机械通气的临床应用课件.ppt

1,机械通气*HazardsofLoweringVtHypercapniaThevolumeofaeratedlungisdecreasedIncreaseinshuntingWorseningoxygenation1,机械通气*PulmonaryComplicationsVAP翻身改善气管支气管引流保持半卧位减少反流采用封闭性吸痰装置吸引气囊上方分泌物洗手！！减少抑酸剂和制酸药物的使用1,机械通气*CardiovascularComplicationsDecreasedvenousreturn,cardiacoutput,andbloodpressureDuetoincreasedintrathoracicpressureHypovolemiaKeepPIPandPEEPaslowaspossiblePhysiologiccompensation1,机械通气*RelationshipbetweenCOandend-diastolicvolume1,机械通气*GastrointestinalComplications急性胃粘膜病变出血腹胀：影响呼吸功能使用胃粘膜保护剂尽量使用胃肠道营养1,机械通气*肝脏的副作用内脏血流减少导致门脉血流减少胸内压增高导致肝静脉回流减少过度通气导致内脏血管的收缩胆道粘膜下静脉充血1,机械通气*Renalside-effects—sodiumandwaterretension降低动脉灌注压降低心搏出量增加肾静脉压胸内压增高导致心钠素释放减少激活肾素血管紧张素醛固酮系统增加血浆ADH的水平增加交感神经的张力改变肾内灌注1,机械通气*脑血管的影响胸内压增高导致颅内压增加脑灌注压降低（CPP=MAP-ICP）预防：头抬高15-30?维持血压保持在PaCO2正常范围升压药物1,机械通气*Acid-BaseComplicationsAcidosisSepsisandhypoventilationStimulatesbreathingArrhythmiasIncreasesdemand,prolongsCMVIncreaseVE,decreaseI/E,treatunderlyingcauseAlkalosisSteroids,diureticsorhyperventilationInhibitsbreathingArrhythmiasAnoxiaoftissuePotentialcauseoffailedweaningTreatunderlyingcause,decreaseVT，increaseI/E1,机械通气*撤机注意事项患者状态的调整：心理准备、营养准备、水电解质酸碱失衡的纠正、其它脏器功能的维持撤机过程的监测：呼吸频率、心率、血压、一般状况、矛盾呼吸有无、潮气量、分钟通气量、动脉血气撤机过程的护理：心理护理、人工气道的管理1,机械通气*机械通气的撤离撤机指征原发病得到改善呼吸功能显著改善神志清楚血液动力学稳定胃肠道功能稳定无高分解代谢生理指标MIP-30cmH2OVC10?15ml/kg,IC10ml/kgVT5ml/kg,VD/VT0.55?0.6FEV110ml/kgMV10L/min,MVV2*MVQs/Qt15%FiO20.4,PaO2≧60mmHg,PaCO250mmHgPaO2/FiO22001,机械通气*CriteriafortoleratingweaningtrialsOxygenation(PaO2/=60mmHgorSaO2/=90%onFIO2/=0.40-0.50)Ventilation(PaCO2increase/=10mmHgorpHdecrease/=0.10)Bloodpressure(systolicbloodpressure/=90or/=180mmHg;increaseordecrease/=20%)Heartrate(/=50or/=140beats/min;increaseordecrease