呼吸麻醉教学资料呼吸曲线及环的简要介绍.ppt

¨ ¨波型波型 流速流速- -时间曲线时间曲线 压力压力- -时间曲线时间曲线 容量容量- -时间曲线时间曲线 ¨ ¨图形图形 压力压力- -容量环容量环 流速流速- -容量环容量环 流速流速- -容量环容量环 呼吸曲线及环的简要介绍呼吸曲线及环的简要介绍容量压力环图容量压力环图容量时间图容量时间图容量压力图容量压力图压力时间图压力时间图流速压力环图流速压力环图流速时间图流速时间图流速压力环流速压力环压力时间图压力时间图流速时间图流速时间图流速容量环流速容量环容量时间图容量时间图流速容量环流速容量环流速容量环流速容量环容量压力环容量压力环流速压力环流速压力环顺应性= V/ P阻抗= P/ V.时间常数= V/ V.Inadequate Inadequate InspiratoryInspiratory Flow FlowFlow (L/min)Time (sec)NormalAbnormalActive Inspiration or AsynchronyActive Inspiration or AsynchronyPatient’s effortResponse to BronchodilatorResponse to BronchodilatorBeforeTime (sec)Flow (L/min)PEFRAfterLong TEHigher PEFRShorter TE容量容量- -时间曲线时间曲线InspirationInspirationExpirationTime (sec)Time (sec)Volume (ml)Inspiratory Tidal VolumeT TI IPressure/volume loop-100-1000 0100100200200300300400400500500600600VolVol [ml] [ml]-5-50 05 5101015152020Paw [cmHPaw [cmH2 2O]O]Pressure/volume loopVentilator work of breathing-100-1000 0100100200200300300400400500500600600VolVol [ml] [ml]-5-50 05 5101015152020Paw [cmHPaw [cmH2 2O]O]VentPatient WOBimpFCV - PCVFlow Controlled VentilationPress. Controlled VentilationSet values: PIP+PEEP;increases mean airway pressure,improves gas distribution.VT depends on R, C.inconsistent changes in VT with changes in PIP and PEEP.Low internal resistanceSpontaneous inspiration is not impairedHigh,variable inspiratory flows Cycle time or flow靠监测保正靠监测保正VT(the decelerating flow is thought to improve the distribution of gas flow;when compared to volume control ventilation there is a more rapid improvement in lung compliance and oxygenation)Set values: VT,PEEP. PIP depends on R, CHigh internal resistanceSpontaneous inspiration is impaired due to resistance,volume cycle.Limt inspiratory flowsLess atelectasis compared to pressure controlThe limited flow available may not meet the patient‘s desired inspiratory flow rate.if the patient continues to inspire vigorously .added,unnecessary work is done,this can lead to fatigue. 产生压力伤产生压力伤,容量伤容量伤,adverse hemodynamic effects不同步不同步,人机对抗人机对抗Lung Compliance Changes and the Lung Compliance Changes and the P-V LoopP-V LoopVolume (Volume (mLmL) )Preset PIPVT levelsP Pawaw (cm H (cm H2 2O)O)COMPLIANCEIncreasedNormalDecreasedPressure Targeted VentilationOverdistensionOverdistensionVolume (ml)Pressure (cm HPressure (cm H2 2O)O)With little or no change in VTPaw risesNormalAbnormalAir LeakAir LeakVolume (ml)Pressure (cm HPressure (cm H2 2O)O)Air Leak呼吸功与呼吸功与呼吸功与肺的肺的顺应性顺应性C C A: Resistive Work B: Elastic WorkPressure (cm H2O)Volume (ml)B BA AIncreased RIncreased RawawPressure (cm H2O)Higher PTANormal SlopeNormal SlopeVolVol ( (mLmL) )Lower SlopeLower SlopeAir LeakAir LeakInspirationExpirationVolume (ml)Flow Flow (L/min)(L/min)Air Leak in mLNormalAbnormalAirTrappingAirTrappingInspirationExpirationVolume (ml)Volume (ml)Flow (L/min)Does not returnDoes not returnto baselineto baselineNormalAbnormalIncreased Airway ResistanceIncreased Airway ResistanceInspirationExpirationVolume (ml)Flow (L/min)Decreased PEFRNormalNormalAbnormal“Scooped out” pattern机控和自控的机控和自控的P/V环变化环变化。