机械通气总论 杜斌课件.pptVIP

机械通气总论北京协和医院杜 斌 机械通气的开始 机械通气的开始1949 – 1950年 Scandinavia脊髓灰质炎流行呼吸麻痹者死亡率80%1913年 Janeway第一台定型呼吸机 机械通气的开始1952年 Denmark脊髓灰质炎流行Blegdam Hospital31名呼吸肌麻痹患者27名相继死亡麻醉科医生Bjan Ibsen 气管插管 Mortality from Paralytic PolioLassen HCA. The Lancet 1:37-41,1953July-Aug 机械通气的开始75名病人手法通气24小时内动员250名医学生用手捏气囊260名护士参加床边护理消耗250筒氧气27名工人更换氧气筒死亡率从87%降低到40%以下 机械通气的开始 机械通气的开始 Mortality from Paralytic Polio:Lassen HCA. The Lancet 1:37-41,1953July-AugDecNovAugSeptOctMechanical Ventilation 机械通气的开始负压呼吸机(“铁肺”)1928年Boston儿童医院无创通气首次用于临床20世纪40至50年代脊髓灰质炎爆发流行时广泛使用正压呼吸机1955年麻省总医院首次使用有创通气现已成为机械通气的标准The iron lung created negative pressure in abdomen as well as the chest, decreasing cardiac output.Iron lung polio ward at Rancho Los Amigos Hospital in 1953. ICU中的机械通气机械通气的适应症急性呼吸功能衰竭 66%ARDS 8%慢性呼吸功能衰竭急性加重 13%昏迷 15%神经肌肉疾病 5%Esteban A, Anzueto A, Alia I, et al. How Is Mechanical Ventilation Employed in the Intensive Care Unit? An International Utilization Review. Am J Respir Crit Care Med 2000; 161: 1450-1458 ICU中的机械通气人工气道气管插管 75%经口气管插管 96%经鼻气管插管 4%气管切开 24%面罩 1%Esteban A, Anzueto A, Alia I, et al. How Is Mechanical Ventilation Employed in the Intensive Care Unit? An International Utilization Review. Am J Respir Crit Care Med 2000; 161: 1450-1458 机械通气的比例1. Esteban A, Alia I, Ibanez J, et al. Modes of mechanical ventilation and weaning. A national survey of Spanish hospitals. Chest 1994; 106: 1188-1193; 2. Esteban A, Anzueto A, Alia I, et al. How is mechanical ventilation employed in the Intensive Care Units? An international utilization review. Am J Respir Crit Care Med 2000; 161: 1450-1458; 3. Esteban A, Anzueto A, Frutos F, et al. Characteristics and outcomes in adult patients receiving mechanical ventilation. JAMA 2002; 287: 345-355 呼吸模式VCVPCVSIMVSIMV + PSVPSVCPAPBIPAPAPRVPRVC/autoflow/VV+VS/VV+AutomodeVAPS/PAMRVASVPAV+/PPS… 机械通气的常用模式Esteban (1992)Esteban (1996)Esteban (1998)VCV55%47%53%PCV1%–5%SIMV26%6%8%SIMV + PSV8%25%15%PSV8%15%4%其他模式2%7%15%1. Esteban A, Alia I, Ibanez J, et al.