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1、机械通气工作原理1主要内容概述参数测量/计算运动方程2概述345O2AIRTo Patient50 psig50 psigBLENDERRESERVOIR10-15 PSIGAir and O2 are mixed in a blender, stored as a mixed gas in a reservoir then pass through a single proportional valve.PROPORTIONAL VALVESingle Proportional SystemHamilton Veolar, Bird 6400-8400st 6O2AIRTo Patient5
2、0 psig50 psigEach gas has its own solenoid, flow sensor and pressure regulator . Both valves controlled by microprocessor.FLOW SENSORFLOW SENSORTwo Proportional Valve SystemNPB 7200-840, DRAGER E2-4, SERVO 3007O2Pulmonetic LTV Turbine/Blender SystemBlended gas to patientDelivery Control ValveBlower
3、with Intragral Digital Blender8O2AIR50 psig50 psigAir and O2 solenoids combined with active exhalation valve.PATIENTEXHTwo Proportional Valve System With Active Exhalation Valve9PB-840101112双比例电磁阀：精确调整氧浓度、流速和波形13EVMotorPoppetSeat低阻力主动呼气阀14低阻力主动呼气阀15安全阀16171819学习目的掌握常见呼吸机的工作原理：气路、电路、及计算机控制技术比较常见呼吸机的优
4、缺点，了解未来呼吸机的发展方向及技术热点设计研发全球领先的新一代Ventilator，代号：协作一号20这显然是不可能的学习目的21学习目的对机械通气原理有一个大致的了解！2223概念呼吸外呼吸气体在血液中的运输内呼吸24概念呼吸外呼吸通气弥散气体在血液中的运输内呼吸25概念通气2627n n压差是气体运动的动力P1P2R28-500Normal RespirationEnd-Expiration29-100-5Normal RespirationInspiration30-10 to -50Normal RespirationExpiration31吸气PbPaPa PbPa Pa机械通气3
5、2自主呼吸胸廓容量改变胸廓容量改变气流气流压差压差33机械通气压差压差 容量变化容量变化气流气流34机械通气机器产生机器产生压差压差 容量变化容量变化气流气流35概念通气机 用来辅助或替代呼吸肌工作的机器36概念机械通气 使用通气机驱动气体进出呼吸系统37机械通气负压通气正压通气概念38机械通气负压通气正压通气概念394041Iron lung polio ward at Rancho Los Amigos Hospital in 1953.424344机械通气负压通气正压通气概念45机械通气负压通气正压通气概念46474849概念通气机械通气正压通气505152535455概念正压通气容量控
6、制压力控制56 Volume 500 mlVolume 500 ml57Pressure 20 cm H2OPressure20 cm H2O58 Pop!59 Pressure 3500 cm H20valvePressure 35 cm H20Tidal volume 500 ml60 Microprocessor Control Pressure 3500 cm H20Inhalationvalve(resistor)solenoidMicroprocessorexhale valveTidal volume 500 mlPressure 35 cm H2061描述气体运动参数压力流速时
7、间容量62参数测量/计算63监测参数测量参数计算参数64测量参数压力流速时间65计算参数容量顺应性阻力66管道 + 气球 模型67Tube + Spring Model弹性阻力弹性阻力摩擦阻力摩擦阻力68Y型管通气机内部食道压力测定部位69压力测定部位70压力测定部位71流速测定方法压差传感器热线型传感器超声传感器72流速测定方法压差传感器30 L/min Flow20 cmH200 cmH2073流速测定方法温差传感器74Flow Sensor7576Heated Wire Anemometer77Broken wire78流速测定方法温差传感器（热线型传感器）晶体热膜式流量传感器79超声流
8、量传感器流速测定方法80流速测定方法超声流量传感器81T1X-ducerX-ducerGas flowT2X-ducerX-ducerGas flow流量计算原理 T2 - T1 = Tdiff Tdiff 与气体流量成比例流速测定方法超声流量传感器82流速测定部位Y型管通气机内部通气机83流速测定部位Y型管84流速测定部位通气机内部85测量参数压力流速时间86计算参数容量顺应性阻力87容量计算timetimeVolumeVolumeFlowFlow88容量容量流速流速时间时间容量计算容量容量 = = 流速流速 时间时间89容量计算气体容量与压力、温度和水蒸气含量密切相关BTPSBody Te
9、mperature Pressure Saturated(In the lungs of the patient)90Some easy principles of physics (i)What happens if you heat a certain gas Volume?The initial volume of gas increases 1L of gas at 20C increases to 1.058 L at 37C while the pressure level remains the same91The initial volume of gas increases
