美国熊牌1000III型呼吸机故障检修与保养

本文主要对美国熊牌1000I I I呼吸机的故障原因进行了分析,并就此提出了解决方法和几点保养方案。     

BiPAP无创通气治疗COPD合并Ⅱ型呼吸衰竭疗效观察

目的探讨双水平正压无创通气（BiPAP）对慢性阻塞性肺疾病（COPD）合并Ⅱ型呼吸衰竭的治疗价值。方法70例COPDⅡ型呼衰患者中随机分成通气组和对照组，对照组给予常规抗感染、平喘、祛痰对症治疗和低浓度氧疗，通气组除了常规治疗外，加无创机械通气（BiPAP）治疗，采用通气口鼻面罩，设定参数S／T模式，呼吸频率14—20次／min，氧浓度40％左右，吸气压（IPAP）以10cm H2O开始，逐渐增加压力至25cmH2O，呼气压（EPAP）3—6cmH2O，每日上机2次，每次3h，7d为1个疗程。结果通气组治疗后动脉血气分析中pH值和PaO2逐渐上升，PaCO2值下降，临床症状改善，减轻呼吸肌疲劳，减慢呼吸频率和心率，呼吸困难减轻。结论本法治疗COPD合并Ⅱ型呼吸衰竭有效，减少气管插管或气管切开以及相应的并发症，减少病人的痛苦和医疗费用。     

幼儿室间隔缺损术后两种机械通气撤机方法的效果比较

目的比较幼儿室间隔缺损修补术后同步间歇指令通气(SIMV)模式撤机法与直接撤机法的效果。方法将50例室间隔缺损修补术后行机械通气的患儿随机分为两组,观察组30例,予SIMV模式过渡撤机,对照组20例,采用直接撤机法。比较两种撤机方法的效果。结果两组撤机时间比较差异有统计学意义(P<0.01),观察组所需的时间更短,并且呼吸机相关性肺炎(VAP)的发生率更低(P<0.05);两组再置管率比较无统计学差异(P>0.05);撤机前后的心率、呼吸及血压的变化值比较均有统计学意义(P<0.01),观察组变化幅度较小;两组撤机前后的PaO2、PaCO2及pH值的比较均无统计学差异(P>0.05)。结论在幼儿室间隔缺损修补术后,应用SIMV法撤机能够缩短呼吸机辅助的时间和降低VAP的发生率,所以效果优于直接撤机法。     

与呼吸机联用的智能化一氧化氮治疗仪的研制

为满足临床一氧化氮（NO）吸入治疗安全、可靠、方便、经济的原则，研制了与呼吸机连用的智能化一氧化氮治疗仪。通过摸索呼吸机在不同参数下与不同浓度的NO之间配气之间的关系，设计了程序，使NO吸入智能化。同时采用质量流量控制器、单片机为主体的电路控制系统。此外，还设计了NO混合装置，使NO同呼吸机的给气混合更加均匀。经过临床实验证明：研制的智能化一氧化氮治疗仪提供的NO能有效降低肺动脉高压（PH），提高血氧饱和度（SaO2），且产生二氧化氮（NO2）小于5ppm，使用安全方便。     

WMZ-01便携式箱仪一体麻醉机的研制

介绍一种便携式箱仪一体麻醉机。具有麻醉和呼吸功能,以及各项参数安全报警功能,并能够显示潮气量与呼吸比,主要用于医院各类外科手术麻醉。     

浅快呼吸指数在预测呼吸机撤离中的价值

目的探讨浅快呼吸指数(Rapid Shallow Breath Index,RSBI)在加强医疗病房(Intensive Care Unit,ICU)机械通气超过72h的患者撤离呼吸机的预测作用。方法采用前瞻性研究方法,对满足常规撤机标准的33例患者,进行120min自主呼吸试验(Spontaneous Breath Trial,SBT)并动态监测5、15、30,60、120min五个时点的RSBI,根据撤机结果分为撤机成功组和撤机失败组。应用SPSS 15.0统计软件对数据进行统计分析。结果23例患者完成了120min SBT,其中有12例撤机失败。在SBT 5min和SBT 15min时候,RSBI在撤机成功组和撤机失败组之间没有统计学意义(P>0.05),而在SBT 30min及SBT 30min以后时点撤机失败组的RSBI明显高于撤机成功组的RSBI (P<0.05)。5个时点的RSBI的ROC下面积分别为0.52、0.71、0.91、0.96、0.99。结论在ICU中,对机械通气超过72h以上的患者撤离呼吸机的时候,SBT 2h时的RSBI较之前的RSBI具有更高的预测价值。     

