醫(yī)藥衛(wèi)生]呼吸力學(xué)與呼吸機(jī)波形及其臨床意義-文庫(kù)吧資料
2025-01-10 08:09本頁(yè)面
【正文】 Volume Pressure Volume Pressure Controlled Assisted Spontaneous 評(píng)估吸氣流速 Volume Volume Pressure Pressure Normal Insufficient Flow Pressure Volume Loops Cusping 過(guò)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(guò)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(shí) VP曲線拐點(diǎn)的意義 ?上拐點(diǎn)提示：壓力導(dǎo)致局部肺泡過(guò)度膨脹 ?下拐點(diǎn)代表：使肺泡開(kāi)始打開(kāi)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(yīng)用 ?評(píng)價(jià)支氣管擴(kuò)張劑的療效 ?評(píng)估是否漏氣 ?評(píng)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！ 。 MAP ? A=A1+A2+…+An Pressure Inspiration + Exhalation ? A Mean Airway Pressure Peak Inspiratory Pressure Time 術(shù)語(yǔ) : PEEP, I:E Ratio Pressure Time Positive End Expiratory Pr. T insp. T exp. I : E = 1 : 2 I : E = 4 : 1 PEEP PIP PIP PEEP T insp. 術(shù)語(yǔ) : Flow and Volume Minute Ventilation = Tidal Volume x Breath Rate Pressure Flow Time Tidal Volume 環(huán) Pressure Volume Volume Flow Insp. Expir. Insp. Expir. 壓力 時(shí)間曲線 波形各段意義 ?A/ 觸發(fā) : ? 病人 (assisted) ? 呼吸機(jī) (controlled) ?B/ 限制 : ? 流速 ? 壓力 ?C/ 切換 : ? 容量 ? 時(shí)間 A B C 切換與限制 Cycled Pressure Time Time Limited Pressure 在吸氣相所記錄的測(cè)量值 圖 2. 在吸氣相和呼氣相中所評(píng)估的變量 1 2 3 4 5 6 30 10 P aw cmH 2 0 Sec 壓力 時(shí)間曲線 Pressure Time Curve 1 2 3 45 630 10P awcmH20S e cA C C ES S F U N C TI O N 60 T O C H A N G E O R EX I T W A V EF O R MSFE B 11 1996 W A V E F O R M M O N I T O R I N G P A T I E N T I D 9878798 7 13 : 5 0Volume Expiration 1 2 3 4 5 6 30 P aw cmH 2 0 Sec Volume 壓力 時(shí)間曲線 V . Inspiration Pressure Time Curve 1 2 3 45 630 10P awcmH20S e cA C C ES S F U N C TI O N 60 T O C H A N G E O R EX I T W A V EF O R MSFE B 11 1996 W A V E F O R M M O N I T O R I N G P A T I E N T I D 9878798 7 13 : 5 0Volume Expiration 1 2 3 4 5 6 30 P aw cmH 2 0 Sec Volume 壓力 時(shí)間曲線 V . Expiration Pressure Time Curve Volume Expiration 1 2 3 4 5 6 30 P aw cmH 2 0 Sec Volume Pressure Inspiration
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