机械通气地演变.ppt

机械通气的演变 首都医科大学附属复兴医院 席修明 2008.11.20 广州 历史回顾-Negative Pressure Ventilation (Iron Lung) that was wildly used during the polio epidemics in 50th “On August 25,1952, I was called in as anasthetist for consultation in the Epidemiological Hospital of Copenhagen Within the preceding three weeks there had been 31 patients bulbar poliomylitis treated in respirators-tank as well as cuirass. 27 had died .” Four patients were seen in the autopsy room that day. One of them –a 12-year-boy-had died in a respirator with a blood pressure of 160 and biocarbonate level in the serum far above the normal level. The lung did not appear to be sufficiently atelecttic to make adequate ventilation impossible She was a 12-year-old girl who paralysis of all four extremities. She had atelectasis of the lung and was gasping for air. Her temperature was 40.2C. She was cyanotic and sweating. A tracheotomy was done , a cuffed endotracheal tube put in, good suction, and 100mg Pentothal, her own respiration stopped and I found that I could now inflate her lung……….. 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月是正压机械通气的生日 历史回顾-The first ICU in the world 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 机械通气12小时病人的病死率，ICU建立前（U-Pen General Hospital Medical and Surgical Care Areas 1965.6-1968.8 1969 建立RICU后的机械通气病人病死率 1992.1 Esdeban 对西班牙47个ICU机械通气模式和脱机方法进行了调查，290名病人机械通气时间大于24小时 Modes of Mechanical Ventilation and Weaning - A National Survey of Spanish Hospital 病人机械通气的天数 Modes of Mechanical Ventilation and Weaning - A National Survey of Spanish Hospital 脱机模式与成功率 T-piece 最好 SIMV PS SIMV+PS How is the Mechanical Ventilation Employed in ICU ？ 1996.11-1997.1 Esteban 主持8个国家412个ICU参加的机械通气流行病学调查 共有4153住ICU病人，其中1638名机械通气（39%） How is the Mechanical Ventilation Employed in ICU ？ 人工气道的选择（8个国家） How is the Mechanical Ventilation Employed in ICU ？常用的机械通气模式 How is the Mechanical Ventilation Employed in ICU ？常用的脱机模式 How