SERVO系列呼吸机培训课件

Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,134,Mastertitelformat bearbeiten,Mastertextformat bearbeiten,Zweite Ebene,Dritte Ebene,Vierte Ebene,Fnfte Ebene,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,13,SERVOi,呼吸平台临床使用培训,2008,年,8,月,14,日,北京儿童医院,HISTORY,2000,2001,2002,2003,MAQUET,November 2000,ALM,January,2001,HERAEUS MED,July,2002,SIEMENS LSS,October,2003,JOSTRA,July,2003,2004,2005,2006,2007,2008,OTY,Telemedicine,August 2006,Boston,Scientific,CS/VS,January,2008,Back to list of content,Milestones in Expansion:,FACTS & FIGURES,Global Market Shares Medical Systems:,Market share in %,Market size in,Market growth in,2005,2006,2007, m,%,OR tables,43,44,44,485,5,OR lights,39,40,40,219,5,CSUs,17,19,19,165,5,Ventilators,30,32,32,590,5,HLMs,HCUs,20,22,22,85,3-5,Oxys, tubing,cannulae,10,12,12,650,3-5,Back to list of content,MAQUET,critical care AB ,Solna,Sweden,SERVO-i,SERVO-i infant,SERVO-i MR,SERVO-s,配件,病人部分,Description Patient Unit,超声流量传感器,The Ultrasonic flowmeter,直流式设计，减少呼气阻力,独立消毒,呼出气体模块,Expiratory cassette,用户界面,User Interface,顺应性,Cdyn,amic,.,Cstatic,阻力,Ri,nsp,.,Re,xp,呼吸功,WOBp,atient,WOBv,entilator,时间常数,Tc,onstant,浅快呼吸指数,SBI,Shallow Breath Index,口腔闭合压,P0.1,全面的监测信息,控制模式,Controlled ventilation,2.,支持模式,Supported ventilation,3.,自主呼吸,Spontaneous breathing,4.,混合模式,Combined control and supported or spontaneous and supported ventilation,呼吸模式,Modes of ventilation,控制模式,容量控制,Volume Control,压力控制,Pressure Control,压力调节容量控制,Pressure Regulated Volume Control,2,.,支持模式,压力支持,Pressure Support,3,.,自主呼吸,持续气道正压,Continuous Positive Airway Pressure,混合模式,Synchronized Intermittent Mandatory Ventilation,同步间歇指令通气,SIMV(VC)+PS,同步间歇指令通气,SIMV(PC)+PS,同步间歇指令通气,SIMV(PRVC)+PS,呼吸模式,Ventilation Mode,呼吸模式,Modes of ventilation,呼吸模式 控制通气,控制通气的临床应用,（一）主要用于病人有严重的呼吸抑制或伴有呼吸暂停，如麻醉、中枢,神经系统功能障碍、神经肌肉疾病、胸部外伤或药物过量等情况。,好处：在于呼吸肌疲劳或衰竭有关的情况下应用控制通气，可最大限度地减,轻呼吸肌负荷，降低呼吸氧耗，有利于呼吸肌的休息和恢复疲劳。,（二）为心肺功能均差的病人提供最大的呼吸支持，以减少病人的呼吸用力和,焦虑，缓解急性冠状动脉缺血。,例如：休克，肺水肿，躁动的,ARDS,病人,注意：小儿尽量使用压力控制模式,控制通气,（一）如果参数设置不当，容易 造成通气不足或通气过度。,（二）病人自主呼吸较强时，容易发生人机对抗。,（三）镇静剂和肌松剂的使用，导致药物副作用。,镇静剂血管扩张、低血压和心排量降低,肌松剂抑制病人痰液的分泌和廓清，容易引起肺,不张和肺部感染,（四）较长时间应用，会导致呼吸肌萎缩和呼吸机依赖。,控制通气缺点,指征明确的情况下使用,控制通气,容量控制通气,Volume,Control Ventilation,容量控制通气参数设置,Volume,Control Settings,容量控制通气,Volume Control,吸呼比,I:E,Ratio,(X+Y):Z,I:E,吸呼比,正常值：,1:2,Y,Tpause,平台时间,呼吸周期的,10%,The Curves Displayed in Volume Controlled Ventilation Mode,在,VC,和,SIMV(VC),模式下压力曲线,气道峰压,(Peak Pressure,Ppeak,),：,吸气时气道内达到的最大的压力。