PB840呼吸机突然关机等故障检修2例

介绍了840呼吸机在使用过程中出现的两例故障,并进行了分析与排除。     

Pulmonary infection control window in treatment of severe respiratory failure of chronic obstructive pulmonary diseases: a prospective, randomized controlled, multi-centred study

Background Early withdraw from invasive mechanical ventilation (MV) followed by noninvasive MV is a new strategy for changing modes of treatment. This study was conducted to estimate the feasibility and the efficacy of early extubation and sequential noninvasive MV commenced at beginning of pulmonary infection control window in patients with exacerbated hypercapnic respiratory failure caused by chronic obstructive pulmonary diseases (COPD). Methods A prospective, randomized controlled study was conducted in eleven teaching hospitals’ respiratory or medical intensive care units in China. Ninety intubated COPD patients with severe hypercapnic respiratory failure triggered by pulmonary infection (pneumonia or purulent bronchitis) were involved in the study. When the pulmonary infection had been controlled by antibiotics and comprehensive therapy, the 'pulmonary infection control window (PIC window)' has been reached. Each case was randomly assigned to study group (extubation and noninvasive MV via facial mask immediately) or control group (invasive MV was received continuously after PIC window by using conventional weaning technique).Results Study group (n=47) and control group (n=43) had similar clinical characteristics initially and at the time of PIC window. Compared with control group, study group had shorter duration of invasive MV ［(6.4±4.4) days vs (11.3±6.2) days, P=0.000］, lower rate of ventilator associated pneumonia (VAP) (3/47 vs 12/43, P=0.014), fewer days in ICU ［(12±8) days vs (16±11) days, P=0.047］ and lower hospital mortality (1/47 vs 7/43, P=0.025).Conclusions In COPD patients requiring intubation and invasive MV for hypercapnic respiratory failure, which is exacerbated by pulmonary infection, early extubation followed by noninvasive MV initiated at the start of PIC window may decrease significantly the duration of invasive MV, the risk of VAP and hospital mortality.     

Performance characteristics of 10 home mechanical ventilators in pressure-support mode: a comparative bench study

OBJECTIVE: Inspiratory pressure (Pi) support delivered by a bilevel device has become the technique of choice for noninvasive home ventilation. Considerable progress has been made in the performance and functionality of these devices. The present bench study was designed to compare the various characteristics of 10 recently developed bilevel Pi devices under different conditions of respiratory mechanics. DESIGN: Bench model study. SETTING: Research laboratory, university hospital. MEASUREMENTS: Ventilators were connected to a lung model, the mechanics of which were set to normal, restrictive, and obstructive, that was driven by an ICU ventilator to mimic patient effort. Pressure support levels of 10 and 15 cm H(2)O, and maximum were tested, with "patient" inspiratory efforts of 5, 10, 15, 20, and 25 cm H(2)O. Tests were conducted in the absence and presence of leaks in the system. Trigger delay, trigger-associated inspiratory workload, pressurization capabilities, and cycling were analyzed. RESULTS: All devices had very short trigger delays and triggering workload. Pressurization capability varied widely among the machines, with some bilevel devices lagging behind when faced with a high inspiratory demand. Cycling was usually not synchronous with patient inspiratory time when the default settings were used, but was considerably improved by modifying cycling settings, when that option was available. CONCLUSIONS: A better knowledge of the technical performance of bilevel devices (ie, pressurization capabilities and cycling profile) may prove to be useful in choosing the machine that is best suited for a patient's respiratory mechanics and inspiratory demand. Clinical algorithms to help set cycling criteria for improving patient-ventilator synchrony and patient comfort should now be developed.     

新生儿机械通气时撤机失败原因分析

目的分析新生儿机械通气时呼吸机撤机失败原因。方法对自1999年4月至2006年2月我院儿内科新生儿重症监护病房（NICU），应用人工呼吸机235例中出现撤机失败的29例进行临床分析。结臬应用机械通气治疗新生儿呼吸衰竭时，撤机失败率早产儿组较足月儿组和过期产儿组高（P〈0．01）；多脏器功能损害组较非多脏器功能损害组高（P〈0．01）；机械通气时间3d以上组较机械通气0—3d组高（P〈0．05）；无静脉营养支持组较静脉营养支持组高（P〈0．05）。结论及时治疗原发病、合理使用呼吸机、加强机械通气管理、及时适时撤机、正确诊治呼吸机相关性肺炎、加强营养支持，是减少呼吸机撤机失败的关键。