呼吸系统临床管理王斌ppt课件.ppt

* 对气道阻力增大的患者动态观察该流速-容积环呼气相的形态改变，可对降低气道阻力治疗效果作出直观的评价。 PEFR呼气峰值流速 * Respiratory muscles‘ work needs to overcome airway resistance and elastic recoil forces of the lung during spontaneous breathing. We as engineers prefer a model for better understanding biological processes. On the right hand side you see this model of the mechanical part of the lung consisting of the distensible alveolar region with the property of a compliance C and the resistance of the airways R. The respiratory muscles have to develop a pressure Prm that is composed of a resistive pressure component Pres for overcoming the airway resistance and an elastic component Pel for distending the lung. With various types of lung disease an increased resistance or decreased compliance leads to an increase of resistive or/and elastic work of breathing which may cause respiratory muscle failure particularly in premature infants. As a result the patient has to be ventilated mechanically. 1:40 * The ventilator can support the baby by a pressure only. And when we say ?Proportional Assist“ we have to ask proportional to what. Two signals are easy to measure: the respiratory flow and volume. Let us see what happens, if we control the pressure by flow. Then the pressure in mbar changes per l/s. However mbar per l per second is the dimension of a resistance. That means the ventilator has the property of a resistance. Due to the negative sign of this resistance we call it ? Negative Ventilator resistance“ It‘s very interesting that the engineer Poon and the engineer Schaller choosed the same expressions independent of each other. We call this method ?Flow proportional assist ventilation“ The same happens when we control the pressure by volume. We get the dimension mbar per ml. This is the dimension of an elastance and the ventilator offers a Negative Ventilator Elastance. We call this method ?Volume proportional assist ventilation“. 0:80 * This slide shows the technique of proportional assist ventilation. We