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1、气囊扩张疗法MHIApril 26, 2016pBagsqueezing挤压(Clement&Hubsch1968)pManualInflationofthelungswithoxygen(usually100%)ptoatidalvolumeof1liter(Windsoretal1972)ptoatidalvolumelargerthanbaseline(McCarren1996)pToatidalvolume50%greaterthanthatdeliveredbytheventilator比呼吸机给的潮气量多50%(Singeretal1994)定义p增加肺容量/防止肺塌陷Increa
2、selungvolume/preventionoflungcollapsep产生快速呼吸流速以刺激/仿效咳嗽Generateafastexpiratoryflowratesimulatecoughingp增加静态肺顺应性，降低呼吸道阻力Increasestaticpulmonarycomplianceandreducedairwayresistancep改善氧合Enhanceventilation(removalofCO2)目的组成构件呼吸球囊进氧贮氧袋单通道阀p贮氧袋p储气阀p衔接管p氧气管p单通道阀（呼吸活瓣）p安全阀MHI/Bagging/bagsqueezingp鼓肺p气道廓清流程进行
3、吸痰缓慢吸气、快速呼气，5-6次患者与球囊相互配合，缓慢呼吸2-3次连接贮氧袋、呼吸球囊、氧气管吸痰时间15s慢快的放松缓慢吸气，缓慢呼气保证贮氧袋充分扩张pMHI+胸部振动、扣拍p快速呼气以助分泌物的排除pIncrease in lung volume/prevention of lung collapseStiller et al 1990, Hodgeson et al 2000, Maa et al 2005pSecretion removal (review)Denehy 1999 pIncrease static pulmonary compliance肺顺应性肺顺应性Jones
4、et al 1992pImproved static lung compliance and reduced airway resistance Choi and Jones 2005pImproved static compliance and oxygenation Blattner et al 2008EffectofManualHyperinflation注意事项p高吸气压会导致肺气压伤p注意过高吸气压p不适合急性呼吸窘迫综合征，急性支气管痉挛患者p未处理的气胸p肺大泡、心血管系统不稳定p头部损伤，颅内压18mmHgp低心脏输出量p平均动脉压60mmHgp需要高剂量强心药禁忌症pPat
5、hologicalconditionspUndrainedpneumothorax（张力性气胸）pBronchopleuralfistula（支气管胸膜瘘）pBronchospasm（支气管痉挛）pPulmonarybullae（肺大泡）pLungtumours（肺部肿瘤）pCentralairwayobstruction（大气道阻塞）pLungabscess（肺脓肿）pHaemoptysis（咯血）禁忌症pPhysiologicalparameters:pCardiovascularinstabilitypMAP102mmHgpHR123pHighdoseinotroperequirement高剂量强心药物pNeurologicalinstabilitypICP19mmHgpCPP62mmHg禁忌症pPathologicalconditionspUndrainedpneumothorax（张力性气胸）pBronchopleuralfistula（支气管胸膜瘘）pBronchospasm（支气管痉挛）pPulmonarybullae（肺大泡）pLungtumours（肺部肿瘤）pCentralairwayobstruction（大气道阻塞）pLungabscess（肺脓肿）pHaemoptysis（咯血）谢thanks
