2022年医学专题—呼吸机相关基础知识.ppt

呼吸机相关呼吸机相关(xinggun)基础基础蚌医一附院 重症医学科李亚军(yjn)The First Affiliated Hospital of Bengbu Medical College in intensive medicineThe First Affiliated Hospital of Bengbu Medical College in intensive medicine第一页，共三十八页。相关呼吸生理相关呼吸生理(shngl)基础基础The First Affiliated Hospital of Bengbu Medical College in intensive medicineThe First Affiliated Hospital of Bengbu Medical College in intensive medicine鼻 咽 喉 气管(qgun)支气管(qgun)肺终末细支气管通气通气(tng q)部分部分换气部分换气部分呼吸系统呼吸系统第二页，共三十八页。呼吸系统呼吸系统(h x x tn)The First Affiliated Hospital of Bengbu Medical College in intensive medicineThe First Affiliated Hospital of Bengbu Medical College in intensive medicine生命体和外界环境之间氧氧和二氧化碳二氧化碳(r yng hu tn)的交换第三页，共三十八页。呼吸系统呼吸系统(h x x tn)The First Affiliated Hospital of Bengbu Medical College in intensive medicineThe First Affiliated Hospital of Bengbu Medical College in intensive medicine通气通气(tng q)弥散弥散(msn)灌注灌注第四页，共三十八页。自主呼吸自主呼吸(hx)原理原理The First Affiliated Hospital of Bengbu Medical College in intensive medicineThe First Affiliated Hospital of Bengbu Medical College in intensive medicine吸气吸气(x q)肌收肌收缩缩吸气吸气(x q)肌舒肌舒张张吸气吸气呼气呼气主动主动被动被动第五页，共三十八页。人工通气人工通气(tng q)原理原理The First Affiliated Hospital of Bengbu Medical College in intensive medicineThe First Affiliated Hospital of Bengbu Medical College in intensive medicine吸气吸气(x q)呼气呼气(h q)机械力机械力弹性回缩力弹性回缩力被动被动主动主动第六页，共三十八页。通气通气(tng q)原理原理The First Affiliated Hospital of Bengbu Medical College in intensive medicineThe First Affiliated Hospital of Bengbu Medical College in intensive medicine自主自主(zzh)通通气气机械机械(jxi)通通气气压压力力变变化化容容量量变变化化第七页，共三十八页。机械机械(jxi)(jxi)(jxi)(jxi)通气通气(ventilation)(ventilation)机械通气是患者自然通气或氧合功能出机械通气是患者自然通气或氧合功能出现现(chxin)障碍时运用器械使患者恢复有效通障碍时运用器械使患者恢复有效通气并改善氧合的方法气并改善氧合的方法The First Affiliated Hospital of Bengbu Medical College in intensive medicineThe First Affiliated Hospital of Bengbu Medical College in intensive medicine第八页，共三十八页。呼吸机的作用呼吸机的作用(zuyng)？The First Affiliated Hospital of Bengbu Medical College in intensive medicineThe First Affiliated Hospital of Bengbu Medical College in intensive medicine外呼吸外呼吸(hx)第九页，共三十八页。机械机械(jxi)通气的目的？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(boch)呼吸道通畅 改善压力容积关系The First Affiliated Hospital of Bengbu Medical College in intensive medicineThe First Affiliated Hospital of Bengbu Medical College in intensive medicine第十页，共三十八页。人工人工(rngng)气道气道 经鼻气管(qgun)插管 经口气管插管 气管切开The First Affiliated Hospital of Bengbu Medical College in intensive medicineThe First Affiliated Hospital of Bengbu Medical College in intensive medicine第十一页，共三十八页。呼吸机的基本呼吸机的基本(jbn)构造构造主机主机附加附加(fji)结构结构监测结构监测结构The First Affiliated Hospital of Bengbu Medical College in intensive medicineThe First Affiliated Hospital of Bengbu Medical College in intensive medicine第十二页，共三十八页。question给患者送气 一直(yzh)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 medicineThe First Affiliated Hospital of Bengbu Medical College in intensive medicine第十三页，共三十八页。常用的通气常用的通气(tng q)概念概念潮气量（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(zhch)（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 medicineThe First Affiliated Hospital of Bengbu Medical College in intensive medicine第十四页，共三十八页。常用常用(chn yn)的通气概念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(yl)、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 medicineThe First Affiliated Hospital of Bengbu Medical College in intensive medicine第十五页，共三十八页。机械机械(jxi)(jxi)通气物理量通气物理量-压力压力The First Affiliated Hospital of Bengbu Medical College in intensive medicineThe First Affiliated Hospital of Bengbu Medical College in intensive medicineB平台平台平台平台(pngti)(pngti)压压压压time(sec)第十六页，共三十八页。机械通气机械通气(tng q)(tng q)物理量物理量-流速、容量流速、容量The First Affiliated Hospital of Bengbu Medical College in intensive medicineThe First Affiliated Hospital of Bengbu Medical College in intensive medicine第十七页，共三十八页。目标目标(mbio)The First Affiliated Hospital of Bengbu Medical College in intensive medicineThe First Affiliated Hospital of Bengbu Medical College in intensive medicine潮气量潮气量压力压力(yl)压力压力(yl)潮气量潮气量容量控制容量控制压力控制压力控制第十八页，共三十八页。呼吸机模式呼吸机模式(msh)V/PCV(volume/pressure controlled ventilation)V/P-A/C(volume/pressure-assisted/controlled)V/P-SIMV(volume/pressure-synchronized intermittent mandatory 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 medicineThe First Affiliated Hospital of Bengbu Medical College in intensive medicine第十九页，共三十八页。机械机械(jxi)通气时相通气时相The First Affiliated Hospital of Bengbu Medical College in intensive medicineThe First Affiliated Hospital of Bengbu Medical College in intensive medicineABCD触发触发(chf)阶段阶段吸气吸气(x q)阶段阶段吸气转换呼气吸气转换呼气呼气阶段呼气阶段pressuretime第二十页，共三十八页。触发触发(chf)阶段阶段The Fir