10、up to the saturation point of water 1L of dried gas at 20C increases to 1.023 L if humidified to 100% where 2.3% of the gas mixture is water vaporSome easy principles of physics (ii)What happens if you humidify dried gas?92The initial volume of gas decreases proportionally to the applied pressure 1L
11、 of gas at 1013 mbar will decrease to 980mL if an additional pressure of 20mbar is appliedSome easy principles of physics (iii)What happens if you humidify dried gas?93Evita 4VtBeatmungsparameter verndern : entsprechendes Element anwhlenIPPVVt1000Setting BTPSDisplay BTPSDRGERN ormal T emperature P r
12、essure D ry910 mL20 C, 0 % RHB ody T emperature P ressure S aturated1000 mL37 C, 100 % RHN ormal T emperature P ressure S aturated930 mL20 C, 100 % RH容量测定94Evita 4VtBeatmungsparameter verndern : entsprechendes Element anwhlenIPPVVt1000Setting BTPSDisplay BTPSDRGERN ormal T emperature P ressure D ry9
13、10 mL20 C, 0 % RHLC_BTPS.ds4TestLungN ormal T emperature P ressure D ry910 mL20 C, 0 % RHN ormal T emperature P ressure D ry910 mL20 C, 0 % RHD D Vi - Ve = Leak容量测定95VolumePressureD D VD D PC = D VD P静态顺应性96静态顺应性流速为零时测定（指令通气 + 吸气暂停）受患者体位和肌肉松弛程度等影响97静态顺应性 500 15-5= 50 ml/cmH20Compliance =VtePlateau -
14、 PEEPPlateau Pressure 15 cmPIP 20 cmVTE 500 ccPeak Flow = 60 L/minPeak Flow = 60 L/minPlateau Pressure 15 cmPIP 20 cmVTE 500 ccPEEP 5 cm98内源性PEEP的存在造成顺应性计算值偏低VTE 500 ccPTPlateau = 20PEEP = 5Lung PEEP = 10 500 20-5= 33 ml / cmH20 500 20-10= 50 ml / cmH20静态顺应性99R = D D PD D F气道阻力100Plateau Pressure 15
15、 cmPIP 20 cmVTE 500 ccPeak Flow = 60 L/minResistance =PIP - PlateauPeak FlowResistance = 20 - 151 L / sec= 5 cmH20 / L / sec 气道阻力101102呼气呼气吸气吸气通气概念103机械通气工作原理吸气由什么触发Trigger吸气相通气机限制什么Limit吸气相什么时候结束 Cycle呼气相预设压力Baseline104机械通气工作原理A TriggerB LimitC CycleD BaselineABCD105机械通气工作原理吸气由什么触发（Trigger）？患者（压力/流
16、速/容量/胸部阻抗/腹部活动）通气机（时间）操作者106吸气相通气机限制什么（Limit）？流速压力机械通气工作原理107吸气相什么时候结束（ Cycle）？流速压力时间容量机械通气工作原理108切换PressureTimeTime限制Pressure机械通气工作原理109容量控制与压力控制通气机械通气工作原理110Comparison chartVolume PressureFlowI-timeSpontaneous variablevariablevariablevariableVCVFIXEDvariableFIXEDFIXEDPCVvariableFIXEDvariableFIXEDP
17、SVvariableFIXEDVariablevariable111运动方程112描述气体运动参数压力流速时间容量113描述肺部情况基本参数C= D D VD D PR = D D PD D F114运动方程压力、流速、容量、时间与顺应性、阻力之间的关系？115ventilationventilationpressure pressure to deliver to deliver tidal volumetidal volume =elastic elastic pressurepressureto inflate lungs to inflate lungs and chest walla
18、nd chest wall+resistive resistive pressurepressure to make air flow to make air flow through the through the airwaysairwaysPmus Pvent = EV Rf = 1/CV RfPmus Pvent = Pelastic Presistive Equation of Motion116运动方程通气驱动压 = 弹性回缩压流速阻力压 =容量弹力流速阻力 =容量/顺应性流速阻力117运动方程容量控制方波118运动方程容量控制方波119运动方程压力控制120运动方程通气驱动压 = 呼吸肌产生负压 通气机产生正压stiff lungmus = - 25 mbarVt = 500 ml +20 mbarC = 20 ml / mbarE = 50 mbar / LPmus = - 5 mbarVt = 500 ml121Vt = 500 mlPmus = - 5 mbarVt = 500 ml + 5 mbarspontaneous breathingventilated呼吸肌产生负压与通气机产生正压是等效的122主要内容概述参数测量/计算运动方程123正压通气工作原理124谢谢125
