机械通气治疗危重症支气管哮喘20例临床分析

目的 探讨机械通气治疗危重症支气管哮喘的方法和疗效.方法 对20例危重症支气管哮喘患者行气管插管机械通气治疗,观察机械通气前和机械通气后2 h、12 h、24 h的pH值、PaO2、PaCO2、SaO2等动脉血气指标的变化情况.结果 18例(90%)患者抢救成功.机械通气后PaO2、SaO2均明显升高,PaCO2明显降低,pH值明显改善.结论 机械通气是治疗危重症支气管哮喘患者的有效方法,适当的通气模式和参数、应用"肺保护策略"能够迅速改善氧合,避免出现呼吸机相关性肺损伤.     

有创机械通气治疗急危重左心衰的临床研究

目的：观察有创机械通气治疗急危重左心衰的效果。方法：选择2012年4月——2014年4月于我院住院治疗的83例急危重左心衰患者,均已进行抗心衰常规药物治疗,因效果差,病情迅速变化,而予以紧急经口气管插管及呼吸机辅助呼吸。比较机械通气患者生命体征、动脉血气及血浆NT-proBNP值的变化。结果：24小时后患者通气迅速改善,缺氧逐渐纠正,患者心率、无创血压、呼吸频率、血氧饱和度较前明显改善,血浆NT-proBNP浓度亦较前明显下降,且患者在使用呼吸机辅助通气期间未出现血流动力学的恶化。结论：机械通气是抢救及危重左心衰患者的重要措施,能迅速改善患者通气,纠正低氧血症。     

机械通气新模式（3）

1闭合环通气简介 所谓"闭合环通气"(C10sedloop ventilation,CLV),通俗地说,可称为智能化通气.呼吸机模拟医生实施机械通气的全过程,获取患者的通气需要和各相关资料,自动监测各项指标,分析监测结果并及时自动地调整呼吸机参数.     

80例人机对抗原因分析

目的分析机械通气人机对抗的原因,提高机械通气技术水平。方法回顾性分析80例行机械通气治疗发生人机对抗的原因及处理方法。结果80例患者在机械通气过程中共发生人机对抗172例次。人机对抗的原因是：患者自身因素162例次（94．1％）,使用者技术水平7例次（4．0％）,呼吸机因素3例次（1．7％）。经及时处理,所有患者最后均顺利脱机。结论在机械通气过程中发生人机对抗时,先从患者方面查找原因,再考虑使用者技术水平及呼吸机因素,判断准确,则采取的处理更有针对性及有效。     

急性呼吸窘迫综合征患者机械通气中小潮气量联合低平台压的应用

目的探讨小潮气量联合低平台压运用于急性呼吸窘迫综合征患者机械通气中的效果。方法选取我院收治的100例急性呼吸窘迫综合征患者,按治疗方案的不同分为两组各50例。对照组给予常规治疗,研究组在常规治疗的基础上运用小潮气量联合低平台压进行干预,比较两组的呼吸机相关参数、并发症发生率、机械通气时间以及住院时间。结果研究组的潮气量、PEEP、气道平台压等呼吸机相关参数均显著优于对照组(P<0.05)。研究组的并发症发生率为4.00%,显著低于对照组的20.00%(P<0.05)。研究组的机械通气时间、住院时间均显著少于对照组(P<0.05)。结论小潮气量联合低平台压应用于急性呼吸窘迫综合征患者机械通气中,可有效改善患者的呼吸机相关参数,降低并发症发生率,缩短机械通气时间与住院时间。     

氨溴索在AOPP致呼吸衰竭患者机械通气中的临床应用观察

目的研究氨溴索针剂对急性有机磷农药中毒致呼吸衰竭患者机械通气过程中的治疗效果。方法急性有机磷农药中毒并呼吸衰竭的机械通气患者,在机械通气过程中采用氨溴索针剂治疗,比较两组间的呼吸机相关性肺炎发生率、气管导管痰栓堵塞发生率、机械通气时间及住院时间。结果氨溴索治疗显著降低呼吸机相关性肺炎发生率、气管导管痰栓堵塞发生率、机械通气时间及住院时间。结论在急性有机磷农药中毒致呼吸衰竭患者的机械通气治疗同时使用氨溴索,促进痰液排出,优化气道管理,降低机械通气的相关并发症,可取得良好的治疗效果：     

