呼吸机波形分析ppt课件

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,.,*,呼吸机波形分析Ventilator Waveform Analysis,唐殿成,.,呼吸机波形分析Ventilator Waveform An,1,学习流程,1. Know Your Normal First:,Time-based waveforms in Volume and Pressure-targeted ventilation,Volume-Pressure and Flow-Volume Loops,2. Abnormal Time-Based Waveforms:,Flow-Time Curve,Volume-Time Curve,Pressure-Time Curve,3. Abnormal Loops:,Pressure-Volume Loop,Flow-Volume Loop,.,学习流程1. Know Your Normal First:,2,Normal Time-based Curves（1）,容量控制通气,1、Pressure-Time,2、Flow-Time,3、Volume-Time Curves,.,Normal Time-based Curves（1）容量控,3,Normal Time-based Curves（2）,压力控制通气,1、Pressure-Time,2、Flow-Time,3、Volume-Time Curves,.,Normal Time-based Curves（2）压力控,4,原理,流速时间曲线反映了吸气相和呼气相各自的流速变化，流速的单位为升/分（纵轴），而时间单位为秒（横轴），横轴上的曲线为吸气流速，横轴下的曲线为呼气流速，呼吸机输送的容量是流速在时间上积分计算而得且等于流速曲线下面积。,流速,LPM,时间,1,4,5,3,2,图1 流速曲线（方波）-机械呼吸,吸气相,呼气相,.,原理 流速时间曲线反映了吸气相和呼气相各自的流速变,5,Flow versus Time,ACCELERATING,DECELERATING,SINE,SQUARE,.,Flow versus TimeACCELERATINGDE,6,原理,容量时间曲线中，,上升肢代表了容量输送到病人，下降肢代表了总的呼出潮气量。典型的呼出容量等于吸入容量，除非存在着漏气。,V,T,LITERS,A,B,吸时间,呼时间,TIME,.,原理 容量时间曲线中，上升肢代表了容量输送到病,7,Volume vs Time,Inspiration,Expiration,Time (sec),Volume (ml),Inspiratory Tidal Volume,T,I,.,Volume vs TimeInspirationExpir,8,压力-时间曲线的,原理,A至B点的压力明显增加是由于从呼吸机至肺整个系统的阻力所致，此压力即为克服阻力的压力。,C点为峰压代表充气压力，对抗气流的压力和肺扩张的压力,。,D至E点平台压力，需要扩张肺泡的压力,。,平台期无气体供应到肺，吸气流速是零,。 E点呼气开始。F点呼气结束，压力再次回复到呼气末水平,.,压力-时间曲线的原理 A至B点的压力明显增,9,Pressure versus Time,Inspiration,Expiration,P,aw,(cm H,2,O),Time (sec),T,I,Peak Inspiratory Pressure,PIP,PEEP,T,E,.,Pressure versus TimeInspirati,10,Normal,Volume-Pressure and Flow-Volume Loops,.,Normal Volume-Pressure and Flo,11,Pressure-Volume Loop,Controlled,Assisted,Spontaneous,Vol (ml),P,aw,(cm H,2,O),I: Inspiration,E: Expiration,I,E,E,E,I,I,.,Pressure-Volume LoopControlle,12,Abnormal Time-Based Waveforms,1、,Flow-Time Curve,2、,Volume-Time Curve,3、,Pressure-Time Curve,Abnormal Loops,1、,Pressure-Volume Loop,2、,Flow-Volume Loop,.,Abnormal Time-Based Waveforms.,13,Abnormal,Flow-Time,Curve（1）,1、,Airway Obstruction 气道阻塞,表现：呼气峰流速降低、呼气时间延长,常见原因：气道阻力增加（气管内黏液增加或分泌物聚集）,.,Abnormal Flow-Time Curve（1）1、A,14,Abnormal,Flow-Time,Curve（2）,2、,Air trapping,气体陷闭and auto-PEEP,（1）黄色为正常波形：呼气流速回到基线（下一次吸气之前）,（2）红色为异常波形：呼气流速未回到基线，表明存在,气体陷闭,和,auto-PEEP,。呼气不完全、或呼气时间不足够、或呼气时气道不稳定或陷闭，这种现象非常常见，尤其COPD病人,.,Abnormal Flow-Time Curve（2）2、A,15,Abnormal,Volume-Time,Curve（1）,1,、Air Leak 漏气,表现：,呼气容积不能回到基线,常见原因：回路或气管内插管漏气,.,Abnormal Volume-Time Curve（1）1,16,Abnormal,Volume-Time,Curve（2）,2、,Active Exhalation主动呼气,正常：呼气降到基线水平,异常：呼气降到基线水平以下。