麻醉中的呼吸管理(修改版).pptVIP

PEEP调整 Peep=0cmH2O Peep=5cmH2O Peep=8cmH2O 小 结 应重视全身麻醉中发生的肺不张 大潮气量、低呼吸频率或中等潮气量加PEEP是正常成人术中的肺保护性通气策略 电阻抗断层扫描（EIT）技术是必威体育精装版的术中和ICU呼吸监测，有助于早期发现肺不张及各种通气不良状况的存在 感谢聆听，欢迎批评 * * 有关笑气的参考文献 30. GunnarssonL,StrandbergA,BrismarBetal.Atelectasis and gas exchange impairment during enflurane/nitrousoxide anesthesia. Acta AnaesthesiologicaScandinavica 1989; 33: 629e637. 31.JoyceCJWilliamsAB.Kinetics of absorption atelectasis during anesthesia: a mathematical model. Journal of Applied Physiology 1999; 86: 1116e1125. * Fig. 7. Influence ofoxygenconcentrationduringinductionofanesthesiaonatelectasisformation.Blacksymbolsshowindividual patients. 12patientsreceived100%O2 during 3e4 minutesbeforeinduction,theirexpiredO2 (FETO2) beingshown.Another12 patients werepreoxygenatedwith80%O2 and stillanother12patientswith60%O2. Notethevaryingamountofatelectasisandthe considerable dependenceoninspiredoxygenconcentration.Theopensymbol(circle)demonstratesthealmostcompleteabsenceof atelectasis in10patientswhowerepreoxygenatedwithaninspiredoxygenconcentrationof30%.Datafromreferences28,29. With permission bytheeditorofAnesthesiology. * Fig. 8. Upperpanel:Atelectasis() asmeasured1cmabovethediaphragmafterinductionofanesthesiawithandwithoutpre- oxygenation.Resultsarepresentedincm2toenablecomparisonwithdatatakenfrom 29 in whichsubjectswereventilatedwith 30% oxygeninnitrogen.Errorbarsindicatethestandarderrorofthemean.Lowerpanel:Graphicrepresentationofstudyprotocolfor the threegroupsdepictedintheupperpanel.A:inductionofanesthesia.B:trachealintubation.Fromreference 37 with permission by theeditorofAnaesthesia(stillwaitingforpermission). * Fig. 1. Axial view of the right hemi-thorax.Trans-pulmonary pressure(Ptp) is the difference between airway pressure (Paw) and pleural pressure(Ppl). In mechanical ventilation, the Paw is positive and homogeneously distributed within lungs while the Ppl shows avertical gradient of pressure following the gravity vector. This results in higher Ptp in the ventral zone sand lowe