容積流量曲線呼氣相的臨床應(yīng)用.ppt

1、容積流量曲線呼氣相的臨床應(yīng)用,安順市人民醫(yī)院,容積流量曲線,容積 (ml),PEFR,EELV,吸氣,呼氣,流量 (L/min),PIFR,VT,漏氣,吸氣,呼氣,容積(ml),流量 (L/min),漏氣(mL),正常 異常,氣體陷閉,吸氣,呼氣,容積(ml),流量 (L/min),不能回到基線水平,正常 異常,氣道阻力升高,吸氣,呼氣,容積(ml),流量 (L/min),PEFR降低,正常 異常,“Scooped out” pattern,氣道分泌物/管路中積水,吸氣,呼氣,容積(ml),流量 (L/min),正常 異常,定量分析,計(jì)算時(shí)間常數(shù)的簡(jiǎn)單方法,Brunner JX, Laubsc

2、her TP, Banner MJ, et al. Simple method to measure total expiratory time constant based on the passive expiratory flow-volume curve. Critical Care Med 1995; 23(6):1117-1122,流量 (L/min),容積(L),0,Vt,PEFR,計(jì)算時(shí)間常數(shù)的簡(jiǎn)單方法,Brunner JX, Laubscher TP, Banner MJ, et al. Simple method to measure total expiratory ti

3、me constant based on the passive expiratory flow-volume curve. Critical Care Med 1995; 23(6):1117-1122,流量 (L/min),容積(L),0,Vt,PEFR,TauE = Vt / PEFR,計(jì)算時(shí)間常數(shù)的簡(jiǎn)單方法,Brunner JX, Laubscher TP, Banner MJ, et al. Simple method to measure total expiratory time constant based on the passive expiratory flow-volu

4、me curve. Critical Care Med 1995; 23(6):1117-1122,模擬肺 y = 0.975x + 0.169 r2 = 0.974,動(dòng)物試驗(yàn)(犬) y = 1.033x + 0.038 r2 = 0.969,計(jì)算時(shí)間常數(shù)的簡(jiǎn)單方法,結(jié)論 評(píng)估時(shí)間常數(shù)(TauE) 呼氣潮氣量(Vte) 呼氣峰流量(PEFR) 有助于設(shè)置機(jī)械通氣時(shí)的呼氣時(shí)間(Texp),Brunner JX, Laubscher TP, Banner MJ, et al. Simple method to measure total expiratory time constant based

5、 on the passive expiratory flow-volume curve. Critical Care Med 1995; 23(6):1117-1122,呼氣閥對(duì)容積流量曲線呼氣相的影響,Lourens MS, van den Berg B, Hoogsteden HC, et al. Flow-volume curves as measurement of respiratory mechanics during ventilatory support: the effect of the exhalation valve. Intensive Care Med 1999;

6、 25: 799-804,呼氣閥對(duì)容積流量曲線呼氣相的影響,Lourens MS, van den Berg B, Hoogsteden HC, et al. Flow-volume curves as measurement of respiratory mechanics during ventilatory support: the effect of the exhalation valve. Intensive Care Med 1999; 25: 799-804,流量 (L/min),容積(L),0,Vt,50Vt,V50, ex,Vend, ex,SF50 = arctg,V50

7、, ex Vend, ex Vt50,( ),PEFR,呼氣閥對(duì)容積流量曲線呼氣相的影響,Lourens MS, van den Berg B, Hoogsteden HC, et al. Flow-volume curves as measurement of respiratory mechanics during ventilatory support: the effect of the exhalation valve. Intensive Care Med 1999; 25: 799-804,有呼氣閥,無呼氣閥,有呼氣閥,無呼氣閥,呼氣閥對(duì)容積流量曲線呼氣相的影響,Lourens

8、MS, van den Berg B, Hoogsteden HC, et al. Flow-volume curves as measurement of respiratory mechanics during ventilatory support: the effect of the exhalation valve. Intensive Care Med 1999; 25: 799-804,呼氣閥對(duì)容積流量曲線呼氣相的影響,結(jié)論 呼氣閥 導(dǎo)致呼氣峰流量顯著降低 不影響SF50 容積流量曲線呼氣相的后半部分有助于評(píng)價(jià)機(jī)械通氣患者的呼吸力學(xué)指標(biāo),Lourens MS, van den B

9、erg B, Hoogsteden HC, et al. Flow-volume curves as measurement of respiratory mechanics during ventilatory support: the effect of the exhalation valve. Intensive Care Med 1999; 25: 799-804,呼氣相時(shí)間常數(shù): 臨床資料,目的: 比較不同方法得到的呼氣相時(shí)間常數(shù) 容積流量曲線呼氣相 阻斷法 設(shè)計(jì): 前瞻試驗(yàn) 背景: 大學(xué)醫(yī)院內(nèi)科ICU 患者(n = 38): 重度COPD (n = 18) 中度COPD (n =

