1、A Free sample background from Slide 1A Free sample background from Slide 2生命之吻！A Free sample background from Slide 3机械通气的目的机械通气的目的建立人工气道建立人工气道促进肺泡复张促进肺泡复张促进二氧化碳排出促进二氧化碳排出纠正呼吸衰竭纠正呼吸衰竭保持有效氧合保持有效氧合目前广泛应用于临床一线呼吸医学、重症监护、急诊医学、目前广泛应用于临床一线呼吸医学、重症监护、急诊医学、外科术后、睡眠呼吸障碍等诸多领域，机械通气应用适当与外科术后、睡眠呼吸障碍等诸多领域，机械通气应用适当与否，
2、直接关系到患者的生死存亡否，直接关系到患者的生死存亡应用得当会起到立竿见影的效果应用得当会起到立竿见影的效果A Free sample background from Slide 4A Free sample background from Slide 5A Free sample background from Slide 6A Free sample background from Slide 7A Free sample background from Slide 8定压通气定容通气完全控制压力控制通气(PCV)容量控制通气(VCV)间歇指令通气(SIMV + PSV)完全支持压力支持通
3、气(PSV)A Free sample background from Slide 9指令通气指令通气同步指令通气同步指令通气有支持的自主呼吸有支持的自主呼吸完全自主呼吸完全自主呼吸患者的呼吸功患者的呼吸功呼吸机的呼吸功呼吸机的呼吸功A Free sample background from Slide 10完全休息完全休息大量体力消耗大量体力消耗模式的选择模式的选择 = 仅仅是医生的选择仅仅是医生的选择A Free sample background from Slide 11A Free sample background from Slide 12A Free sample backgr
4、ound from Slide 13A Free sample background from Slide 14A Free sample background from Slide 15A Free sample background from Slide 16A. PIP, B. Pplat, C. End-expiratory pressurePawPResistance P = Resistance P = ComplianceAB0Time (sec)C吸气开始呼气开始吸气暂停PIP -PplatPplat-PEEPA Free sample background from Slid
5、e 17A Free sample background from Slide 18A Free sample background from Slide 19A Free sample background from Slide 20A Free sample background from Slide 21A Free sample background from Slide 22A Free sample background from Slide 23A Free sample background from Slide 24A Free sample background from
6、Slide 25A Free sample background from Slide 26A Free sample background from Slide 27A Free sample background from Slide 28A Free sample background from Slide 29A Free sample background from Slide 30A Free sample background from Slide 31A Free sample background from Slide 32Consolidation and alv coll
7、apseA Free sample background from Slide 33A .低氧血症低氧血症肺泡塌陷：肺泡塌陷：ARDS重力依赖区重力依赖区 炎症或不张区炎症或不张区生理性低氧缩血管反应：障碍生理性低氧缩血管反应：障碍A Free sample background from Slide 34How Does Excessive Mechanical Stress Inflame the Lung?“Shear”A Free sample background from Slide 35Verbrugge et al. Crit Care Med 1999;27：779Purin
8、e: a marker of ATP breakdown and VILI42 SD ratsPCV 6minPCV Pre/PEEPBALF purine and proteinA Free sample background from Slide 36Rouby JJ. Am J Respir Crit Care Med, 2001, 165: 1182 A Free sample background from Slide 37Marini JJ, Gattinoni L. Ventilatory management of acute respiratory distress synd
9、rome: a consensus of two Crit Care Med. 2004 Jan;32(1):250-5.“Stretch”“Shear”Airway TraumaA Free sample background from Slide 38A Free sample background from Slide 39A Free sample background from Slide 40A Free sample background from Slide 41A Free sample background from Slide 42A Free sample backgr
10、ound from Slide 43A Free sample background from Slide 44A Free sample background from Slide 451. RM后后 PEEP: 20cmH2O2. PEEP递减递减: 2cmH2O/5min3. PEEP阈值阈值: PaO2/FiO25%4. PEEP: PEEP阈值阈值 +2cmH2OA Free sample background from Slide 46A Free sample background from Slide 47A Free sample background from Slide 48