,此压力代表大气道内压力。,正常值：,9,16cmH2O,机械通气上限值：,35,40cmH2O,平台压,(,Plateau Pressure,Pplat,),：,吸气屏气末的压力,.,平台压代表肺泡内压力。,正常值：,5,13cmH2O,机械通气上限值：,30,35cmH2O,呼气末正压（,End,exp.pressure,，,PEEP,）：,呼气末气道内的压力。,用来保持肺泡开放。,正常值：,0,容量控制,VC,和同步间歇指令通气,SIMV(VC),在,VC,和,SIMV(VC),模式下压力曲线,顺应性压力（,PComplianceComp,),顺应性压力平台压呼气末正压,反映了病人肺的弹性。,容量控制,VC,和同步间歇指令通气,SIMV(VC),在,VC,和,SIMV(VC),模式下流速曲线,吸气相：在吸气相流速保持恒定，,在屏气时流速为零。,呼气相：在呼气开始时，流速最,大。随后，流速逐渐减小，并在呼,气末回到零。,吸气和呼气流速记录在同一个波形,里。正的表示吸气流速（在,0,线以上）；负的（在,0,线以下）表示呼气流速。,吸气容量和呼气容量在没有漏气的情况下是相等的：等于流速曲线和,0,线之间的面积。,相同的潮气量,随着治疗的进展,气道峰压会下降,容量控制,VC,和同步间歇指令通气,SIMV,（,VC,）,压力,/,流速,/,容量时间曲线,Pressure/Flow/Volume-Time Curves,压力时间曲线（,P-,t,）,.,x:,吸气时间,Inspiration time,y:,平台时间,Pause time,z:,呼气时间,Expiration time,1:,开始吸气,Start of Inspiration,2:,气道峰压,Peak,inspiratory,pressure,3:,早期吸气平台压,Early,inspiratory,pause pressure,4:,吸气平台压,End,inspiratory,pause pressure,5:,早期呼气压力,Early expiratory pressure,6:,呼气末正压,PEEP,End expiratory pressure,流速时间曲线,(,F,-t),.,x:,吸气时间,Inspiration time,y:,平台时间,Pause time,z:,呼气时间,Expiration time,7:,吸气峰流速,Peak,inspiratory,flow,8:,0,流速,Zero flow phase,9:,呼气峰流速,Peak expiratory flow,10:,呼气流速坡度,Slope decelerating expiratory limb,11:,呼气末流速（,Vee,),End expiratory flow,压力,/,流速,/,容量时间曲线,Pressure/Flow/Volume-Time Curves,容量时间曲线,V-t,.,x:,吸气时间,Inspiration time,y:,平台时间,Pause time,z:,呼气时间,Expiration time,12: Start of inspiration,13: The slope represents current delivery of,inspiratory,tidal volume,14: End inspiration,15: The slope represents current patient delivery of expiratory tidal volume,16: End expiration,压力,/,流速,/,容量时间曲线,Pressure/Flow/Volume-Time Curves,容量控制,VC,和同步间歇指令通气,SIMV(VC),优点,:,能够有效的控制病人所得到的容量,容量控制,VC,和同步间歇指令通气,SIMV(VC),缺点,1:,气道压力受阻力和顺应性的变化影响,顺应性,-,Pplat,阻力,Ppeak-Pplat,容量控制,VC,和同步间歇指令通气,SIMV(VC),缺点,2 :,容易造成过度膨胀或局部肺泡的不张,不利于肺保护,容量控制（,VC,）气流特征,压力控制通气,Pressure,Control Ventilation,压力控制设置,Pressure,Control Settings,压力控制,Pressure,Control,密切关注病,人通气,量的变化,缺点,病人所获得的潮气量受阻力和顺应性的影响,优点,能够有效控制病人气道内的压力,有利于气体的分布,有利于肺保护,压力控制,Pressure,Control,压力控制（,PC,）气流特征,Pressure Control,压力控制模式（,Pressure control,）适应征,压力控制模式适用于在系统中有漏气的情况，比如没有气囊的插管,Pressure Controlled mode is preferred when there is leakage in the breathing system, such as due to an,uncuffed,endotracheal,tube,病人的气道峰压需要严格的限制,in situations when the maximum airway pressure must be controlled.,小儿,Neonate and,pediatric,压力控制模式描述,在压力控制中，在吸气相压力保持恒定，流速为减速波因为任何原因的,压力下降，流速都会迅速升高来维持预设的吸气压力,输送的容量取决于高于,PEEP,的压力控制水平，肺的顺应性以及气道和插,管的阻力,最大气流为,3.3 l/sec - 200 l/min.,每次的容量都可能发生变化,压力控制,Pressure,Control,在压力控制和压力支持模式中，压,力保持恒定,在整个吸气相，吸气压力越高，病人,吸入的气流越多。