呼吸机生理及应用.ppt

* NAVA Training Presentation 2007 NAVA Training Presentation.ppt * Respiratory Control: Conventional ventilator technology uses a pressure drop or flow reversal to provide assistance to the patient. This is the last step of the signal chain leading to inhalation. This last step is subject to disturbances such as intrinsic PEEP, hyperinflation and leakage. The earliest signal that can be registered with a low degree of invasivity is the excitation of the diaphragm. This signal is proportional to the integrated output of the respiratory center and thus controls the depth and cycling of the breath. The excitation of the diaphragm is independent of pneumatic influence and insensitive to the above problems with pneumatic triggering technologies. By following diaphragm excitation and adjusting the support level in synchrony with the rise and fall of the electrical discharge, the ventilator and the diaphragm will work with the same signal input. In effect, this allows the ventilator to function as an extra muscle, unloading extra respiratory work induced by the disease process. Reference: Sinderby C, Navalesi P, Beck J, Skrobik Y, Comtois N, Friberg S, Gottfried SG, Lindstrom L. 1999. Neural Control of Mechanical Ventilation in respiratory failure. Nat. Med. 5:1433-1436. * * * * * * * * * * * * * * * * * * * * * * * 假设总的死腔量为100ml潮气量400ml，呼吸频率20次/分，分钟通气量8L有效通气量=（400-100）*20=6L潮气量200ml，呼吸频率40次/分，分钟通气量同样为8L有效通气量=（200-100）*40=4L 在肺泡内完成气体交换的过程 氧分压（PO2）：溶解于血液中氧的压力 二氧化碳分压（PCO2)：溶解于血液中二氧化碳的压力 顺浓度梯度方向，氧气从肺泡内进入血液，二氧化碳由血液进入肺泡内 肺换气: 左心室 气体在全身的运输: 动脉血，氧含量高，CO2含量低 全身各器官 摄取氧气，排出CO2 右心室 静脉血，氧含量低，CO2含量低高 肺 在肺泡处进行气体交换 肺泡 氧气进入血液 CO2排出体外 肺静脉 呼吸系统解剖及基本功能 呼吸的调控 呼吸动力学基本概念 需要机械通气的常见疾病 主要内容: 顺应性,弹性 阻力 呼吸功 Servo呼吸机丰富的呼吸动力学监测功能 反映胸廓与肺的弹性 正常的顺应性是维持正常呼吸状态的前提 顺应性与弹性（Elasticity）成倒数关系 分为静态顺应性（Cstat）与动态顺应性（Cdyn） 顺应性（Compliance）: 顺应性的计算 静态顺应性（Cstat）=ΔV/Pplat－PEEPtotal动态顺应性（Cdyn）= ΔV/Ppeak－PEEP Cstat正常值60-100ml/cmH2O，Cdyn由于将克服气道阻力的压力也计算在内，因此数值上低于Cstat，约50-80ml/cmH2O，监测值受潮气量大小影响。弹性（E）与顺应性互