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机械通气的临床应用 PowerPoint PPT Presentation


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机械通气的临床应用. 机械通气是治疗呼吸衰竭的重要手段,在麻醉、复苏及危重病人的抢救中占有十分重要的地位。随着科学技术的进步,机械通气在近几年来有了很大的发展:新的通气模式不断增多,智能化程度越来越高,监测手段逐步完善,通气策略的改变等,使机械通气技术进入了一个新的时期,应用越来越广泛。但是,任何技术都有它的不足之处,机械通气也不例外,应用不当会给病人带来许多不利影响,甚至危及生命。因此对使用者提出了较高的要求。. 适应症和禁忌症 (一)临床适应症 1 、预防性机械通气 ( 1 )血流动力学不稳定者

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机械通气的临床应用

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  • 1

  • 1

  • 2

  • 3

  • 4

  • 5


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  • 2

  • 1PaCO2PHPaO2PH

  • 2


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  • 1<10-15ml/kg 65-75ml/kg

  • 2MIF25cm H2O

  • 3>15-20% <5%

  • 4/VD/VT>0.6 0.33-0.45

  • 5FEV1.0<10ml/kg

  • 6PaCO2>50-55mmHg(COPD


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  • 7PaO2<60mmHg(FiO2>0.5)

  • 8RR>35 /

  • 9PA-aO2>50mmHg(FiO2=0.21)8 mmHg

  • 10pA-aO2>300mmHgFiO2=1.022-75mmHg


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  • /CMVIntermittent Positive Pressure Ventilation IPPV/A/C


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  • Intermittent Mandatory Ventilation IMVSynchronized Intermittent Mandatory Ventilation SIMVSIMV


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  • Pressure Support Ventilation PSV25%<20cmH2O


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  • Continuous Positive Airway Pressure CPAP


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  • Bi-Level Positive Airway Pressure BiPAP:


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  • 6Pressure Controlled Ventilation PCV


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  • 7Rressure Regulated Volume Control PRVCPRVC5cmHO2,75%75%3cmHO250%


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  • 18-14/12/COPDARDS

  • 28-15ml/kg10ml/kgml/kg

  • 11.5-2COPD13-51-41

  • 4FLOW30-70L/min

  • 5

  • 6FiO20.5-0.60.5-0.61.0PaO2


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  • 7PEEPFiO20.6,PaO260mmHgPEEP2-5cmH2O1PEEP3-12cmH2O15cmH2O

  • 81-3cmH2O3-6L/min

  • 9Pause time: 0-0.61

  • 10


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  • 1PaO270mmHg1PEEPHb2

  • 2PaCO245mmHg CO2CO2


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  • 3PaO2PaCO2123


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  • 1230.5ml/


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  • 130minPO28.0PA60mmHg;PaCO2PaCO25.336.67kPa(4050mmHg).2:CO2,(5).3,.4X,X;5:PEEP,.


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  • ,.

  • Low tidal volume()

  • : .

  • :.

  • :;PSVA/C;;;.


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  • Low minute volume()

  • .

  • :;;MMV;.


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  • High minute volume():ARDS.

  • :;,PEEP;;,,.


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  • : high Rispratory rate:

  • low airway pressure:()

  • :;,,PSV;;.


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  • high airway pressure:(ARDS).

  • :;;;;;;;;;.


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  • (),,.

  • :;;;;.


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  • apnea:.

  • :;;A/CSIMV;.


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  • :(),.

  • :,;,,;;;.


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  • ()

  • ()


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    • ,

      • ().

      • ;;.

  • :,,


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  • 1

  • 2

  • 3

  • 4

  • 5CO2

  • 6


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  • 1>10-15ml/Kg

  • 2.MIF>20-25cmH2O

  • 3<15

  • 4/Vd/Vt<0.6

  • 5FEV1.0>10ml/kg

  • 6FiO2<0.4 PaO2<50-55 mm/Hg PaO2>60 mm/HgCOPDPH7.30

  • 7>25 ml/cmH2O

  • 8>5ml/kg>10ml/kg

  • 9PA-aO2<300-500mmHgFIO2=1.0)

  • 10PaO2>300mmHgFIO2=1.0)

  • 11>40mmHg

  • 12<10L/min

  • 13<35/


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  • 1

  • 2TT

  • 3CPAPARDSCPAP


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  • 4SIMV

  • 5PSVPSV

  • 6VSVPRVC

  • 7MMVSIMV+PSVCPAP+PSV


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