,在压力控制模式中，流速有很高,的依赖性。,病人气道压力会影响吸气流速。如果在治疗过程中，气阻力增加，则吸气流速会减小。,吸气相，流速为减速波,流速在吸气开始最大（此时，肺,内的阻力最低），随着肺逐渐的,充盈，阻力越来越大，流速也随,之减小,呼气相流速在呼气开始时最大,因为，此时肺内的压力最高,压力控制,Pressure,Control,压力时间曲线,Pressure-Time Curve.,x:,吸气时间,Inspiration time,z:,呼气时间,Expiration time,1:,开始吸气,Start of Inspiration,2:,吸气末压力,End,inspiratory,pressure,3:,呼气末压力,End expiratory pressure,压力,/,流速,/,容量时间曲线,Pressure/Flow/Volume-Time Curves,流速时间曲线,Flow-Time Curve.,x:,吸气时间,Inspiration time,z:,呼气时间,Expiration time,4:,吸气峰流速,Peak,inspiratory,flow,5:,吸气末流速,End,inspiratory,flow,6:,呼气峰流速,Peak expiratory flow,7:,呼气末流速（,Vee,）,End expiratory flow,压力,/,流速,/,容量时间曲线,Pressure/Flow/Volume-Time Curves,容量时间曲线,Volume-Time Curve.,x:,吸气时间,Inspiration time,z:,呼气时间,Expiration time,8:,开始吸气,Start of inspiration,9:,吸气末,End inspiration,10:,呼气末,End expiration,随着治疗的进展,在相同的压力情,况下,我们可以看到潮气量在增加,说明病人的病情有好转,压力,/,流速,/,容量时间曲线,Pressure/Flow/Volume-Time Curves,呼吸模式 控制通气,OH 5:008,压力调节容量控制,(Pressure regulated Volume Control),PRVC,刘靖,2005 8 16,推荐：,成人,6-8ml/kg,正常体重,吸气上升时间,Inspiratory,Rise Time,吸气上升时间,Inspiratory,Rise Time,指吸气流量或压力上升到峰值所需要的时间，以呼吸周期时间的百分比或秒表示,合理的吸气上升时间能够提高呼吸机和病人的同步性,增加舒适度,缩短脱机时间,吸气上升时间,Inspiratory,Rise Time,控制模式,PC, VC,SIMV,（,VC,）,SIMV,(PC),吸气上升时间,(%),范围：,0-20%,默认：,5%,支持模式,-,PSV,CPAP,吸气上升时间,(,S,),Range 0 - 0.4 s,Default 0.05s,需要较快流速患者,ARDS,患者使用压力模式时,较短的吸气上升时间可以产生较快的流速,与病人较强,的通气需求相协调,过慢的吸气上升时间导致低的气流,不能满足病人的需求,从而导致病人过多的吸气做功,(,呼吸医学讲义 俞森洋,),病人的触发有可能受到抑制,短的吸气上升时间能够减少病人做功，因为此时呼吸机的送气速度快,于病人自己的驱动,从而导致肌肉萎缩和延长脱机时间,吸气上升时间临床意义,较长的吸气上升时间可以令气道,压缓慢上升,由病人来引导呼吸,机送气,吸气上升时间临床意义,剪切力,时间常数短,的肺泡,时间常数长,的肺泡,较长的吸气上升时间可以令气道,压缓慢上升,避免时间常数较短,肺泡过度膨胀,减少不同复张程,度肺泡之间的应力,触发灵敏度,Trigger Sensitivity,Invasive: 0 50 cmH2O,NIV: 2 20 cmH2O,刘靖,2005 8 16,呼气末正压,PEEP,内源性,PEEP,概念,intrinsic positive end-expiratory,pressure,PEEPi,是指在没有用呼吸机预设,PEEP,的情况下,肺泡压力在呼气末从而也在整,个呼气 过程保持正压。,临床上产生内源性,PEEP,的原因,1,气流阻力增加（和呼气流速受限）,2,呼气时间缩短，如反比通气和浅快自主呼吸,3,吸气后呼气肌的兴奋性增高,概念：,触发灵敏度是决定患者产生吸气流量所需的,努力程度，以及患者还需做多大的呼吸工作,量才能开始呼吸。,方式：,流量触发,压力触发,设置原则,在不引起误触发的前提下，尽量的灵敏,触发灵敏度,Trigger Sensitivity,触发灵敏度,Trigger,Sensitivity,流量触发,Flow Triggering,概念：持续气流的*,10,默认值：,5,调节范围：,0,10,持续气流,:,成人,2 L/min,儿童,0.5L/min, 2l/min,2l/min,病人吸入,0.6l/min,（,2x30%,）,1.4l/min(2x70%),7,3,1,压力触发,Pressure,Triggering,范围：,-20,0,cmH2O,要触发一次呼吸，必须形成一定的负压。