比较（1965-1968 普通病房 vs 1969 on RICU) Impact of the Respiratory Intensive Care Unit on Survival of Patients with Acute Respiratory Failure Conclusion A dramatic reduction in mortality from ARF has been achieved when these patients were treated in a unit with specially trained physicians, nurses and auxiliary personnel Availability of accurate monitoring, inhalation and physical therapy on the unit Interaction of the physicians, nurses and