醫(yī)藥衛(wèi)生]呼吸力學與呼吸機波形及其臨床意義-資料下載頁
2025-01-04 08:09本頁面
【正文】 1 容量 時間曲線 2 3 4 5 6 SEC VT 800 ml 1 Inspiration 容量 時間曲線 2 3 4 5 6 SEC VT 800 ml 1 Expiration 容量 時間曲線 容量 時間曲線的臨床意義 ?肺內氣體陷閉 ?呼吸回路漏氣 壓力 容積環(huán) ?水平軸描述壓力，縱軸描述容量 0 20 40 60 20 40 60 P aw cmH20 V T LITERS 壓力 容積環(huán) 0 20 40 60 20 40 60 P aw cmH20 V T LITERS 指令呼吸 Inspiration 0 20 40 60 20 40 60 P aw cmH20 V T LITERS Inspiration Expiration 指令呼吸 壓力 容量環(huán) Volume Pressure Volume Pressure 0 20 40 60 20 40 60 P aw cmH20 V T LITERS 自主呼吸 Inspiration Expiration 0 20 40 60 20 40 60 P aw cmH20 V T LITERS Inspiration Expiration 輔助呼吸 0 20 40 60 20 40 60 P aw cmH20 V T LITERS 這是？ 0 20 40 60 20 40 60 P aw cmH20 V T LITERS Dotted loop changes to solid loop any ideas? 0 20 40 60 20 40 60 P aw cmH20 V T LITERS Indicates a drop in Compliance (higher pressure for the same volume) Did you say changing pliance? 0 20 40 60 20 40 60 .2 .4 P aw cmH20 V T LITERS .6 C D A B What does this represent? What is A? What is B? What is C? And how about D? 0 20 40 60 20 40 60 P aw cmH20 V T LITERS “ D” = Lower Inflection Point A B “ A” represents PEEP “ B” Represents Inspiratory Pressure 過度膨脹 .6 .2 .4 “ C” = Upper Inflection point 最佳 PEEP V P PEEP: 3 cmH2O V P PEEP: 8 cmH2O Changing Lung Volume in CV: Paw = Lung Volume 臨床應用： ?計算吸氣面積 ?計算順應性 ?計算阻力 ?評估肺泡過度膨脹 ?衡量壓力支持水平及其做功 典型的 PV環(huán) Volume Pressure Volume Pressure Volume Pressure Controlled Assisted Spontaneous 評估吸氣流速 Volume Volume Pressure Pressure Normal Insufficient Flow Pressure Volume Loops Cusping 過度膨脹 ? Overdistension occurs when the volume limit of some ponents of the lung has been exceeded ? Abrupt decrease in pliance at the termination of inspiration ? Results in a terminal “Beaking” of the P/V Loop Volume Pressure Volume Pressure Zone of Overdistention “ Safe” Window Zone of Derecruitment and Atelectasis Injury Injury 最佳肺容量（安全窗） ? 膨脹過度 ?肺泡痿陷 Mean Airway pressure 25 cm H2O CT Scan : ARDS pig model 30 kg Optimized Lung Volume Strategy: Mean Airway Pressure 40 cm H2O CT Scan : ARDS pig model 30 kg Optimized Lung Volume Strategy: CDP= FRC CT 1 CT 2 CT 3 Paw = CDP Continuous Distending Pressure 急性呼衰時 VP曲線拐點的意義 ?上拐點提示：壓力導致局部肺泡過度膨脹 ?下拐點代表：使肺泡開始打開的最小壓力 Volume Pressure LPIflex UPIflex 容積 流速環(huán) 流速 容量環(huán) Volume Flow Volume Flow 臨床應用 ?評價支氣管擴張劑的療效 ?評估是否漏氣 ?評估吸氣阻力和呼氣流速受阻 F V V F After Suction Before Suction 氣道阻塞 重度阻塞 漏氣 Volume Pressure Volume Flow Volume Time 謝謝！
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