济南高频振荡通气.ppt

济南高频振荡通气演示文稿;济南高频振荡通气;什么是高频振荡通气;1915：Hendersonetalobservedthatpanting;

1954:Briscoeetal.firstdescriptionofhigh-frequencyventilation;

1970s:aseriesofinvestigations;

1980s:intenseanimalandhumanresearchonHFOV;

1990’s,therewasawealthofinformationfrommultipleinvestigators,usingmultipleanimalmodels,suggestingthatHFOVcausedlessinjurytotheimmaturelung;;什么是HFOV？;;;;;;;机器差异;;为什么要用HFOV

（高Paw，小Vt）;1)成人和儿童(ARDS);Thebabylung TheARDSlungissmall,withanormal portionhavingthedimensionofthelung ofa5-to6-yearoldchild (200–300goflungtissueascomparedto700g)

;“Openthelungandkeepthelungopen”

HFOVvsCMV(IPPV)

Fundamentaldifferences;Radford:inRespiratoryPhysiology(eds.RahnandFenn);Mortality: 31.0vs.39.8

(p0.007);以上是使用HFOV的理由

HFOV使用有什么不同特点？;physiology;physiology;;;CO2清除/通气

CMVvsHFOV;CO2清除/通气

振幅;开始HFOV

清除CO2—使胸部震动;CO2清除/通气

频率;CO2清除/通气

频率;Changesintidalvolumewithincreasingfrequency;开始设定时的频率;HFOV气体交换的决定因素

氧合

;ManagementoftheInfant

onHFOV;Radford:inRespiratoryPhysiology(eds.RahnandFenn);ManagementoftheInfant

onHFOV;HFOV氧合决定因素

Paw对PVR影响;;氧合情况;RimensbergerPC

CritCareMed1999;27:1940-5;使用我们掌握的生理学知识使肺达到高容积状态;ManagementoftheInfant

onHFOV;ManagementoftheInfant

onHFOV;ManagementoftheInfant

onHFOV;ManagementoftheInfant

onHFOV;ManagementoftheInfant

onHFOV;;;;;HFOV在早产儿肺疾病中应用

临床经验证据;;1989:HiFistudy—nobenefit.还在学习使用；

此后小样本研究：benefitorequivalence，noincreaseddamage

;History—clinicaltrial;;撤机;谢谢大家！