E200呼吸机的机械通气方式及临床应用

呼吸机治疗的目的是帮助病人完成有效的肺泡通气和交换。在应用呼吸机时必然考虑两个问题：一是病人自主呼吸的目前情况,需要让呼吸机完成哪方面的不足？若自主呼吸完全停止,毫无疑问需要呼吸机完全替代;若肺泡气体交换障碍,需用呼吸机提高功能残气量。二是呼吸机本身的功能是否满足病人的需要？怎样调节才能保证既解决病人的通气不足,又能减少对病人的生理干扰？这些都涉及呼吸机通气方式问题。现就我院常用的Ｅ２００呼吸机的机械通气方式及临床应用做一简介。１　容量控制通气（ＶＣＶ）容量控制通气时首先预置控制通气的潮气量、吸…     

机械通气治疗儿童危重症甲型H1N1流感肺炎临床观察

目的:探讨机械通气在治疗儿童危重症甲型H1N1流感肺炎的作用。方法:回顾性分析实施机械通气的11例危重症儿童甲型H1N1流感肺炎的临床资料,根据机械通气的选择时机分A组7例为早期机械通气组,B组4例为常规机械通气组。对该病机械通气指征、呼吸机参数、机械通气时间及治疗效果进行分析。结果:A组在出现气促、胸片两肺出现模糊影、血气示过度通气即予正压通气,呼吸机参数吸气峰压(PIP)达22 cm H2O、呼气末正压(PEEP)达7 cm H2O、氧浓度(FiO2)40%～50%即可改善低氧血症,总上机时间4～5天,全部治愈。B组出现明显低氧血症、肺部大量湿罗音、胸片示两肺白肺、血气示Ⅰ型甚至Ⅱ型呼吸衰竭时上呼吸机,呼吸机参数PIP高达25 cm H2O、PEEP高达10 cm H2O、FiO280%～100%仍不能改善低氧血症,机械通气持续24～48 h后经皮氧饱和度方升至90%以上,总上机时间7～10天,1例死亡、3例安全撤机。结论:早期机械通气是治疗儿童甲型H1N1流感肺炎合并急性呼吸窘迫综合征的有效途径;以最小的PEEP达到适宜的氧合指标是提高机械通气成功率、防止肺损伤的关键。     

机械通气治疗危重症支气管哮喘的监护体会

目的总结机械通气治疗危重症支气管哮喘患者的监护经验。方法 2003年8月—2011年6月应用机械通气治疗危重症支气管哮喘患者21例,对患者实施监护,确保呼吸机正常运行,做好气道管理。结果安全脱机存活19例,死亡2例,抢救成功率90.5%。结论加强对患者监护,是机械通气顺利实施的保证,能有效改善患者的呼吸功能,减少危重症支气管哮喘患者的死亡率。     

胸肽肽α1在长期机械通气患者预防呼吸机相关肺炎的应用

目的：分析胸肽肽α1（日达仙）在长期机械通气患者预防呼吸机相关肺炎的应用价值。方法：对1例高龄长期应用机械通气患者给予胸肽肽α1 1.6mg，皮下注射，每周两次，治疗1年余，分析应用胸肽肽α1后0．5年及0．1－1年时间内与未应用胸肽肽α1两个0．5年时间的体温变化，肺部感染次数，痰培养结果及病重，病危天数，药费，检查费等，并对血常规、血生化结果进行比较。结果：应用胸肽肽α1后体温升高天数减少；呼吸机相关肺炎发生次数减少，对抗生素不敏感的嗜麦芽寡养单胞菌消失，各项检查次数减少，血尿素氮恢复正常，病情处于平稳状态。结论：长期机械通气患者应用胸肽肽α1治疗可减少呼吸机相关肺炎次数，改善患者全身状况，减少医疗费用。     

呼吸机主要性能指标的质量控制技术

目前呼吸机的临床应用越来越广泛，各医院对所购进呼吸机的性能判定通常是依据设备供应商提供的技术指标，医院缺乏自己的检测和判定设备技术性能的方法和设备。采用呼吸机的质量监测技术，提出对潮气量调节范围、分钟最大通气量、输出气体最低氧浓度、呼吸频率范围、呼吸比、最大安全压力等技术参数进行检测的方法和技术性能要求，可以客观评价呼吸机的主要技术指标，保证临床安全、准确地使用呼吸机。     

智能化呼吸机控制技术与临床应用

介绍了智能化呼吸机的智能控制机理、控制技术以及SmartCare和AutoFlow模式的应用,分析了机械通气时智能化呼吸机的故障及对策,探讨了机械通气过程中智能化呼吸机故障报警等级对患者的影响,提出了研制开发智能化呼吸机是大势所趋,提倡进行开发性使用,加强人员学习和培训,充分发挥智能化呼吸机的作用。     