负压值 越大，病人所作的功越多,触发灵敏度应该在没有自触发风险的情况下，尽量的灵敏。,病例分析：,现象,：,COPD,病人,体重,60kg,，触发方式为流量触发,9,，,SIMV(PRVC)+PS; RR=12,PEEP=4,SIMV RR=12,监测,RR=17,在呼气末吸气开始的压力波形前部分出现波动，但病人未触发呼吸机,分析,：表明病人有吸气努力，但未触发呼吸机。,观察呼气末流速（,Vee,），有时为,0,，有时为,1,，表明病人存在呼气困难。,呼气屏气激活，总,PEEP,（,PEEPtatal,）为,16cmH2O.,所以，内源性,PEEP=12cmH2O,对策：,适当增加,PEEP ?,气道解痉挛,(,是否存在气道痉挛？,),延长呼气时间,包括增加,I:E,中的呼气时间，降低呼吸频率,减少潮气量,The first breath delivered to the patient is a Volume Controlled breath. The measured pause pressure is then used as the pressure level for the next breath. The set Tidal Volume is achieved by automatic, breath by breath pressure regulation, in steps of maximum 3 cmH20.,The Pressure Regulated Volume Control mode is a combination of Volume Control and Pressure Control modes. PRVC delivers a Pressure Controlled breath with a volume guarantee at the lowest possible pressure. The flow is decelerating.,压力调节容量控制,(Pressure regulated Volume Control),PRVC,刘靖,2005 8 16,压力调节容量控制,(Pressure regulated Volume Control),PRVC,PRVC,临床好处,PRVC,结合了压力控制和容量控制的优点，经,Andersen,和,Hazelaet,等人的临床试用，证,明其能为所有年龄组的急性呼吸衰竭病人提供有效通气支持，并能满足各种复杂病情,的通气。,现代机械通气的理论和实践,报警少,ICU,工作量少,自主呼吸和机械通气的协调性好，可减少或避免镇静剂或肌松剂的应用,潮气量恒定，可保障自主呼吸力学不稳定病人的通气安全,吸气流速波形为减速波，气道阻塞时可减少涡流，从而减少压力消耗，,降低吸气峰压,有利于塌陷肺泡的复张,改善氧合,自动补充漏气,尽早脱机,PRVC,的临床好处,PRVC,适应征,术后病人,急性肺水肿,哮喘病人,局限性肺不张,对病情了解不深时,PRVC,相对禁忌症,大量漏气病人,举例： 哮喘,容量控制,VC,或,SIMV(VC),呼吸非常困难的哮喘病人经常以,可诱发动态过,度充气的频率触发通气,分钟通气量过大,动态过度充气和,AUTOPEEP,压力控制,压力支持或,SIMV(PC)+PS,由于支气管痉挛气道阻力高、过度 充气、人机不协调等,潮气量减小，通气不足,当气流阻塞减轻时,潮气量急剧上升， 过度通气,压力调节容量控制,PRVC,或,SIMV(PRVC)+PS,或容量支持,VS,减少由于病情缓减或恶化而引起的通气不足或通气过度,注：在,PRVC,时，呼吸频率的设置以达到基本通气或稍低通气为目标，推荐,10-12,次,压力支持通气,Pressure,Support Ventilation,压力支持通气（,Pressure Support Ventilation,）,压力支持通气是每次由病人触发，并在吸气相给予预设的恒定的压力水平,压力支持（,PS,）的临床应用,（一）呼吸衰竭病人早期和中期的常用模式,好处：减少病人镇静剂的需要,增加舒适性,例如：中枢驱动高的病人,（二）撤机,推荐：初步判断具备撤机条件的病人,每次降低,PS,水平,2cmH2O,每天降低,1,3,次,PS,水平降低至,5,8cmH2O,维持理想通气数小时,认为病人可撤机和拔管,压力支持水平的床旁调节,观察病人的自主呼吸频率,理想自主呼吸频率：,25,30,次,观察病人的潮气量,理想潮气量,Vt,ml/kg,病人舒适度,压力支持设置,Pressure,Support Settings,压力支持通气是每次由病人触发，并在吸气相给予预设的恒定的压力水平,压力支持通气,Pressure,Support Ventilation,压力支持模式,吸气上升时间可以根据病人吸气,努力程度自动调整,吸气终止,Inspiratory,Cycle Off,Inspiratory,Cycle off,吸气终止：,指在自主呼吸和支持通气模式下，由吸气转为呼气的转折点。以峰流速的表示,范围：,1-,7,0%,默认 ：,30%,如果吸气时间被拖延到呼吸,中枢呼气相，呼气肌群会处,于收缩状态，显著导致病人,做功增加，并可能脱机困难。,刘靖,2005 8 16,吸气终止 临床意义,通过增加吸气终止百分比，,吸气能够与中枢相协调，,减少呼吸肌群收缩的恶性,循环。