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1、呼吸机相关基础,蚌医一附院 重症医学科 李亚军,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,相关呼吸生理基础,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,鼻 咽 喉 气管 支气管 肺,终末细支气管,通气部分,换气部分,呼吸系统,呼吸系统,The First Affiliated Hospital of Bengbu Medical College in intensive
2、medicine,生命体和外界环境之间氧和二氧化碳的交换,呼吸系统,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,通气,弥散,灌注,自主呼吸原理,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,吸气肌收缩,吸气肌舒张,吸气,呼气,主动,被动,人工通气原理,The First Affiliated Hospital of Bengbu Medical College in inte
3、nsive medicine,吸气,呼气,机械力,弹性回缩力,被动,主动,通气原理,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,自主通气,机械通气,压力变化,容量变化,机械通气(ventilation),机械通气是患者自然通气或氧合功能出现障碍时运用器械使患者恢复有效通气并改善氧合的方法,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,呼吸机的作用？,The First Aff
4、iliated Hospital of Bengbu Medical College in intensive medicine,外呼吸,机械通气的目的？,改善通气，纠正呼吸性酸中毒 改善换气，纠正低氧血症 减少呼吸肌作功，节约氧耗 保持呼吸道通畅 改善压力容积关系,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,人工气道,经鼻气管插管 经口气管插管 气管切开,The First Affiliated Hospital of Bengbu Medical College in inten
5、sive medicine,呼吸机的基本构造,主机 附加结构 监测结构,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,question,给患者送气 why.PS.when 一直送下去吗 呼气.PS.要呼完吗 who 转换 how 送.PS.呼多少 监测,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,常用的通气概念,潮气量（Vt）：患者在平静状态下，每次所能吸入或呼出的气体容量
6、吸气压力（Pi）：辅助/控制通气时在吸气相叠加在PEEP之上的压力 分钟通气量（MV）：每分钟吸入或呼出气体的总量，分钟通气量=呼吸频率*潮气量 压力支持（PS）：患者自主呼吸时在PEEP压力之上呼吸机提供的一个帮助吸气的压力 PEEP：呼吸机提供的在呼气末维持的压力,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,常用的通气概念,吸气时间：呼吸机供气时间 吸呼比：在每次呼吸中，吸气所用时间和呼气所用时间之间的比值 呼吸频率：患者每分钟的呼吸的次数 窒息通气：仅在自主呼吸模式中，如果在预
7、先设定的时间后病人没有自主呼吸或触发呼吸机，呼吸机将启动后备通气程序 吸气触发：流速、压力、时间 呼气触发：患者由吸气项转化为呼气项的判断标准,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,机械通气物理量-压力,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,B平台压,time(sec),机械通气物理量-流速、容量,The First Affiliated Hospital of
8、 Bengbu Medical College in intensive medicine,目标,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,潮气量,压力,压力,潮气量,容量控制,压力控制,呼吸机模式,V/PCV(volume/pressure controlled ventilation) V/P-A/C(volume/pressure-assisted/controlled) V/P-SIMV(volume/pressure-synchronized intermittent m
9、andatory ventilation) PSV(pressure support ventilation) CPAP(continuous positive airway pressure) BIPAP(bi-level positive airway pressure),The First Affiliated Hospital of Bengbu Medical College in intensive medicine,机械通气时相,The First Affiliated Hospital of Bengbu Medical College in intensive medicin
10、e,A,B,C,D,触发阶段,吸气阶段,吸气转换呼气,呼气阶段,pressure,time,触发阶段,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,Time trigger,Pressure trigger,Flow trigger,Time trigger,呼吸机控制通气的启动，根据设定的频率，按一定时间间隔送气,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,Sensitiv
11、ity,反应患者自主吸气触发呼吸机作功的大小，这个吸气引起管道系统内压力、流速的变化，变化被系统感知即触发呼吸机供气,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,Pressure trigger,患者引起管道内压力变化触发呼吸机启动 一般设置在-2-0.5cmH2O,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,Flow trigger,患者的吸气动作引起管道内气流速变化 一
12、般设置13L/min,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,Flow trigger,由于流速触发中背景气流的存在，患者吸气时即刻新鲜的气体 流速触发比压力触发更敏感，呼吸机的反应时间(响应时间)较短,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,吸气相 PS 定容,The First Affiliated Hospital of Bengbu Medical Coll
13、ege in intensive medicine,吸气相 PS 定容,潮气量：预设 气流大小：预设 气流形态：方波或减速波,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,方波或减速波,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,flow,time(sec),flow,time(sec),0,0,吸气,吸气,吸气,吸气,呼气,呼气,呼气,呼气,方波,减速波,吸气相 PS 定压
14、,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,吸气相 PS 定压,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,“定压”是指吸气压力恒定 气流大小不定 气流形态：减速波 吸气流速曲线下面积不定，无法“定容”,影响因素：患者的吸气用力程度、气道阻力、肺的顺应性,吸气向呼气切换,时间切换：通过预设的吸气时间使吸气终止 容量切换：吸气达到预设潮气量时,吸气终止 压力切换：呼吸道达到
15、设置压力时使吸气终止 流速切换：当吸气流速降至预设的峰流速%以下,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,呼气相 PS PEEP,是指呼吸机在吸气时产生正压，将气体压入肺内，呼气相气道压始终保持在正压水平的通气模式 防止肺泡萎缩，提高肺顺应性，降低呼吸功和耗氧量，增加肺泡和间质的压力，促进肺间质和肺泡水肿的消退，减少生理无效腔，增加肺泡通气量，改善通气-血流比值，降低肺内静-动脉分流，提高PaO2，改善组织供氧,The First Affiliated Hospital of B
16、engbu Medical College in intensive medicine,通气模式及机制,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,自己学习,目标,参数设置,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,Alarms,压力报警 通气量报警 呼吸频率报警 其他报警,The First Affiliated Hospital of Bengbu Medical College in intensive medicine,Thank you for your attention,The First Affiliated Hospital of Bengbu Medical College in intensive
