机械通气患者压力容积曲线 -协和 杜斌.ppt

准静态PV曲线的测定方法(I): 低流量法 测定原理: 顺应性计算公式 准静态PV曲线的测定方法(I): 低流量法 测定原理: 顺应性计算公式 ? 若V(t)恒定 则克服阻力的压力差恒定 此时气道压力与呼吸系统顺应性呈负相关 准静态PV曲线的测定方法(I): 低流量法 低流量法测定PV曲线: 历史演变 Suratt et al (JAP 1980; Chest 1981) 吸气流量0.60 ± 0.10 (0.40 – 0.65) L/sec PV曲线的顺应性与静态法相同 Ranieri et al (Am J Respir Crit Care Med 1994) 低流量法PV曲线有助于确定PEEP导致的肺泡复张及过度膨胀 Servillo et al (Am J Respir Crit Care Med 1997); Lu et al (Am J Respir Crit Care Med 1999) 吸气流量20 – 60 lpm时, PV曲线斜率测定准确, 但高估UIP和LIP 准静态PV曲线的测定方法(I): 低流量法 Suratt PM, Owens DH, Kilgore WT, Harry RR, Hsiao HS: A pulse method of measuring respiratory system compliance. J Appl Physiol 1980, 49: 1116-1121 Suratt PM, Owens DH: A pulse method of measuring respiratory system compliance in ventilated patients. Chest 1981, 80: 34-38 Ranieri VM, Giuliani R, Flore T, Dambrosio M, Milic-Emili J: Volume–pressure curve of the respiratory system predicts effects of PEEP in ARDS: ‘occlusion’ versus ‘constant flow’ technique. Am J Respir Crit Care Med 1994, 149: 19-27 Servillo G, Svantesson C, Beydon L, et al: Pressure–volume curves in acute respiratory failure. Automated low flow inflation versus occlusion. Am J Respir Crit Care Med 1997, 155: 1629-1636 Lu Q, Vieira S, Richecoeur J, et al: A simple automated method for measuring pressure-volume curve during mechanical ventilation. Am J Respir Crit Care Med 1999, 159: 275-282 准静态PV曲线的测定方法(I): 低流量法 低流量法测定PV曲线: 历史演变 Mankikian et al (Crit Care med 1983) 吸气流量1.7 lpm 准静态PV曲线与静态法(超大注射器法)相同 吸气时间长达60 s Servillo et al (Am J Respir Crit Care Med 1997); 吸气流量15 lpm时, 准静态PV曲线右移, 但斜率不变 高估UIP和LIP Mankikian B, Lemaire F, Benito S, et al: A new device for measurement of pulmonary pressure-volume curves in patients on mechanical ventilation. Crit Care Med 1983； 11: 897-901 Servillo G, Svantesson C, Beydon L, et al: Pressure–volume curves in acute respiratory failure. Automated low flow inflation versus occlusion. Am J Respir Crit Care Med 1997, 155: 1629-163 准静态PV曲线的测定方法(I): 低流量法 减去克服气道阻力所需压力 进一步降低吸气流量 Ptot = Ptrach + Pres(tube) Ptrach