呼吸机操作:从零开始

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                    <p><img data-type="gif" src="http://mmbiz.qpic.cn/mmbiz_gif/dx3KibwtDhvc6YBndBzrYvfAVPCGNAlsqB9f7SjRnXkibcO3P2CSjz7TnOO8RAArOGOjobic1D5DCTCzzAoxv9jfw/0?wx_fmt=gif" data-ratio="0.1703125" data-w="640"  /></p><p style="max-width: 100%; min-height: 1em; box-sizing: border-box !important; word-wrap: break-word !important;">呼吸机的使用对你我并不陌生，可是对于刚刚到急诊科摆弄呼吸机的菜鸟来说，那个频频报警的家伙并不那么友善，有时会突然给我们来个下马威，有时候作为ICU老鸟的你遇到某个头痛的报警，回过头来从呼吸机的工作原理上也许会找到答案，不是吗？<br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  />呼吸机的工作原理<br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  /><br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  />　　（一）呼吸机的切换方式<br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  /><br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  />　　1、压力切换--定压型呼吸机<br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  /><br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  />　　2、容量切换--定容型呼吸机<br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  /><br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  />　　3、时间切换<br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  /><br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  />　　4、流速切换<br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  /><br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  />　　5、两种以上切换方式的结合<br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  /><br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  />　　（容量+压力切换）<br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  /><br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  />　　（二）常用的机械通气模式<br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  /><br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  />　　1、控制通气<br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  /><br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  />　　特点：<br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  /><br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  />　　无论患者自主呼吸如何，呼吸机总是按预先设置的频率，潮气量（压力），进行规律的通气，适用于自主呼吸消失或很微弱的患者，应用于自主呼吸较强患者，则很难达到自主呼吸的协调。<br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  /><br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  />　　间歇指令通气（IMV）<br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  /><br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  />　　2、辅助通气<br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  /><br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  />　　它与控制通气不同的是，机械通气的启动由患者自发吸气来触发。因而通气频率决定于患者的自主呼吸，潮气量则决定于预先设置的容积（或压力）的大小。对于自主呼吸频率稳定的患者，应尽量采用辅助通气而避免采用控制通气模式。<br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  /><br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  />　　同步间歇指令通气（SIMV）<br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  /><br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  />　　压力支持通气（PSV）<br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  /><br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  />　　3、辅助/控制通气<br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  /><br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  />　　是一种较先进的通气模式。它与单纯辅助通气不同的是，当自主呼吸频率过慢时，每分通气量小于设定量时，呼吸机本身可检知，并自动的控制通气方式来补充，以防止通气不足的发生。<br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  /><br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  />　　4、间歇指令通气（IMV）<br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  /><br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  />　　同步间歇指令通气（SIMV）<br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  /><br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  />　　二者的共同特点是，在单位时间内既有机械通气，又有自主呼吸。IMV是控制通气与自主呼吸的结合，SIMV是辅助通气与自主呼吸的结合，当设定的呼吸频率&gt;16次/分时，可达到辅助/制通气的效果。<br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  /><br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  />　　优点：<br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  /><br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  />　　①不需要大量的镇静剂<br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  /><br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  />　　②可减少因通气过度而发生碱中毒的机会<br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  /><br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  />　　③长期通气治疗可防止呼吸机萎缩的发生，有利于脱离机械通气<br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  /><br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  />　　④降低平均气道压，减少机械通气对循环系统的不良影响。<br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  /><br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  />　　缺点：<br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  /><br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  />　　①对患者增加通气的要求反应不良，不适当应用会导致呼吸机疲劳<br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  /><br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  />　　②增加患者呼吸机消耗，不适当应用会导致呼吸机疲劳<br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  /><br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  />　　5、压力支持通气（PSV）<br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  /><br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  />　　该通气模式比其他辅助通气模式更接近生理状态。患者每次自发吸气，都自动接受预先设置的一定的压力支持。<br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  /><br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  />　　6、SIMV加PSV<br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  /><br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  />　　二种模式叠加在一起，使SIMV中的自主呼吸变成了PSV方式，从而避免呼吸机疲劳的发生。