中华危重病急救医学
中華危重病急救醫學
중화위중병급구의학
Chinese Critical Care Medicine
2014年
12期
875-878
,共4页
机械通气%容量控制通气%肺类型%气体类型%泄漏%潮气量
機械通氣%容量控製通氣%肺類型%氣體類型%洩漏%潮氣量
궤계통기%용량공제통기%폐류형%기체류형%설루%조기량
Mechanical ventilation%Volume-controlled ventilation%Lung model%Air type%Leakage%Tidal volume
目的:研究容量控制通气中,如何保证进入患者肺内的有效潮气量接近医生的设置值。方法呼吸机通气模式选择容量控制通气模式。模拟肺选择主动模肺ASL 5000或密歇根模拟肺1601,气阻、气容和肺类型等参数在模拟肺中设置。潮气量数值从呼吸机测试仪PF 300上读取。在同一潮气量设置情况下,改变模拟肺类型、管路顺应性、泄漏状态、气体类型等设置,测量E5、Servo i、Evital 4、Evital XL呼吸机中的潮气量,对结果进行分析、比较。结果在呼吸机潮气量设置值不变的情况下,不同肺类型、呼吸机泄漏、呼吸机管路顺应性和气体类型的设置都会对实际进入患者体内的潮气量带来很大的影响。患者肺顺应性的降低和阻力的增加将引起较高的气道峰压,从而使得在管路中损失的潮气量增加,进入患者肺内的有效潮气量减少。当回路存在泄漏而呼吸机又不能够提供泄漏补偿功能时,进入患者肺内的有效潮气量也会效减少。当呼吸机的气体类型设置和患者吸入气体类型不一致时,也可能使进入患者体内的有效潮气量和呼吸机的设置值存在很大差别。结论如希望进入患者肺内的有效潮气量接近医生的设置值,至少应对管路顺应性、泄漏状态、气体类型等可控因素进行精确控制和有效补偿。
目的:研究容量控製通氣中,如何保證進入患者肺內的有效潮氣量接近醫生的設置值。方法呼吸機通氣模式選擇容量控製通氣模式。模擬肺選擇主動模肺ASL 5000或密歇根模擬肺1601,氣阻、氣容和肺類型等參數在模擬肺中設置。潮氣量數值從呼吸機測試儀PF 300上讀取。在同一潮氣量設置情況下,改變模擬肺類型、管路順應性、洩漏狀態、氣體類型等設置,測量E5、Servo i、Evital 4、Evital XL呼吸機中的潮氣量,對結果進行分析、比較。結果在呼吸機潮氣量設置值不變的情況下,不同肺類型、呼吸機洩漏、呼吸機管路順應性和氣體類型的設置都會對實際進入患者體內的潮氣量帶來很大的影響。患者肺順應性的降低和阻力的增加將引起較高的氣道峰壓,從而使得在管路中損失的潮氣量增加,進入患者肺內的有效潮氣量減少。噹迴路存在洩漏而呼吸機又不能夠提供洩漏補償功能時,進入患者肺內的有效潮氣量也會效減少。噹呼吸機的氣體類型設置和患者吸入氣體類型不一緻時,也可能使進入患者體內的有效潮氣量和呼吸機的設置值存在很大差彆。結論如希望進入患者肺內的有效潮氣量接近醫生的設置值,至少應對管路順應性、洩漏狀態、氣體類型等可控因素進行精確控製和有效補償。
목적:연구용량공제통기중,여하보증진입환자폐내적유효조기량접근의생적설치치。방법호흡궤통기모식선택용량공제통기모식。모의폐선택주동모폐ASL 5000혹밀헐근모의폐1601,기조、기용화폐류형등삼수재모의폐중설치。조기량수치종호흡궤측시의PF 300상독취。재동일조기량설치정황하,개변모의폐류형、관로순응성、설루상태、기체류형등설치,측량E5、Servo i、Evital 4、Evital XL호흡궤중적조기량,대결과진행분석、비교。결과재호흡궤조기량설치치불변적정황하,불동폐류형、호흡궤설루、호흡궤관로순응성화기체류형적설치도회대실제진입환자체내적조기량대래흔대적영향。환자폐순응성적강저화조력적증가장인기교고적기도봉압,종이사득재관로중손실적조기량증가,진입환자폐내적유효조기량감소。당회로존재설루이호흡궤우불능구제공설루보상공능시,진입환자폐내적유효조기량야회효감소。당호흡궤적기체류형설치화환자흡입기체류형불일치시,야가능사진입환자체내적유효조기량화호흡궤적설치치존재흔대차별。결론여희망진입환자폐내적유효조기량접근의생적설치치,지소응대관로순응성、설루상태、기체류형등가공인소진행정학공제화유효보상。
Objective To study the ways which ensure the delivery of enough tidal volume to patients under various conditions close to the demand of the physician. Methods The volume control ventilation model was chosen,and the simulation lung type was active servo lung ASL 5000 or Michigan lung 1601. The air resistance,air compliance and lung type in simulation lungs were set. The tidal volume was obtained from flow analyzer PF 300. At the same tidal volume,the displaying values of tidal volume of E5,Servo i,Evital 4,and Evital XL ventilators with different lung types of patient,compliance of gas piping,leakage,gas types,etc. were evaluated. Results With the same setting tidal volume of a same ventilator,the tidal volume delivered to patients was different with different lung types of patient,compliance of gas piping,leakage,gas types,etc. Reducing compliance and increasing resistance of the patient lungs caused high peak airway pressure,the tidal volume was lost in gas piping,and the tidal volume be delivered to the patient lungs was decreased. If the ventilator did not compensate to leakage,the tidal volume delivered to the patient lungs was decreased. When the setting gas type of ventilator did not coincide with that applying to the patient,the tidal volume be delivered to the patient lungs might be different with the setting tidal volume of ventilator. Conclusion To ensure the delivery of enough tidal volume to patients close to the demand of the physician, containable factors such as the compliance of gas piping,leakage,and gas types should be controlled.