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呼吸机的临床应用 PowerPoint PPT Presentation


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呼吸机的临床应用. 大连开发区医院呼吸科 高治庆. BP840 BP7200. 鸟牌 2000. 鸟牌 8400. 纽邦 150. 为什么要用呼吸机?. 答:因为他有病!. 什么病需要用呼吸机呢?. 适应症: ◎ 肺部疾病: COPD 、 ARDS 、支气管哮喘、间质性肺病、肺炎、肺栓塞等。   ◎ 脑部炎症、外伤、肿瘤、脑血管意外、药物中毒等所致中枢性呼衰;   ◎ 严重的胸部疾患或呼吸肌无力;   ◎ 心肺复苏。. 为什么呼吸机能治疗这些病?.

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呼吸机的临床应用

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BP840 BP7200


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2000

8400

150


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COPDARDS


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123ABV/QC


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3540/68/PaO250mmHg,50mmHgPaCO2pH


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  • Galen1543Vesalius1664Hooke1774TossachFothergillRoyal Humanne Society


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1827-1828Leroy

20


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  • Dalziel18321864JonesDalziel

    Driker-Shaw1928iron lung50


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The iron lung is a negative-pressure noninvasive ventilator that was used extensively in North America during the polio epidemics of 1950s.


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  • 5760


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  • 503040195231327Ibsen


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  • 1934FrenknerSpiropulsator

  • 1942Bennett1948TV-2P1951Engstrom Medical


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  • respirator


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Negative pressure

applied to chest wall

Positive pressure

applide at airway

Tank

Negative-pressure

ventilation

Positive-pressure

ventilation


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  • 1.2.-3.


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  • 1//2.


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  • 3.


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  • 1.CMV

    2.ACMV

    3.IMV/SIMV

    4.PSV

    5.MVV

    6.PRVCV

    7.VSV

    8.PAV

    SIMV+PSV


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C

A

SIMV

CPAP

PSV +


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A/C

P

5

3

t


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SIMV

P

5

3

t


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CPAP

P

5

3

t


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  • -

    --


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  • 1.PEEP

    2.NEEP


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  • 1.CPAP

    2.APRV

    3.BIPAP


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  • 1.FiO2

    50%FiO22.VT:

    615ml/kgVTPCVPSVVTVTVT3050cmH2OARDS68mm/kgPSV2530 cmH2O


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  • 3.RR:

    1VTMV

    21220/ARDS

    3SIMVSIMV


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  • 4.I/E

    1/1.5-2I/ECOPD1/2ARDSI/EI/E1,PEEPi


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  • 5.

    20%


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  • 6.PEEP

    PEEPbest PEEP

    1

    2DO2

    3

    4

    5Q S/Q T

    (6)PEEP


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  • 6.PEEP

  • PEEP<10cmH2O

  • PEEP 20cmH2O

  • PEEP 25cmH2O


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  • 7.trigger

    110120ms100ms-1-3 cmH2O12L/min


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  • 8.

    9.sigh:

    50%100%


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C A SIMV CPAP PS

VT ml/ 6--8-10ml/Kg 400

f /m 12--25 16

FiO2 % 1.0--0.4--0.21 0.4

PEEP cmH2O 0--5--19 5


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  • 1.1234


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  • 2.1SpO22--3WOB()VO2()EEPTP-


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  • 3.1234


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  • 1.3236100%24250ml


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  • 2.

    FiO270%215


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  • 3.510m(2)

    4.1/21


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  • 5.25mmHg25mmHg()45

    25cmH2O18.5mmHg4-8

    4-85


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  • FiO2<0.4PEEP<5cmH2O

  • PaO2>60mmHgSaO2 >90%

  • PA-aDO2 < 350mmHg

  • PaO2/FiO2>200

  • <35/min

  • -15 -30cmH2O


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  • CPAP

  • SIMV

  • PSV


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  • (noninvasive ventilation NIV):


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NIPPV

  • COPDNIPPV

  • COPD

  • ARDS


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1

2

3

4

5

6CO230


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