呼吸机比例压力支持模式简介

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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>比例压力支持</p></section></section></section> </section> </section></section></section><section powered-by="gulangu"><section><section><p>&nbsp; &nbsp; &nbsp; &nbsp;目前的通气模式均不能矫正患者呼吸努力和通气效果之间的生理变化关系，容易产生人机对抗和通气支持不足或支持过度等。</p><p><br  /></p><p>&nbsp; &nbsp; &nbsp; &nbsp;比例压力支持（proportional pressure support，PPS）是一种同步辅助的通气模式。呼吸机按照患者吸气努力的大小成比例地提供压力支持。病人能舒适获得由自己支配地呼吸形式和通气水平。呼吸机补偿病理性阻力增加（流量辅助）和补偿肺顺应性降低（容量辅助）作造成的额外呼吸功的增加。PPS 可被看作为ASB基础上的革命性飞跃。</p><p><br  /></p></section></section></section><section powered-by="gulangu"><section><section> <section> <section powered-by="gulangu"><section><section><p>通气原理</p></section></section></section> </section> </section></section></section><section powered-by="gulangu"><section><section><p>&nbsp; &nbsp; &nbsp; &nbspPS需直接设定PAW、肺泡通气量和呼吸频率，而是设定潮气量辅助（VA）（cmH2O/L）、流速辅助（FA）(cmH2O/L/S)和辅助比例K1及K2（％），其中VA用于克服弹性阻力，FA用于克服气道阻力。应用PPS时，患者吸气肌收缩产生Pmus，触发呼吸机送气的同时，PPS系统的流量传感器感知患者吸气瞬间产生的FLOW 和VOLUME，通过快速反馈以设定的辅助比例产生PAW支持通气。可以下列公式来表示：Pmus＋Paw＝Res × flow + Ers × Volume.</p><p><br  /></p><p>&nbsp; &nbsp; &nbsp; &nbspPS辅助通气时吸气的每一瞬间，Paw随Pmus的增强而升高，实质为呼吸机的吸气力量按照设定比例增强。患者控制每一个呼吸周期的呼吸形式，Pmus决定呼吸机送气的开始、维持和终止，自主呼吸和呼吸机送气时相能保持良好的同步性，患者可根据自身的不同通气需要相应调节呼吸形式。</p><p><br  /></p><p>&nbsp; &nbsp; &nbsp; &nbsp;应用条件：呼吸中枢功能正常；吸气位于肺压力－容积曲线的陡直段。</p><p><br  /></p></section></section></section><section powered-by="gulangu"><section><section> <section> <section powered-by="gulangu"><section><section><p>设定原则和方法</p></section></section></section> </section> </section></section></section><section powered-by="gulangu"><section><section><p>&nbsp; &nbsp; &nbsp; &nbsp;同时设定VA与FA；辅助比例以80％一下的辅助比例最为安全；根据患者需要和病情变化适当调整辅助比例。</p><p><br  /></p><p>&nbsp; &nbsp; &nbsp; &nbsp;特点：保持患者对呼吸模式的控制，减少人机对抗；降低气道峰压；防止通气支持不足或肺泡过度膨胀。</p><p><br  /></p><p>&nbsp; &nbsp; &nbsp; &nbsp;探讨更合理的Res和Ers测定方法，观察PPS长时间应用的通气效果、VA和FA更科学组合以及PPS对血流动力学和氧输送等的影响是决定PPS应用发展的关键问题。</p><p><br  /></p></section></section></section><section powered-by="gulangu"><section><section><p><img src="image/20201019/36958b8518a210a63f643f4330d2ba03_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/20201019/2f1ee447a0bd3ba1c18834c16fce7782_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>