<br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  /><br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  />　　7、双气道正压通气（BiPAP）<br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  /><br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  />呼吸机的连接<br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  /><br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  />　　1、无创通气连接<br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  /><br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  />　　①口鼻罩<br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  /><br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  />　　②鼻罩<br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  /><br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  />　　注意面罩的密闭<br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  /><br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  />　　2、有创通气连接<br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  /><br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  />　　①气管插管<br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  /><br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  />　　②气管切开插管<br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  /><br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  />　　注意气囊充气<br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  /><br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  />机械通气的适应证选择<br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  /><br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  />　　益处：<br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  /><br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  />　　①维持适当的通气<br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  /><br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  />　　②在一定程度上改善交换功能<br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  /><br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  />　　③减少呼吸功的消耗<br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  /><br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  />　　1、神经肌肉疾患引起的呼吸衰竭<br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  /><br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  />　　2、因镇静剂、中毒导致了呼吸衰竭<br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  /><br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  />　　3、心肌梗死或充血性心力衰竭合并呼衰<br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  /><br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  />　　4、ARDS或其他原因肺水肿及肺炎，支气管哮喘引起的呼吸衰竭<br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  /><br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  />　　5、COPD患者慢性呼吸衰竭急性恶化<br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  /><br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  />　　6、用于预防目的的机械通气治疗<br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  /><br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  />　　对于轻、中度，神志清醒，呼吸频率&lt;35次/分，能配合面罩通气者，给予无创通气。<br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  /><br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  />　　对中、重度，神志不清，呼吸频率&gt;35次/分，张口呼吸，不能配合面罩通气者，给予有创通气，先行气管插管，必要时气管切开插管。</p><p><br  /></p><p style="max-width: 100%; min-height: 1em; color: rgb(62, 62, 62); font-size: 16px; white-space: normal; line-height: 25.6px; box-sizing: border-box !important; word-wrap: break-word !important; background-color: rgb(255, 255, 255);"><span style="max-width: 100%; font-size: 14px; text-indent: 0em; font-family: Arial, Verdana, sans-serif; line-height: 1.75em; box-sizing: border-box !important; word-wrap: break-word !important;">地址：广州市天河区银利街银利茶叶博览中心E栋4楼E4030室 &nbsp;&nbsp;</span><span style="max-width: 100%; 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font-size: 14px; font-family: Arial, Verdana, sans-serif; box-sizing: border-box !important; word-wrap: break-word !important;">微信公众帐号：</span></p><p><img data-s="300,640" data-type="jpeg" src="http://mmbiz.qpic.cn/mmbiz_jpg/dx3KibwtDhvfh2wVX4NftfnfjcZWIKK6EQDWtTTsYwjfQBnsqkThAZP5OlDmg5S3g22gSqMWhAxr2O4MydSJHnQ/0?wx_fmt=jpeg"  /></p><p style="max-width: 100%; min-height: 1em; color: rgb(62, 62, 62); font-size: 12px; text-indent: 0em; white-space: normal; font-family: Arial, Verdana, sans-serif; line-height: 1.75em; box-sizing: border-box !important; word-wrap: break-word !important; background-color: rgb(255, 255, 255);"><span style="max-width: 100%; font-size: 14px; box-sizing: border-box !important; word-wrap: break-word !important;">维修咨询：QQ: &nbsp;712638 404</span><br style="max-width: 100%; box-sizing: border-box !important; word-wrap: break-word !important;"  /></p><p style="max-width: 100%; min-height: 1em; color: rgb(62, 62, 62); font-size: 12px; text-indent: 0em; white-space: normal; 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text-indent: 0em; white-space: normal; font-family: Arial, Verdana, sans-serif; line-height: 1.75em; box-sizing: border-box !important; word-wrap: break-word !important; background-color: rgb(255, 255, 255);"><span style="max-width: 100%; font-size: 14px; box-sizing: border-box !important; word-wrap: break-word !important;">配件咨询：QQ: &nbsp; 712638 407</span></p><p style="max-width: 100%; min-height: 1em; color: rgb(62, 62, 62); font-size: 12px; text-indent: 0em; white-space: normal; font-family: Arial, Verdana, sans-serif; line-height: 1.75em; box-sizing: border-box !important; word-wrap: break-word !important; background-color: rgb(255, 255, 255);"><span style="max-width: 100%; font-size: 14px; box-sizing: border-box !important; word-wrap: break-word !important;">交流Q群：1106 11074</span></p><p style="max-width: 100%; min-height: 1em; color: rgb(62, 62, 62); font-size: 12px; text-indent: 0em; white-space: normal; font-family: Arial, Verdana, sans-serif; line-height: 1.75em; box-sizing: border-box !important; word-wrap: break-word !important; background-color: rgb(255, 255, 255);"><span style="max-width: 100%; font-size: 14px; box-sizing: border-box !important; word-wrap: break-word !important;">网址：http://www.yiliaoshebeiweixiu.com</span></p><p style="max-width: 100%; min-height: 1em; color: rgb(62, 62, 62); font-size: 12px; text-indent: 0em; white-space: normal; font-family: Arial, Verdana, sans-serif; line-height: 1.75em; box-sizing: border-box !important; word-wrap: break-word !important; background-color: rgb(255, 255, 255);"><span style="max-width: 100%; font-size: 14px; box-sizing: border-box !important; word-wrap: break-word !important;">电子邮箱：service@yiliaoshebeiweixiu.com</span></p><p><br  /></p>