2016呼吸机的应用基础PPT课件.pptx

呼吸机入门云南省第一人民医院 急诊ICU陈国兵目录目录什么是呼吸机（Ventilator）?靠自身动力和控制能力来实现呼吸功能的机器。—精密的电子气泵！简单来说：打气筒最早的呼吸机“spirophore”, the first whole body negative pressure device, constructed in 1876这是最早的呼吸机，应用于煤气中毒的抢救。现代呼吸机World War II Morden Ventilators目录五、呼吸机的基本结构空氧混合器气源主机外部管道病人湿化器呼吸机连接湿化器或雾化器冷水湿化器 加热湿化器 雾化湿化器 热湿交换器（人工鼻）呼吸机连接目录机械通气的适应症符合下述条件应实施机械通气 经积极治疗后病情恶化；意识障碍； 呼吸形式严重异常，如呼吸频率35~40次/分或6~8次/分，或呼吸节律异常，或自主呼吸微弱或消失；血气分析提示严重通气和/或氧合障碍：PaO250mmHg，尤其是充分氧疗后仍50mmHg；PaCO2进行性升高，pH动态下降。建议：尽早插管，尽早拔管机械通气的相对禁忌证机械通气的并发症人工气道相关的并发症导管易位 气道损伤 气道出血 气管切开并发症 呼吸机相关肺损伤 气压伤、容积伤、萎陷伤和生物伤 呼吸机相关肺炎 机械通气对肺外器官功能的影响 机械通气的方式无创通气：noninvasive有创通气：invasive呼吸机的连接方法面罩、鼻罩气管插管气管切开呼吸机连接目录呼吸机常规参数的设置Vt (潮气量)：400－500mlf（频率）: 12－20次/minVi （吸气流速）：40－100L/minTi（吸气时间）:0.8－1.2sFiO2（吸氧浓度）：PEEP（呼吸末正压）：3－5cmH2OI：E （吸呼比）：1：2机械通气的模式ACAPAVCPCVPVACPACVACPV机械通气的模式机械通气常用的模式辅助控制通气（Assist-Control ventilation, ACV） 同步间歇指令通气( Synchronized Intermittent Mandatory Ventilation ,SIMV) 持续气道正压通气（Continuous Positive Airway Pressure, CPAP） 小 结目录机械通气时的报警使用备用电源ON BATTERY POWERDo not be like this !充耳不闻视而不见保持沉默Who’s Watching the Patient?我的个人微信公共号：文医园谢 谢！云南省第一人民医院 急诊ICU陈国兵The machine was invented by Sir Henry Gauvain. Originally for treatment of coal gas poisoning it found its most famous use in the mid-1900s when victims of poliomyelitis (more commonly known as polio), stricken with paralysis (including of the diaphragm, the cone shaped muscle at the bottom of the rib-cage whose action controls intrathoracic pressure), became unable to breathe, and were placed in these steel chambers to survive. The first iron lung was used on October 12, 1928 at Children’s Hospital, Boston, in a child unconscious from respiratory failure; her dramatic recovery, within seconds of being placed within the chamber, did much to popularize the “Drinker Respirator.”[1] An Emerson iron lung. The patient lies within the chamber, which when sealed provides an effectively oscillating atmospheric pressure. This particular machine was donated to the Centers for Disease Control and Pre