1、.1 郭凤梅东南大学附属中大医院重症医学科人机不同步 关注呼吸机设置.2人机不同步l 概念： 机械通气与患者自主呼吸不同步的现象l 分类： 吸气触发 吸气呼气切换 吸气潮气量.3Asynchrony during non-invasive ventilation6 ICUS60 acute respiratory failure patientsEMGdi was measuredIntensive Care Med, 2009; 35(5): 840-6.44%患者存在严重人机不同步.4 Time asynchrony during invasive MVPats 62 ACV和PSV MV
2、24h监测食道压力、流速压力波形30分钟内无效触发、双触发的次数不同步指数不同步事件次数/患者所有吸气努力次数24患者人机不同步指数10%(严重人机不同步)Thille AW, Intensive Care Med 2006;32:15151522.5Asynchrony-ventilation induced lung injury N Engl J Med, 2010; 363: 1107-1116.6Consequence of asynchrony N Engl J Med, 2010; 363: 1176-1180.7N Engl J Med, 2010; 363: 1176-118
3、0.8Consequence of asynchrony 机械通气机械通气大于大于7天天气管气管切开率切开率病死率病死率0%20%40%60%80%100%Asynchronyindex10%Asynchronyindex10%*p0.05Thille AW, Intensive Care Med 2006;32:15151522n镇静、肌松剂使用增多n改变自主呼吸形式n机械通气时间延长.9触发延迟延长机械通气时间Asynchrony index：defined as the number of asynchrony events divided by the total RRIntensiv
4、e Care Med 2006; 32:15151522.10分 类 吸气触发： 吸气呼气切换： 吸气潮气量：.11 Auto triggerPossible ReasonspatientCardiogenic oscillatorsVentilatorLower triggeringCircuit leaksWater in circuit.12Ventilator waveformsTrigger asynchronylIneffective effortThille AW, Clinical Pulmonary Medicine 2007;14:350-359.13触发延迟Am J Re
5、spir Crit Care Med 2005; 172: 12831289.14-1cmH2O.15-2cmH2O.16-3cmH2O-3cmH2O.17Double triggernPossible ReasonsPossible ReasonsnpatientpatientnStrong and prolonged inspiratory Strong and prolonged inspiratory efforteffortnVentilatorVentilatorReduce mechanical inflation timeReduce mechanical inflation timeALI patient with ACV.18Flow asynchrony pressure trace is dished outCritical Care Nurse. 2009; 29: 41-55.Intensive Care Med. 2006; 32: 3447.19Cycle-off asynchronyCritical Care Nurse. 2009; 29: 41-55.lpremature terminationldelayed termination.20