,常见原因主动呼气,.,Abnormal Volume-Time Curve（2）2,17,Abnormal,Pressure-Time,Curves,（1）,1、Increased Resistance,阻力增加,表现：,峰压升高、平台压不变,原因：,气管插管阻塞或分泌物聚集,.,Abnormal Pressure-Time Curves（,18,Abnormal,Pressure-Time,Curves,（2）,2、Decreased Compliance,顺应性降低,表现：,峰压和平台压均升高,原因：顺应性降低（ARDS）,.,Abnormal Pressure-Time Curves（,19,Pressure-Volume Loops（1）,、PEEP and PV loop.,PV环：可发现和测量PEEP ，自压力轴向右变化。PEEP水平为决定y 轴和x轴在吸气开始的距离,.,Pressure-Volume Loops（1）、PEEP,20,Pressure-Volume Loops（2）,2、,High Resistance,容量控制通气时，容量恒,定，压力依据阻力和顺应性而,变化,当阻力增加时， PIP 上升,（A-B）， PV loops 变宽。,该种PV loop，称为滞后,（Hysteresis）,.,Pressure-Volume Loops（2）2、High,21,Pressure-Volume Loops（3）,3、,High and Low,Compliance 顺应性,容量控制通气时，顺应性,增加，输出lower PIP ；,顺应,性降低，输出higher PIP,.,Pressure-Volume Loops（3）3、High,22,Pressure-Volume Loops（4）,4、Overdistention,过度膨胀,当潮气量达到肺总容量时,发生过度膨胀。,表现PIP 增加,（A-B）时，潮气量改变不明,显。降低潮气量能够修正这种,现象,.,Pressure-Volume Loops（4）4、Over,23,Pressure-Volume Loops（5）,5、,Air Leak,漏气,表现：,呼气支不能回到0点,原因：回路或气管内插管漏气,.,Pressure-Volume Loops（5）5、Air,24,Flow-Volume Loops（1）,1、,Flow-Volume Loop,横轴容积；纵轴流速,上环吸气；下环呼气,A点：吸气开始,B点：吸气峰流速，伴容积增大,C点；潮气量输出结束，流速降为0，呼气开始,D点：呼气峰流速,A点：流速降低至0，肺排空结束，呼气结束，下一次吸气开始,A-C：潮气量,.,Flow-Volume Loops（1）1、Flow-Vol,25,Flow-Volume Loops（2）,2、Increased resistance,气道阻力增加,表现：呼气峰流速降低，,呼气轨迹内陷,。支气管扩张剂可以修正这种现象,常见：,哮喘,.,Flow-Volume Loops（2）2、Increase,26,Flow-Volume Loops（3）,3、,Air trapping and auto-PEEP,表现：,呼气末,流速,未能回到,0基线,，从而产生气体陷闭和,auto-PEEP 。但不能定量。,注意：,flow-time curve,可,以监测到该种现象,.,Flow-Volume Loops（3）3、Air trap,27,Flow-Volume Loops（4）,4、,Air Leak,表现：,呼气末不能回到0,容积水平,（回到0基线）。,可以定量,常见：回路或气管内插管漏气,注意：,volume-time curve,可,以监测到该种现象,.,Flow-Volume Loops（4）4、Air Leak,28,Waveforms For Common Modes of Ventilation,、CPAP Mode,、Assisted-Mode (Volume-targeted ventilation),、SIMV Mode,、SIMV + Pressure Support,、SIMV+PS+PEEP,.,Waveforms For Common Modes of,29,、CPAP Mode,CPAP mode :自主呼吸模式，仅有,Pressure-Time,Curves中设定基线水平,观察:基线水平5 cm H,2,O 、以及病人的触发triggering,.,、CPAP ModeCPAP mode :自主呼吸模式，仅,30,、Assisted-Mode (Volume-targeted ventilation),主要特点：,“assisted” 意指病人触发,注意：在,Flow-time,和,Volume-time curves,形态相似；,Pressure-time curve,表明病人的触发（微小的负折回）,.,、Assisted-Mode (Volume-targe,31,、SIMV Mode,SIMV mode ：提供两种呼吸形式,（自主和指令），通常为两次指令呼吸,中出现自主呼吸,观察：,Flow-time,curve,中自主呼吸呈典型的,sine-wave shape (rounded).,Pressure-time,curve,中微小负折回提,示自主呼吸的触发,Volume-time,curve,提示自主呼吸的,volume 低于ventilator 的volume,.,、SIMV ModeSIMV mode ：提供两种呼吸形式,32,、SIMV + Pressure Support,Pressure support：常附着于SIMV,模式，增大自主呼吸的能力 ，而不受指,令呼吸的影响,观察：,Flow-time curve,：,自主呼吸的形态呈,递减波decelerating （非正弦波,rounded-shape ）,Pressure-time curve,：吸气期，设定,PS水平保持不变，以及存在微小负折回,.,、SIMV + Pressure SupportPress,33,、SIMV+PS+PEEP,flow-time,和,volume-time,curves,基本相似于SIMV+PS,模式,Pressure-time,curves,的,基线抬高。