医学ppt课件呼吸生理及呼吸机工作原理.ppt

23 * * 35 * 36 * 34 * 39 * * * * * * * * * * * * 15 * * * 19 4 * 20 6 * 21 8 * * * * * * 45 How do you know the problem is with the patient? Look at your flow curve. * 45 How do you know the problem is with the patient? Look at your flow curve. * 45 How do you know the problem is with the patient? Look at your flow curve. * * * 24 * 25 15 * 27 17 Make sure to incorporate discussion on active exhalation valve in notes * 29 29 * 28 28 * * Using both the volume- and flow-time curves provides insight to set the appropriate PIP and I-Time in PCV. For example, the physician orders PCV and tells you that he wants a VT of 500 cc. PCV is initiated with a PIP of 20 cm, resulting in a VT of 450 cc. Before increasing the inspiratory pressure to obtain additional VT, maximize inspiratory time. As shown here at the arrow, inspiratory flow does not return to zero before cycling into expiration. This could result in a lesser delivered volume. * Pictured in blue here is potentially lost VT. Increasing inspiratory time to allow the flow to return to baseline may increase VT without increasing PIP. * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * 适用于所有压力型通气 (PCV or PS) 为了满足病人需求或达到平均气道压（MAP）目标，需要调整压力上升时间 允许压力上升时间从慢到快的调整 压力上升时间调节 40 PcmH2O INSP L min EXP 30 20 10 0 10 -20 80 60 40 20 0 20 -80 40 60 V . 0 4 8 12s 2 6 10 慢 中 快 B 压力上升时间调节 智能压力上升算法软件能够根据阻力或顺应性变化自动调整流速 维持相似的曲线形态无论病人尺寸或阻抗变化的干扰 40 PcmH2O INSP L min EXP 30 20 10 0 10 -20 80 60 40 20 0 20 -80 40 60 V . 0 4 8 12s 2 6 10 RES = 5 RES = 20 RES = 50 cmH20/L/SEC cmH20/L/SEC cmH20/L/SEC B 稳定压力、人机同步－SPAP Spontaneous Breaths P T Spontaneous Breaths Synchronized Transitions 病人在两个不同压力水平可以自主呼吸 每一个自主呼吸都可以得到压力支持的支持 C 呼气灵敏度 (Exh Sens) ESENS 可以调整压力支持终止的标准（10-80%） 设定峰流速百分比转换PSV至呼气 调整病人吸气时间 增强病人与呼吸机同步 40% (Set) 流速 Increase ESENS sett