机械通气时心肺交互作用

机械通气不仅在呼吸系统疾病治疗中发挥重要作用,在循环系统疾病治疗中也起重要作用,其中心肺交互作用在机械通气过程中尤为重要。本文就机械通气时的心肺交互作用研究进展作一综述。     

机械通气时机选择对心肺复苏的影响

目的探讨机械通气的时机选择对心肺复苏的影响。方法分析58例心肺复苏患者的临床资料。结果及时通气成功组的SpO2、MAP、窦性心律恢复及心肺复苏成功例数明显高于延时通气成功组。结论早期机械通气有利于提高心肺复苏的成功率。     

机械通气中并发症的原因临床特征与护理对策

目的 为探讨机械通气中并发症发生的原因及临床特征，制定相应的护理对策。方法 对206例辅助机械通气患所出现的临床并发症进行回顾性分析。结果 潮气量、呼吸频率、呼吸比和压力等调节不当，或机械故障和护理不周等将引起通气不足、通气过度、心输出量下降与低血压、肺气压伤，或其它脏器损害等并发症。结论 正确掌握机械通气方法，认真分析并发症的原因，了解并发症的临床特征，及早发现并制定有效护理对策对提高机械通气的疗效有着重要的意义。     

机械通气中呼吸困难的原因及处理

本文报告应用呼吸机抢救呼吸衰竭患者３１８例，其中１６２例在机械通气中发生呼吸困难，占５０．９５％，分析其原因，主要为：呼吸拮抗、气管导管的气囊破裂。导管内腔阻塞及导管弯曲成角等，文中介绍识别呼吸困难的方法及相应的处理措施。     

机械通气抢救呼吸衰竭21例临床分析

我院1995年～1997年抢救21例各种原因引起的急、慢性呼吸衰竭患者时,在常规治疗的基础上并用机械通气,疗效理想,现分析如下。     

机械通气对院内心肺复苏成功率的影响

目的:观察机械通气对院内心肺复苏成功率的影响。方法:回顾性分析机械通气复苏院内心跳呼吸骤停68例的临床资料。结果:5min内获机械通气复苏者的心肺复苏成功率明显高于5min以上者,P<0.05。结论:及时机械通气可提高院内心肺复苏成功率。     

临床旁心肺超声在指导早产儿机械通气诊治中的应用分析

目的：探讨临床旁心肺超声在指导早产儿机械通气诊治中的应用分析。方法：选取2019年2月—2020年2月广东省第二人民医院收治的90例早产儿,其均需接受机械通气诊治,随机分为研究组和对照组各45例,对照组未采用床旁心肺超声技术,研究组采用床旁心肺超声技术。其中脱机成功患儿67例,脱机失败患儿23例。观察分析两组诊断灵敏度、住院时间、呼吸机撤机时间以及呼吸机相关性肺炎发生率等。结果：研究组诊断灵敏度显著高于对照组(P <0.05),且呼吸机相关性肺炎发生率显著低于对照组(P <0.05);研究组住院时间及呼吸机撤机时间均短于对照组,差异有统计学意义(P <0.05);脱机成功患儿心率显著慢于脱机失败患儿,PaO₂水平显著高于脱机失败患儿(P <0.05)。结论：临床旁心肺超声能降低呼吸机相关性肺炎发生率,能使呼吸机撤机时间、住院时间明显缩短,可推广使用。     

两种不同机械通气方法对心肺复苏效果的对比研究

目的　对比两种不同机械通气方法对CPR术成功率的影响 ,寻求最佳的CPR方法。方法　对 31例心跳骤停的病人进行CPR ,据通气方式不同 ,将病人分为ShumperCPR机胸外按压并间歇通气组 (按压 /通气比为 5 :1,17例 ) (研究组 )和ShumperCPR机胸外按压加常规呼吸机控制呼吸通气组 (呼吸频率 18次 /min ,14例 ) (对照组 ) ,比较 2组病人CPR前及CPR进行 1h后动脉血分析、血乳酸浓度及CPR术成功率的差异。结果　ShumperCPR机间歇通气组动脉血气分析中各项指标均优于常规呼吸机控制呼吸通气组 ,P均 <0 0 5 ,前者血乳酸浓度升高值〔(1.2± 0 7)mmol/L〕低于后者〔(2 .5± 1.3)mmol/L〕 ,P <0 0 5 ,心脏复苏成功率前者 (2 9 4 1% )高于后者 (14 2 9% ) ,P <0 0 5。结论　ShumperCPR机胸外按压并间歇通气方式进行CPR较ShumperCPR机胸外按压加常规呼吸机控制呼吸通气效果好 ,临床行CPR术时宜选用ShumperCPR机同时进行胸外按压和间歇通气。     

Mechanical ventilation

Over the past several years, there has been an introduction of numerous modes of mechanical ventilation, each with their own advantages and limitations. This article reviews the common modes of mechanical ventilation, new technologies, and specific ventilator strategies that have been shown to be beneficial. In addition, it reviews the steps that should be taken when troubleshooting a ventilator.     

Mechanical ventilation

The central goal in the management of a patient with acute encephalopathy and encephalitis is the prevention of hypoxemic of hypoxic secondary insults. It is recommended that partial pressure of arterial oxygen should be more than 80 mmHg with mechanical ventilation and supplemental oxygen. About carbon dioxide tension, it is standard practice to ventilate to normocapnia instead of routine setting of hypocapnia. Hyperventilation therapy is limited to specialized conditions with intracranial hypertension which is refractory to other therapy and induces neurological deteriorations. And it is presumed that increasing positive end-expiratory pressure could be related to increase intracranial pressure and decrease cerebral perfusion pressure in these patients especially with low blood pressure. To avoid unfavorable sequelae in brain, lung, and all other organs, we consider that under multimodal brain monitoring, ventilator setting should be decided on a case-by-case basis.     

Using heart-lung interactions to assess fluid responsiveness during mechanical ventilation

According to the Frank-Starling relationship, a patient is a 'responder' to volume expansion only if both ventricles are preload dependent. Mechanical ventilation induces cyclic changes in left ventricular (LV) stroke volume, which are mainly related to the expiratory decrease in LV preload due to the inspiratory decrease in right ventricular (RV) filling and ejection. In the present review, we detail the mechanisms by which mechanical ventilation should result in greater cyclic changes in LV stroke volume when both ventricles are 'preload dependent'. We also address recent clinical data demonstrating that respiratory changes in arterial pulse (or systolic) pressure and in Doppler aortic velocity (as surrogates of respiratory changes in LV stroke volume) can be used to detect biventricular preload dependence, and hence fluid responsiveness in critically ill patients.