机械通气波形2011讲义.ppt

机械通气波形分析Ventilator Waveform Analysis 进行波形分析的必要性 Patient–ventilator dys synchrony imposes an additional burden on the respiratory system and may increase the morbidity of critically ill patients. Thille A W, Rodriguez P, Cabello B, et al. Intensive Care Med, 2006. 32(10): p. 1515-22. Ignorance of these issues may prevent the ventilator from achieving its goals and may cause patient harm. Georgopoulos D, Prinianakis G, and Kondili E. Intensive Care Med, 2006. 32(1): p. 34-47. Inspection of pressure, flow and volume waveforms represents a valuable tool for the physician to recognize and take the appropriate action to improve patient–ventilator synchrony Eumorfia Kondili, Nektaria Xirouchaki and Dimitris Georgopoulos. Curr Opin Crit Care 13:84–89. Nilsestuen J O and Hargett K D. Respir Care, 2005. 50(2): p. 202-34; discussion 232-4. 主要内容 Time-based waveforms Pressure-Time Curve Flow-Time Curve Volume-Time Curve Abnormal Time-Based Waveforms Volume-Pressure and Flow-Volume Loops Pressure-Volume Loop Flow-Volume Loop Abnormal Loops Normal Time-based Curves（1） 容量控制通气 Volume-Time Curves Flow-Time Curves Pressure-Time Curves Normal Time-based Curves（2） 压力控制通气 Volume-Time Curves Flow-Time Curves Pressure-Time Curves Waveforms For Common Modes of Ventilation １、CPAP Mode ２、Assisted-Mode (Volume-targeted ventilation) ３、SIMV Mode ４、SIMV + Pressure Support ５、SIMV+PS+PEEP １、CPAP Mode CPAP mode :自主呼吸模式，仅有Pressure-Time Curves中设定基线水平 观察:基线水平5 cm H2O 、以及病人的触发triggering ２、Assisted-Mode (Volume-targeted ventilation) 主要特点： “assisted” 意指病人触发的辅助通气 Flow-time curves和 Volume-time curves 形态相似； Pressure-time curve 微小的负折回表明病人的触发 ３、SIMV Mode SIMV mode ：提供两种呼吸形式 （自主和指令），通常为两次指令呼吸中出现自主呼吸 Flow-time curve 中自主呼吸呈典型的正弦波形 (rounded). Pressure-time curve 中微小负折回提示自主呼吸的触发 Volume-time curve 提示自主呼吸的volume 低于ventilator 的volume ４、SIMV + Pressure Support Pressure support：常附着于SIMV 模式，增大自主呼吸的能力 ，而不受指令呼吸的影响 Flow-time curve：自主呼吸的形态呈递减波（非正弦波 ） Pressure-time curve ：吸气期，设定PS水平保持不变，以及存在微小负折回 ５、SIMV+