通气基础知识.ppt

* 使用支气管扩张药物后，根据呼气峰流速的大小和呼气流速回归到零所需用的时间长短，可对支气管扩张药物的疗效作出评估。 * 呼气末曲线不能回复到基线0 了解呼吸机的工作状态 ----泄漏！ * 控制通气 * 判断顺应性 * * Low Flow PV Loop (Source: IfU Evita V500, modified EB) The Low Flow PV Loop measuring procedure records pressure-volume curve, which is similar to a static loop. This loop can be used to assess the mechanical properties of the lungs. By slowly filling the lungs with a small, constant flow, only the elasticity properties are determined in the PV-Loop. This almost static process shows a good correlation with the static Super-Syringe or Occlusion Method, as long as the flow is small. There are various approaches for optimizing ventilation settings based on measurements of the lung mechanics. All approaches aim at avoiding a recurrent collapsing and re-opening of alveoli and a possible overinflation of the lungs. It is recommended to set the PEEP on the basis of the lower inflection point (LIP) and to limit the tidal volume VT or plateau pressure Pplat on the basis of the upper inflection point (UIP). Other research recommends taking into account the expiratory limb of the PV-Loop when determining the positive end-expiratory pressure (PEEP) required to maintain an alveolar recruitment. Characteristic points on the expiratory limb are described in this context as the point of maximum curvature (PMC). (cont. Next slide) * PIFR（peak inspiratory flow rate）和PEFR啊（peak expiratory flow rate） 这是VCV，从F-V Loop中我们可以看到至少六点: 1. 呼气流速突然终止提示存在内源性PEEP 2. 呼气肢凹向横轴提示呼气流速受限 呼气峰流速降低提示气道阻塞 3. F-V环呈开环状提示回路出现泄漏 4. 自主呼吸时曲线出现锯齿状改变提示回路中分泌物或水过多 5. 应用支气管扩张剂后呼气峰流速增高，呼气肢更线性化 * * 气道阻力增加 * * * * Calibrate，能够设置参考范围，小三角的地方，如果超过不会报警。设置范围最大为监测值的2倍。 意义：提醒医生治疗进程 气管，肺和胸廓的变化 膈肌的变化 MV的变化 * * * * * * * * * * 触发的概念：告诉呼吸机什么时候送气 方式：机器和人 人触发的方式里，重要的是保持同步性，这就要求除了参数设置得当，机器本身的阀门反应要迅速，这也是区分一线和二线产品的标准之一，质量的体现。 调节触发灵敏度 * Pressure trigger works with pressure sensors, which transform the low pressure to an electrical signal and open the valve if the relevant signal occurs. The triggerlimit has