呼吸机的通气模式简介

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                    <section><section powered-by="gulangu"><section><section><p><img src="image/20201019/810b92a1b8f139d2e78b7624294081ea_1.gif" /></p></section></section></section><section powered-by="gulangu"><section><section><p>通气模式的分类</p></section><p><img src="image/20201019/e44944e753f4959f8a1a8e66a2226148_2.png" /></p> <section></section></section></section><section powered-by="gulangu"><section><section><p>&nbsp; &nbsp; &nbsp; &nbsp; 完全通气支持（full ventilatory support,FVS）,不需要进行自主呼吸以吸入气体及排出CO2。<br  /></p><p>&nbsp; &nbsp; &nbsp; &nbsp; 部分通气支持（partial ventilatory support,PVS）VS要求患者有自主呼吸，因呼吸机只提供所需要通气量的一部分。</p></section></section></section><section powered-by="gulangu"><section><section><p>控制通气</p></section><p><img src="image/20201019/e44944e753f4959f8a1a8e66a2226148_2.png" /></p> <section></section></section></section><section powered-by="gulangu"><section><section><p>&nbsp; &nbsp; &nbsp; &nbsp; &nbsp;（controlled mode ventilation,CMV）又称指令通气，呼吸机以预设频率定时触发，并输送预设潮气量。即呼吸机完成代替患者的自主呼吸。</p></section></section></section><section powered-by="gulangu"><section><section><p><img src="image/20201019/7bc166cc18fcfa5df972e50f496816c5_4.jpg" /></p></section></section></section><section powered-by="gulangu"><section><section><p>&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; 无吸气触发，压力上升前无反向波出现，各波形形态（包括压力上升坡度，峰压，下降坡度以及吸气时间）一致，表明为时间指令性通气。</p></section></section></section><section powered-by="gulangu"><section><section><p>Assisted Ventilation</p></section><p><img src="image/20201019/e44944e753f4959f8a1a8e66a2226148_2.png" /></p> <section></section></section></section><section powered-by="gulangu"><section><section><p>&nbsp; &nbsp; &nbsp; &nbsp; AV是患者吸气用力时依靠气道压得降低（压力触发）或流量的改变（流量触发）来触发，触发后呼吸机即按预设潮气量（或吸气压力）、频率、吸气和呼气时间将气体传送给患者。</p><p>&nbsp; &nbsp; &nbsp; &nbsp; 应用的关键是预设触发灵敏度和潮气量要恰到。</p></section></section></section><section powered-by="gulangu"><section><section><p>辅助-控制通气</p></section><p><img src="image/20201019/e44944e753f4959f8a1a8e66a2226148_2.png" /></p> <section></section></section></section><section powered-by="gulangu"><section><section><p>&nbsp; &nbsp; &nbsp; &nbsp; &nbsp;（Assist-control Ventilation,A-CV）是结合AV和CV的特点，通气靠患者触发，并以CV的预设频率作为备用。</p></section></section></section><section powered-by="gulangu"><section><section><p><img src="image/20201019/7969fe1da3cea6a7f8d853650790f3d1_7.jpg" /></p></section></section></section><section powered-by="gulangu"><section><section><p>&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; 在每次压力-时间曲线上升前均出现负向拐弯波，说明每次机械通气均由患者吸气用力触发。出现的负向拐弯波大小反映了患者触发用功的大小。</p></section></section></section><section powered-by="gulangu"><section><section><p>间歇指令通气</p></section><p><img src="image/20201019/e44944e753f4959f8a1a8e66a2226148_2.png" /></p> <section></section></section></section><section powered-by="gulangu"><section><section><p>&nbsp; &nbsp; &nbsp; &nbsp; &nbsp;(intermittent mandatory ventilation,IMV)是呼吸机以预定的频率输送固定的潮气量（或压力），在两次指令通气间歇期，允许患者自主呼吸。</p><p>&nbsp; &nbsp; &nbsp; &nbsp; &nbsp;大多数呼吸机的IMV模式，指令通气以容量切换方式来实施，已有少数呼吸机以压力切换方式来实行指令通气。