提示附加了 PEEP,.,、SIMV+PS+PEEPflow-time 和 volu,34,Time-Based Waveforms意义,流速-时间曲线,1.鉴别呼吸类型,2.判断,是否存在a,uto-PEEP,3.衡量病人对支气管扩张药物的反应,4.评估,PCV,通气时吸气时间,5.检查流速触发时回路泄漏速度,压力-时间曲线,1.鉴别呼吸类型,2.压力支持通气,3.估算平台压,4.评估吸气触发,5.评价整个呼吸时相，调节峰流速,6.测算静态呼吸力学参数（,C、R,）,容量-时间曲线,1、判断肺内气体是否存在泄漏,2、是否存在用力呼气,.,Time-Based Waveforms意义流速-时间曲线压,35,Waveforms Loops意义,压力-容量环,1、估算吸气相面积和吸气触,发功,2、估算,Flow-by,的效果,3、估算顺应性、阻力,4、是否存在过度膨胀及漏气,5、衡量,PEEP,水平,流速-容量环,衡量对支气管扩张药物的反应,是否存在过度膨胀和漏气,评价气道阻力,.,Waveforms Loops意义压力-容量环流速-容量环.,36,回顾与总结,.,回顾与总结.,37,Flow-Volume Loop,Volume (ml),PEFR,FRC,Inspiration,Expiration,Flow (L/min),PIFR,V,T,.,Flow-Volume LoopVolume (ml)PEF,38,Air,Trapping,Inspiration,Expiration,Normal,Patient,Time (sec),Flow (L/min),Air Trapping,Auto-PEEP,.,Air TrappingInspirationExpirat,39,Air Trapping,Inspiration,Expiration,Volume (ml),Flow,(L/min),Does not return,to baseline,Normal,Abnormal,.,Air TrappingInspirationExpirat,40,Paw (cm H,2,O),Normal,Normal,P,P,lat,(Normal Compliance),Increased,PIP,Increased,P,TA,(increased Airway Resistance,),Normal,PIP,P,Plat,High,R,aw,PIP,P,Plat,Increased Airway Resistance,.,Paw (cm H2O)NormalNormal PPl,41,Response,to,Bronchodilator,Before,Time (sec),Flow (L/min),PEFR,After,Long T,E,Higher PEFR,Shorter T,E,.,Response to BronchodilatorBefo,42,Increased Airway Resistance,Inspiration,Expiration,Volume,(ml),Flow,(L/min),Decreased PEFR,Normal,Abnormal,“Scooped out”,pattern,.,Increased Airway ResistanceIns,43,Overdistension,Volume (ml),Pressure (cm H,2,O),With little or no change in V,T,P,aw,rises,Normal,Abnormal,.,OverdistensionVolume (ml)Press,44,Inadequate Inspiratory Flow,P,aw,(cm H,2,O),Volume,(ml),Normal,Abnormal,Active Inspiration,Inappropriate Flow,.,Inadequate Inspiratory FlowPaw,45,Inadequate Sensitivity,Volume (mL),P,aw,(cm H,2,O),Increased WOB,.,Inadequate SensitivityVolume (,46,Lung Compliance Changes and the P-V Loop,Volume (mL),Preset PIP,V,T,levels,P,aw,(cm H,2,O),COMPLIANCE,Increased,Normal,Decreased,Pressure,Targeted Ventilation,.,Lung Compliance Changes and th,47,Air Leak,Volume (ml),Time (sec),Air,Leak,.,Air LeakVolume (ml)Time (sec)A,48,Air Leak,Volume (ml),Pressure (cm H,2,O),Air Leak,.,Air LeakVolume (ml)Pressure (c,49,Air Leak,Inspiration,Expiration,Volume,(ml),Flow,(L/min),Air,Leak,in mL,Normal,Abnormal,.,Air LeakInspirationExpirationV,50,谢谢,.,谢谢.,51,