呼吸机应用基础.pptVIP

* 处理： 1、气管插管接呼吸机，A/C（PC+PEEP）或SIMV+PSV+PEEP. 辅助呼吸原则：小潮气，小-中剂量PEEP 即：潮气量=5-8ml/Kg，R=12-18 PEEP=5-15cmH2O 2、加强胸部外固定，使用有强心作用的血管活性药（中剂量多巴胺+小剂量多巴酚丁胺），纠正低蛋白血症，监测CVP，增加容量，适用利尿剂，镇静镇痛 * 2天后复查胸片，患者肺部情况较前清晰，胸腔积液少许 逐渐减少呼吸频率，降低FiO2和peep，降低PSV，SPO2 98%，f 16bpm 处理：改CPAP（SPONT），3天后，CPAP降为4cmH2O，患者咳嗽有力，痰少，引流量少，开放脱机 脱机4h，患者无不适，拔管。 * 4天后，患者胸部骨折处疼痛，咳嗽乏力，咳痰困难，氧饱和度稍低86-90%，呼吸频率稍快， 处理：协助咳痰，镇痛，雾化，使用氨溴索等。无创呼吸机辅助通气（SPONT模式） 5天后，顺利脱机 * 掌握机械通气的唯一捷径 ——勤学苦练 * 呼吸机只是一个辅助手段。 学习呼吸机，重在实践。 * Standard care of the patient with severe sepsis consists of a number of medical (and sometimes surgical) interventions intended to normalize physiology and eliminate infection. These are divided into: Source control: This term refers to management of the source of the infection. It can consist of surgery to drain an abscess or removal of an infected catheter. Antibiotics: While the initial therapy may be broad-based and empiric, identification of the specific pathogen by microbiologic studies may result in a switch of the antibiotic to those that are the most specific and bacteriocidal. Hemodynamic support: This term refers to volume replenishment therapy followed, when necessary, by appropriate use of drugs such as norepinephrine to maintain blood pressure and organ perfusion. Mechanical ventilation: Respiratory failure is a common manifestation of pulmonary organ dysfunction in patients with severe sepsis. Mechanical ventilation is instituted to increase oxygenation and improve gas exchange. Renal replacement therapy: Impaired renal function is a sign of organ dysfunction in patients with severe sepsis. Renal replacement therapy consists of temporary hemodialysis or ultrafiltration. Sedation and analgesia: Sedation is often required to treat anxiety and agitation in patients with severe sepsis. Because these patients are at risk for pain and physical discomfort, analgesics also are commonly employed. Ensure adequate nutrition: Sepsis is a hypercatabolic state. Therefore, caloric and nitro