呼吸机知识讲座（1）

氧气是人们生活中时刻不可缺少的。呼吸就是不断地把空气中的氧气吸人体内．再把体内产生的二氧化碳排出体外。人的呼吸系统是由鼻子、气管、支气管和肺组成。肺脏是人体的主要呼吸器官．它在结构上分成呼吸道和肺泡两部分。     

呼吸机机械通气概述及应用

1机械通气概述呼吸机应用于临床已有50多年的历史。呼吸机的使用实际上是建立气道口与肺泡间的压力差,给呼吸功能不全的患者予以呼吸支持。呼吸机的设计原理有2种:负压通气和正压通气。负压通气是制造出一个风箱装置,通过箱压力变化产生负压,模拟人肺的运动而进行通气,负压通气     

呼吸机常见故障的排除

机械通气作为生命支持和呼吸治疗的有效手段，广泛应用于临床各个领域，呼吸机已成为ICU、急诊科、呼吸科的常用设备。随着医学科技的进步，呼吸机的发展经历了从简易的机械控制到全电脑控制的智能化过程，所能控制和监测的项目越来越多，设备越来越复杂，故障也相应地越来越复杂。现以纽邦E-200呼吸机为例（其他型号原理大同小异），归纳一下我们工作中常见的故障。     

机械通气技术及呼吸机的现状与发展

本主要介绍了机械通气技术及呼吸机发展简史、常用技术、现状及发展趋势。     

拉斐尔（银）呼吸机故障两例

瑞士夏美顿公司生产的拉斐尔银呼吸机是一个电子控制的呼吸通气系统,是典型的“机、电、气”一体的精密仪器。适用于儿童和成人,具有较齐全的呼吸通气模式。我院有一台使用多年,故障率较低。下面列出两例拉斐尔银呼吸机在使用中的故障及排除方法,供大家参考和交流。     

呼吸机三种通气模式的描述

不同呼吸机的各通气模式的描述不尽相同，大大增加了临床医护人员使用中的困难，下面是我所了解的三种通气模式的概述。     

呼吸机常见通气模式的探讨

本文介绍了呼吸机中常用的几种呼吸模式,分析了目前使用各种通气方式的原理、特点及适用范围。     

机械通气呼吸机的清洁和消毒

本文阐述了机械通气(呼吸机)常规和SARS情况下的清洁和消毒过程。     

护理干预防治呼吸机相关肺炎探讨

目的:机械通气48h后发生的肺炎称为呼吸机相关性肺炎,是一种特殊类型的医院获得性肺炎,是医院获得性感染的主要死亡原因.医院获得性肺炎病死率很高,约25-70%.大剂量抗生素应用,二重感染,使病人住院费用增加,也增加病人死亡率.在此,介绍加强护理手段,预防应用呼吸机引起相关肺炎.     

COPD机械通气并发呼吸机依赖的原因及护理干预

机械通气是治疗慢性阻塞性肺气肿(COPD)伴发重度呼吸衰竭的主要手段之一,且通气时间较长.通常把通气时间大于72h称为呼吸机依赖[1].呼吸机依赖是临床上行机械通气治疗时常见的并发症之一,撤机失败率很高,是呼吸监护的临床难题之一.该文通过对30例COPD行机械通气治疗时并发呼吸机依赖患者的详细观察分析,认为产生呼吸机依赖的原因主要与病人的心理状态、身体情况、带机并发症的产生以及呼吸机撤机时间的正确把握等有关;实践证明加强对病人的心理身体支持、掌握规范的操作规程、预防带机时的感染及把握适宜的撤机时间等是防治COPD机械通气并发呼吸机依赖的关键.     

呼吸机知识讲座（2）

当前在世界上应用的机械呼吸机多达数百种，从简单的气动定压型机械呼吸机，到装有电子计算机及各种辅助设备的定容型多功能呼吸机。国内临床上常用的亦有数十种之多。这些机械呼吸机的设计、构造、操作方法等都互不相同，很难以一个统一的模式来加以阐述。但无论如何复杂的呼吸机，按各部分构造的功能不同，大致可分为如表一所示的几个功能组成部分。     

呼吸机的性能分析

H1N1疫情的不断发展和扩散,对重新认识呼吸机及其性能在临床工作中的应用非常必要。分析了呼吸机的使用风险,重点阐述了呼吸机的概念以及当今呼吸机主要应用的模式与功能等。     

呼吸机的质量控制

目的：通过对呼吸机的质量检测,确保呼吸机在临床使用中的安全性。方法：按照《呼吸机临床应用质量检测和风险评估表》,对在用呼吸机的外观状态、电气安全、机械通气参数、安全报警功能及机械通气模式等项目进行质量检测和风险评估。结果：抽检的79台呼吸机合格率为77.2%,不合格的因素主要表现在：无开机自检功能、无氧浓度监测报警等;在机械通气参数中,潮气量、吸气压力水平、呼气末正压超标。结论：呼吸机的质量控制是一个系统工程,涉及到临床、医学工程、医疗管理、医院管理等多方面,需要各部门相互配合和支持,共同做好。     

Persistence of Respirator Use Learning

Although retraining and repeat fit-testing are needed for respirator users, the optimal frequency is uncertain. The persistence of proper respirator donning/doffing techniques and changes in quantitative fit factor over 6 months after initial training were measured in this study. Initial training was designed for rapid rollout situations in which direct contact with well-trained occupational health professionals may be infeasible. Subjects (n = 175) were assigned randomly to use either a filtering facepiece N95 (FFR) or dual cartridge half facemask (HFM) respirator. Each was assigned randomly to one of three training methods—printed brochure, video, or computer-based training. Soon after initial training, quantitative fit and measures of proper technique were determined. These measurements were repeated 6 months later. In the six-month followup, subjects were randomized to receive either a brief reminder card or a placebo card. Total performance score, major errors, and quantitative fit all became significantly worse at 6 months. An individual's result soon after training was the most important predictor of performance 6 months later. There was a marginal not statistically significant tendency for those initially trained by video to have better protection 6 months later. The study suggests that persons who use respirators intermittently should be thoroughly retrained and reevaluated periodically.

[Supplementary materials are available for this article. Go to the publisher's online edition of Journal of Occupational and Environmental Hygiene for the following free supplemental resource: Additional statistical analyses.     

Respirator fit factor performance while sweating

The extent to which sweat accumulation inside respirators affects respirator fit has not been quantified. This study represents an attempt to measure facial sweating and to quantify its effects on fit factors of negative pressure, full-facepiece respirators. Respirator fit factor (FF) data were obtained while 14 subjects completed 30 minutes of treadmill walking at an intensity of 75% of age-predicted maximal heart rate in an aerosol test chamber under ambient environmental conditions. Subject facial and whole body sweat production were also measured. Statistical analysis of the treadmill FF results showed that respirator fit was significantly (p < 0.05) degraded after 14 minutes of exercise. Sweat accumulation inside the respirator facepiece averaged 30.9 +/- 15.5 g. However, no significant correlation of subject facial sweat production with overall FF values measured during exercise was found. The results of this study indicate that respirator FFs degrade significantly over time under moderate exercise and environmental conditions and suggest that facial sweat accumulation alone does not account for the reduced FF levels.