波形图解薛剖析.ppt

 新生儿常频机械通气 中国医科大学第二临床学院 儿科 薛辛东 肺功能波型及图形监测 肺功能图形监测的意义 压力-时间曲线 患者触发 流速过低 流速-时间曲线 吸气时间 Short Normal Long  气体潴留 容量-时间曲线 漏 气 肺过度膨胀 流速-容量环  支气管扩张剂的疗效 * * 波型 流速-时间曲线 压力-时间曲线 容量-时间曲线 图形 压力-容量环 流速-容量环 监测机械通气的参数是否合适 动态了解患儿肺功能的状态 观察患儿自主呼吸动的程度 评价某些药物的治疗效果 1 2 3 4 5 6 20 Sec Paw cmH2O Pressure Ventilation Expiration Volume Ventilation 1 2 3 4 5 6 30 Sec Paw cmH2O -10 30 Time (s) -10 1 2 aw P cmH2O Adequate flow Flow set too low 3 1 2 3 4 5 6 SEC 120 120 EXH INSP V . LPM Inspiration Expiration 适宜的吸气时间 500 cc 450 cc Lost VT 1 2 3 4 5 6 SEC 1 2 3 4 5 6 VT 600 cc 120 120 SEC . VLPM 0 非调定PEEP The transition from expiratory to inspiratory occurs without the expiratory flow returning to zero 1 2 3 4 5 6 SEC 120 120 V . LPM 1 2 3 4 5 6 SEC 1.2 -0.4 VT Liters I-Time E-Time A B A = inspiratory volume B = expiratory volume 1 2 3 4 5 6 SEC 1.2 -0.4 VT Liters A A = exhalation that does not return to zero 压力-容量环 Expiration 0 20 40 60 20 40 -60 0.2 LITERS 0.4 0.6 Paw cmH2O Inspiration VT Counterclockwise 肺过度膨胀 B A 0 20 40 60 -20 -40 -60 0.2 0.4 0.6 LITERS Paw cmH2O C A = inspiratory pressure B = upper inflection point C = lower inflection point VT Flow Volume Inspiration Expiration VT INSP EXH BEFORE AFTER 2 1 1 2 3 3 V LPS . 2 1 1 2 3 3 V LPS . ？ * * * Pictured in blue here is potentially lost VT. Increasing inspiratory time to allow the flow to return to baseline may increase VT without increasing PIP. On the other hand, if the transition from exhalation to inspiration occurs without the expiratory flow returning to zero, you have Auto-PEEP present. Air Trapping Flow graphic most helpful End Expiration and End Expiratory Flow Rate keys to identifying air trapping End Expiratory Flow does NOT return to baseline To correct for air trapping increase expiratory time (Increase total cycle time, Decrease inspirator