10、 8) 其他疾病(n = 12),Lourens MS, van den Berg B, Aerts JGJV, et al. Expiratory time constants in mechanically ventilated patients with and without COPD. Intensive Care Med 2000; 26: 1612-1618,呼氣相時(shí)間常數(shù): 臨床資料,Lourens MS, van den Berg B, Aerts JGJV, et al. Expiratory time constants in mechanically ventilate

11、d patients with and without COPD. Intensive Care Med 2000; 26: 1612-1618,RCfv100 = Vt / (V100, exp Vend, ex),RCfv75 = 0.75 x Vt / (V75, exp Vend, ex),RCfv50 = 0.50 x Vt / (V50, exp Vend, ex),RCfv25 = 0.25 x Vt / (V25, exp Vend, ex),參照: 阻斷法,呼氣相時(shí)間常數(shù): 臨床資料,Lourens MS, van den Berg B, Aerts JGJV, et al.

12、 Expiratory time constants in mechanically ventilated patients with and without COPD. Intensive Care Med 2000; 26: 1612-1618,呼氣相時(shí)間常數(shù): 臨床資料,Lourens MS, van den Berg B, Aerts JGJV, et al. Expiratory time constants in mechanically ventilated patients with and without COPD. Intensive Care Med 2000; 26:

13、1612-1618,呼氣相時(shí)間常數(shù): 臨床資料,在接受機(jī)械通氣的COPD及非COPD患者 根據(jù)呼氣相容積流量曲線的后75%容積部分可以計(jì)算時(shí)間常數(shù),Lourens MS, van den Berg B, Aerts JGJV, et al. Expiratory time constants in mechanically ventilated patients with and without COPD. Intensive Care Med 2000; 26: 1612-1618,VCV時(shí)氣管插管的(部分)梗阻,9只小豬 (體重26.1 1.4 kg) 機(jī)械通氣: VC, Vt 10 12

14、 ml/kg, f 18 20 bpm, I:E 1:1 逐漸夾閉氣管插管(8#) 基礎(chǔ)水平 第一級(jí) 第二級(jí) 第三級(jí),Kawati R, Lattuada M, Sjostrand U, et al. Peak airway pressure increase is a late warning sign of partial endotracheal tube obstruction whereas change in expiratory flow is an early warning sign. Anesth Analg 2005; 100: 889-893,VCV時(shí)氣管插管的(部分)

15、梗阻,Kawati R, Lattuada M, Sjostrand U, et al. Peak airway pressure increase is a late warning sign of partial endotracheal tube obstruction whereas change in expiratory flow is an early warning sign. Anesth Analg 2005; 100: 889-893,Tau1 Tau2 Tau3 Tau4 Tau5,VCV時(shí)氣管插管的(部分)梗阻,Kawati R, Lattuada M, Sjostr

16、and U, et al. Peak airway pressure increase is a late warning sign of partial endotracheal tube obstruction whereas change in expiratory flow is an early warning sign. Anesth Analg 2005; 100: 889-893,PIP (cmH2O) 20 (16.7 23.2)* 15 (13.7 16.4) 14 (12.9 15.6) 13 (12.1 13.1),VCV時(shí)氣管插管的(部分)梗阻,結(jié)論 通過呼氣氣流信號(hào)

17、能夠可靠地監(jiān)測(cè)氣管插管的部分梗阻 監(jiān)測(cè)機(jī)械通氣患者的氣管插管狹窄 無論吸氣流量波形如何,Kawati R, Lattuada M, Sjostrand U, et al. Peak airway pressure increase is a late warning sign of partial endotracheal tube obstruction whereas change in expiratory flow is an early warning sign. Anesth Analg 2005; 100: 889-893,PCV時(shí)氣管插管的(部分)梗阻,11只豬(24.5 1.

18、0 kg) 通氣模式 PCV: FiO2 0.4, f 18 bpm, PEEP 0, I:E 1:1 PaCO2 3.8 0.5 kPa,Kawati R, Vimlati L, Guttmann J, et al. Change in expiratory flow detects partial endotracheal tube obstruction in pressure-controlled ventilation. Anesth Analg 2006; 103: 650-657,PCV時(shí)氣管插管的(部分)梗阻,Kawati R, Vimlati L, Guttmann J, et al. Change in expiratory flow detects partial endotracheal tube obstruction in pressure-controlled ventilation. Anesth Analg 2006; 103: 650-657,流量 (L/min),容積(L),0,Vt,Vt 250 m