,流速切换,后备通气,Backup ventilation,后备通气等待时间范围,:,成人,15,4,5,s,默认,20s,新生儿,5-45s,默认,10s,Back up,Always set the Apnea time appropriate to the individual patient situation. If the apnea alarm limit is reached the ventilator will automatically switch to a Back-up,mode.The,alarm should alert staff to take action, either to go back to supported mode or change to a controlled mode of ventilation. It is also very important to set lower and upper alarm limit for expired Minute Volume,容量支持通气,Pressure,Support Ventilation,容量支持通气,Pressure,Support,setting,容量支持通气,Pressure,Support Ventilation,VS,原理及描述,The start breath is given with 10 cmH2O support. From that breath the ventilator calculates and continuously regulates the pressure needed to deliver the pre-set Tidal Volume.,During the remaining 3 breaths of the start up sequence the maximum pressure increase is 20 cmH2O for each breath. After the start up sequence the pressure increases or decreases in steps of maximum 3 cmH2O.,If the delivered Tidal Volume decreases below the set Tidal Volume the pressure support level is increased in steps of maximum 3 cmH2O until preset Tidal Volume is delivered. If the pressure support level causes a larger Tidal Volume than preset, the support pressure is lowered in steps of maximum 3 cmH2O until the preset Tidal Volume is delivered.,The maximum time for inspiration is:- infant 1.5 seconds- adult 2.5 seconds,容量支持,VS,1. Start breath 10 cmH2O,2. Remaining 3 breaths, Max increase 20cmH2O/ breath,3. Increase or decrease by 3 cmH2O,4. If the delivered VT decreases below the set VT then 3cmH2O,5. Max. Ti is 1.5s (infant), 2.5 (adult),Backup Ventilation,刘靖,2005 8 16,Backup Ventilation,持续气道正压通气,Continuous,Positive Airway Pressure (CPAP),持续气道正压通气,概念,适应征,有完整的自主呼吸的病人,持续气道正压通气设置,CPAP,Settings,持续气道正压通气,CPAP,SIMV,(Synchronized Intermittent Mandatory Ventilation),同步间歇指令通气,完全控制通气,控制支持,自主呼吸,SIMV,描述,During SIMV the patient receives mandatory breaths controlled by the ventilator.,The mandatory breaths are synchronized with the breathing efforts of the patient. The patient can breath spontaneously in between the mandatory breaths.,Setting the SIMV rate gives the patient a pre-set number of mandatory breaths. The patient may breath spontaneously between these breaths. SIMV can be used during weaning from the ventilator. As the SIMV rate decreases the patient is given more time for spontaneous breathing.,There are three different SIMV modes:,- SIMV (Volume Control) + Pressure Support,- SIMV (Pressure Control) + Pressure Support,- SIMV (PRVC) + Pressure Support,The Mandatory breath is defined by the basic settings:,Minute Volume, Tidal Volume (depending on configuration), or PC above PEEP, I:E ratio (Pause time in Volume Control),Inspiratory,rise time and Breath cycle time.,In the Minute Volume configuration the Tidal Volume is determined by Minute Volume divided by SIMV rate.,The Breath cycle time is the length of the mandatory breath in seconds. For example: a breath cycle time of 3 seconds with an I:E ratio of 1:2 means that the inspiration will take 1 second and the expiration 2 seconds.,SIMV (PRVC) +,Pressure,Support,刘靖,2005 8 16,控制通气相,关参数,支持通气相,关参数,SIMV Cycle,RR,：,6,Breath Cycle T: 3,控制通气呼吸周期,Breath,Cycle,T,Breath Cycle T is the length of the mandatory breath in seconds.,刘靖,2005 8 16,OH 2:006,During the SIMV,period,the,first triggered breath will be a mandatory breath.,If the patient has not triggered a breath within the first 90%of the Breath Cycle T,A mandatory breath will be delivered,Default Adult,:,4,s,infant,:,1,s,控制通气呼吸周期,Breath,Cycle,T,刘靖,2005 8 16,刘靖,2005 8 16,SIMV (PRVC) +,Pressure,Support,SIMV (VC) + PS Settings,SIMV (VC) + PS,SIMV,控制通气呼吸周期,Breath,Cycle Time,1,15,秒,SIMV,控制通气,Mandatory,Breaths,Breath Cycle T,可调的临床意义,如果病人在,SIMV,时通气过度,情况一：病人病情有改善,此时可以降低,SIMV,频率来减少对病人的控制通气，锻炼病人,情况二：病人浅快呼吸，消耗较多,延长,Breath Cycle T,增加控制通气时间，减少不必要的辅助通,气，减少病人消耗,（画图表示）,控制模式,容量控制 （,VC,）,压力控制 （,PC,）,压力调节容量控制（,PRVC),2,.,支持模式,压力支持,( PS ),3,.,自主呼吸,持续气道正压（,CPAP,）,4.,混合模式,同步间歇指令通气,SIMV(VC)+PS,同步间歇指令通气,SIMV(PC)+PS,同步间歇指令通气,SIMV(PRVC)+PS,呼吸模式,Modes of ventilation,Order. no. 66 71 096 EN Rev.01. 0510,控制模式,容量控制（,VC,）,压力控制,压力调节容量控制（,PRVC,),2,.,支持模式,压力支持,( PS ),容量支持（,VS,）,3,.,自主呼吸,持续气道正压（,CPAP,）,4.,混合模式,同步间歇指令通气,SIMV(VC)+PS,同步间歇指令通气,SIMV(PRVC)+PS,同步间歇指令通气,SIMV(PRVC)+PS,呼吸模式,Ventilation Mode,计算和显示每次,呼吸的动态特征,（,Cdyn,）,测量每次呼吸的,吸气末压力,（,EIP,）和,PEEP,Open Lung Tool,开放肺工具,With the right PEEP (chair legs) you protect the lung (dog) from stress forces (bottom).,危重病人转运无处不在,SERVO-i MR,Inventor PhD Christer Sinderby,NAVA is coming,First version,NAVA,2008,年底即将推出, ,NAVA,(,Neurally,Adjusted,Ventilatory,Assist,),NAVA,(,Neurally,Adjusted,Ventilatory,Assist,),满足您不断增长的临床需求,900C 300A,Servoi,Servos 2002,年,3,月,V 1.0 2002,年,8,月,V 1.1 2003,年,9,月,V1.3 2004,年,9,月,V2.0 2005,年,9,月,V3.0 2006,年,5,月,V3.1 2007,年,11,月,V3.2 2008,年,V4.0 ,Order. no. 66 71 096 EN Rev.01. 0510,