呼吸机双相气道正压方式简介

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                    <section><section powered-by="gulangu"><section><section><p><img src="image/20201019/ce07f54105753da3898fe599c12d73f8_1.gif" /></p></section></section></section><section powered-by="gulangu"><section><section><p><br  /></p></section></section></section><section powered-by="gulangu"><section><section> <section> <section powered-by="gulangu"><section><section><p>双相气道正压通气</p></section></section></section> </section> </section></section></section><section powered-by="gulangu"><section><section><p>&nbsp; &nbsp; &nbsp; &nbsp;双相气道正压通气(biphasic intermittent positive airway pressure，BIPAP)&nbsp;&nbsp;是最近提出的另一种新型通气模式，是压力控制通气和自主呼吸默契结合的产物。可定义为自主呼吸与时间转换、双相气道压力控制的混合通气模式。</p><p>&nbsp; &nbsp; &nbsp; &nbsp;其特点是在呼吸周期中的任何时间患者均可自主呼吸，无论是在低或高的压力时相。为方便起见，可将BIPAP看成是两个不同CPAP水平的自主呼吸过程。在两种压力水平上（Phigh=P1，Plow=P2），患者均可自主呼吸。在Plow和Phigh之间，压力差的变化（△P）引起气流量变化。潮气量取决于△P及顺应性（C）和阻力（R）的变化。</p><p>&nbsp; &nbsp; &nbsp; &nbsp;在BIPAP通气过程中，除了吸入氧浓度外，有四个变量可调节。包括Phigh、Plow，以及压力间期Thigh（=TI）和f（呼吸频率）。</p><p>BIPAP除可自主呼吸外，还具有完成相同潮气量时气道压小及不需镇静剂和肌松剂等特点。可提供从单纯机械通气到完全自主呼吸的大范围的呼吸支持，覆盖从气管插管到停机的全过程。</p><p>&nbsp; &nbsp; &nbsp; &nbsp;与传统的机械通气相反，在BIPAP模式中，无论是控制通气还是自主呼吸，均不孤立，而是相互融合，并可根据机械通气比重的差别分为下面几种形式：</p><p><br  /></p></section></section></section><section powered-by="gulangu"><section><section> <section> <section powered-by="gulangu"><section><section><p>间歇正压通气－BIPAP（IPPV－BIPAP）</p></section></section></section> </section> </section></section></section><section powered-by="gulangu"><section><section><p>&nbsp; &nbsp; &nbsp; &nbsp;属压力和时间控制型，类似于间歇正压通气。患者无自主呼吸，由呼吸机承担全部呼吸工作。通过变化高低压力水平以压力－控制和时间驱动方式产生通气量。</p><p><br  /></p></section></section></section><section powered-by="gulangu"><section><section> <section> <section powered-by="gulangu"><section><section><p>SIMV－BIPAP</p></section></section></section> </section> </section></section></section><section powered-by="gulangu"><section><section><p>&nbsp; &nbsp; &nbsp; &nbsp;机械呼吸支持类似于压力通气SIMV ，但是在高压时也允许自主呼吸。SIMV－BIPAP可用于停机时，可提供自主呼吸。压力变化的频率由IMV频率决定。吸气时间，即高压水平的间期可通过频率f和TI：TE比值来调整。</p><p><br  /></p></section></section></section><section powered-by="gulangu"><section><section> <section> <section powered-by="gulangu"><section><section><p>"真正"BIPAP</p></section></section></section> </section> </section></section></section><section powered-by="gulangu"><section><section><p>&nbsp; &nbsp; &nbsp; &nbsp;在低、高压水平上，患者均可进行自主呼吸，且自主呼吸不受机械通气的影响，而是叠加在2个机械压力水平上。</p><p><br  /></p></section></section></section><section powered-by="gulangu"><section><section> <section> <section powered-by="gulangu"><section><section><p>气道压力释放通气－BIPAP</p><p><span>（APRV－BIPAP）</span></p></section></section></section> </section> </section></section></section><section powered-by="gulangu"><section><section><p>&nbsp; &nbsp; &nbsp; &nbsp;APRV时, 通气不是靠间歇向肺内充气来达到的，而是靠短的周期性压力释放。呼气是通过短时间压力释放完成的，在此期间排除CO2然后回到原CPAP水平，供给机械吸气。因为非常短的压力释放时相，慢肺“功能室”内可建立内源性PEEP（时间常数增加）它可防止呼气末小气道陷闭，结果增加PRC改善通气/血流比并改善氧合。</p></section></section></section><section powered-by="gulangu"><section><section><p><img src="image/20201019/d47241ea2c6ea735f5d332d8617f6360_2.jpg" /></p></section></section></section><section powered-by="gulangu"><section><section><p><br  /></p></section></section></section><section powered-by="gulangu"><section><section> <section powered-by="gulangu"><section><section><p>欢</p></section></section></section> </section><section> <section powered-by="gulangu"><section><section><p>迎</p></section></section></section> </section><section> <section powered-by="gulangu"><section><section><p>关</p></section></section></section> </section><section> <section powered-by="gulangu"><section><section><p>注</p></section></section></section> </section></section></section><section powered-by="gulangu"><section><section><p><br  /></p></section></section></section><section powered-by="gulangu"><section><section> <section powered-by="gulangu"><section><section><p><img src="image/20201019/7e543c3ea063bbf298f995daa775c0af_3.jpg" /></p></section></section></section> </section><section> <section powered-by="gulangu"><section><section> </section></section></section> </section><section> <section powered-by="gulangu"><section><section><p>关注我们</p><p>一起涨姿势！</p></section></section></section> </section></section></section></section>