</p></section></section></section><section powered-by="gulangu"><section><section><p><img src="image/20201019/f813cc510e87420b00b62e06b7985305_9.jpg" /></p></section></section></section><section powered-by="gulangu"><section><section><p>&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; 指令通气的输送不管患者的吸气用力情况，故在指令通气压力上升前常无负向拐弯波，两次指令通气间可见低幅波动的自主呼吸波形，负压表示吸气，正压代表呼气。</p></section></section></section><section powered-by="gulangu"><section><section><p>同步间歇指令通气</p></section><p><img src="image/20201019/e44944e753f4959f8a1a8e66a2226148_2.png" /></p> <section></section></section></section><section powered-by="gulangu"><section><section><p>&nbsp; &nbsp; &nbsp; &nbsp; &nbsp;（syncronic intermittent mandatory ventilation,SIMV）就是进行IMV时，让指令通气的输送与患者的吸气用力同步。</p></section></section></section><section powered-by="gulangu"><section><section><p><img src="image/20201019/3c8ead446be7eee90cec47aa1375cfdf_11.jpg" /></p></section></section></section><section powered-by="gulangu"><section><section><p>压力支持通气</p></section><p><img src="image/20201019/e44944e753f4959f8a1a8e66a2226148_2.png" /></p> <section></section></section></section><section powered-by="gulangu"><section><section><p>&nbsp; &nbsp; &nbsp; &nbsp; PSV是患者吸气触发后，呼吸机提供一恒定的气道正压以克服吸气阻力和扩张肺脏。<br  /></p><p>&nbsp; &nbsp; &nbsp; &nbsp; 提供的气流方式可与患者的吸气流速需要相协调，可根据患者的病理生理及自主呼吸能力改变调整PS水平，提供恰到的呼吸辅助功。</p></section></section></section><section powered-by="gulangu"><section><section><p><img src="image/20201019/67ca95299a5790031c42ca97d86ea3f6_13.jpg" /></p></section></section></section><section powered-by="gulangu"><section><section><p>&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; 每次通气有患者触发，触发后呼吸机马上输送预定的正压，通气频率由患者自己决定，潮气量取决于压力支持水平和患者的吸气用力。图中可知每次通气前触发波，触发后压力迅速升至平台并维持一定时间的平台压以后，成指数减至基线。</p></section></section></section><section powered-by="gulangu"><section><section><p>持续气道正压/呼气末正压</p></section><p><img src="image/20201019/e44944e753f4959f8a1a8e66a2226148_2.png" /></p> <section></section></section></section><section powered-by="gulangu"><section><section><p>&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; （CPAP）/（PEEP）就是在自主呼吸条件下，维持整个呼吸周期均气道正压。</p></section></section></section><section powered-by="gulangu"><section><section><p><img src="image/20201019/a273fd21a6fe5b51c7c0a17e11060c10_15.jpg" /></p></section></section></section><section powered-by="gulangu"><section><section><p>&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; 图中的低幅波动为自主呼吸波形。向上的压力代表呼气。所有呼吸周期均在正压范围内。</p></section></section></section><section powered-by="gulangu"><section><section><p>容量控制通气</p></section><p><img src="image/20201019/e44944e753f4959f8a1a8e66a2226148_2.png" /></p> <section></section></section></section><section powered-by="gulangu"><section><section><p>&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; VCV可以保证患者得到足够的气体。呼吸按预设频率、潮气量、吸呼比、为患者送气。患者的呼吸用力完全被抑制。</p></section></section></section><section powered-by="gulangu"><section><section><p><img src="image/20201019/b7af4710ac5969f4983728b7716af6c3_17.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/20201019/6e6a10282436d73b4b65ae2f9d097a9a_18.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>