课件：呼吸重症患者机械通气护理新进展.pptVIP

后面内容直接删除就行 资料可以编辑修改使用 资料可以编辑修改使用 资料仅供参考，实际情况实际分析 * 成人门齿到声门的距离是12～15cm，声门至隆突是10～15cm。 * * Respiratory mucosal and lung structures and functions may be severely impaired in mechanically ventilated patients when delivered gases are not adequately conditioned. Although under- and over-humidification of respiratory gases have not been defined clearly, a safe range of temperature and humidity may be suggested. During mechanical ventilation, gas entering the trachea should reach at least physiologic conditions (32 degrees C-34 degrees C and 100%relative humidity) to keep the ISB at its normal location. Clinicians must keep in mind that relative humidity is more important than absolute humidity: the warmer the gas, the higher the risk of tracheal mucosa dehydration and proximal airway obstruction. Practical assessment of the adequacy of the humidification system in use is not easy. The consistency (thin, moderate, or thick) of the patients sputum should be evaluated regularly [47]. Full saturation of inspiratory gases is likely when water condensation is observed in the flex tube [91,92]. Nevertheless, no clinical parameter is accurate enough to detect all the effects of inadequate conditioning [45]. When mechanical ventilation is extended beyond several days, adequate conditioning of respiratory gases becomes increasingly crucial to prevent retention of secretions and to maximize mucociliary function; a requirement that respiratory gases reach at least physiologic conditions is appropriate. Respir Care Clin N Am. 2006 Jun;12(2):233-52. * * * * * * * * 气囊压力表测量法 完全抽出气体，将导管充气接口连接套囊压力表充气阀。 在测压表检测下慢慢挤压球囊逐渐充气，每次以0.15ml左右的增减。 直至囊内压达15~25cmH2O(11.4~19mmHg）。 同时监听呼吸机送气声音，直到漏气音刚好消失。 观察压力表，此值为基准值，每次测量的衡量标准。 科学精确地测压，减少并发症。 但价格昂贵，尚不普及。 气囊放气 以往认为，气囊应常规定期放气-充气。 目前认为，气囊定期放气是不需要的。 理由： 目前临床使用的一次性高容量低压硅胶导管，对气管内壁压迫不大。 气囊放气后，1H内气囊压迫区的粘膜血流难以恢复。 放气-充气往往使医护人员忽视充气容积或压力的调整。 气囊放气后使潮气量减少，危重病人不耐受。 气囊放气时滞留物清除不利将会造成呼吸道感染。 清除气囊滞留物技术 人工气道的建立在声门和气囊之间形成了无效腔 此腔隙常有大量分泌物，所以清除术十分必要。 原理： 吸气末时用力挤压简易呼吸器，使肺充气膨胀的同时