简易呼吸器负压通气辅助治疗慢性阻塞性肺病的研究

目的：探索使用自制的简易呼吸器负压通气对慢性阻塞性肺病（COPD）的治疗作用。方法：68例COPD患者随机分为治疗组和对照组,其中治疗组35例,自制简易呼吸器连接吸引器调节负压可以使呼气相负压值为-5 cmH2O（1 cmH2O=98.063 8 Pa）,每天至少通气1 h,连续应用7 d;对照组33例,使用常规鼻导管吸氧。两组均按照常规给予抗感染及对症治疗。观察比较患者的肺功能、动脉血气、住院天数及费用。结果：与对照组相比,治疗组COPD患者的FVC、FEV1（%）、pa（O2）、pa（CO2）均有显著性改善（P〈0.01）。结论：简易呼吸器间歇负压通气对COPD患者有较为肯定的治疗作用。     

Workplace measurement of respirator effects using respiratory inductive plethysmography

A useful system to study the cardiopulmonary effects of respirators in the workplace would be reliable, portable, and lightweight and would not encumber the nose or mouth or require modification to the respirator. Twenty men using such a system (which measured ventilatory parameters by respiratory inductive plethysmography [RIP]) were studied. The subjects all performed their usual jobs which involved some work with and some without a respirator. Twelve subjects used airline respirators and eight used air-purifying respirators. The RIP equipment measurements included respiratory frequency, tidal volume (VT), minute ventilation (V), and heart rate (HR). The RIP data from 20 other subjects was lost because of equipment malfunction, primarily lead separation in those whose jobs involved climbing around large workpieces. In general, the workers' cardiopulmonary parameters increased during respirator wear, probably because of a combination of factors, including the increased exercise of most respirator-requiring tasks and the weight and heat stress associated with the respirator and protective clothing. When the ventilatory parameters with and without a respirator were compared at the same heart rates, no significant differences were noted in VT for the entire group. Respiratory frequency, however, and V increased with respirator wear. The effects of respirators alone were found to be commonly confounded in the workplace by changes in protective clothing, exercise requirements, and ambient heat stress. Further improvements in the portable RIP system are needed before it can be accepted as a reliable ventilatory measurement device in the workplace.     

Physiologic and subjective effects of respirator mask type.

The effect of alternate airflow path designs on full-face mask air-purifying respirators was assessed in 14 healthy volunteers during submaximal exercise. Respirator designs included no respirator (N), full-face mask, dual-cartridge with no nasal deflector (FN), full-face mask respirator with nasal deflector (FD), and a powered air-purifying respirator (PA). Physiologic effects were measured by using respiratory inductive plethysmography and subjective responses by two visual analog scales. There were significant effects of airflow path design upon the physiologic parameters of ventilation, tidal volume, and mean flow rate. There were no significant physiologic or subjective differences between the full-face mask respirators with and without the nasal deflector in place. The PA had less physiologic impact than the nonpowered models but did not show significant subjective benefit. The study suggests that both subjective and objective physiologic responses must be utilized in assessing respirator design.     

Identification of faceseal leak sites on a half-mask respirator

A method has been developed to identify the location and shape of respirator faceseal leak sites by the deposition of a fluorescent tracer. An aerosol generation, conditioning, and exposure system to provide a test environment with stable aerosol concentration and size distribution of 4-methyl-7-diethylaminocoumarin was designed and tested. Faceseal leak sites on a respirator mounted on a mannequin and worn by human subjects were identified by deposition of the tracer aerosol and subsequent observation under long-wave ultraviolet lighting. Test parameters were identified for the optimal definition of leaks. Photographic techniques were developed to document the identified leak sites.     

定期更换不同长度气管套管预防机械通气气道并发症的临床研究

目的研究不同长度气管套管在长期机械通气患者预防并发症的应用效果。方法选取住老年病房呼吸科并行气管切开长期(大于6个月)机械通气的患者59例,采用随机数字法分为对照组30例、实验组29例,每2个月更换导管1次,对照组每次常规使用8 cm导管,实验组使用统一型号3种不同长度导管,分别为8 cm导管、9 cm导管、10 cm导管。结果两组内囊压力高压发生率和气道黏膜损伤情况相比较,差异具有统计学意义(P0.01)。结论应用不同长度气管套管,可以改变患者局部组织受压部位,缩短同一点受压迫、刺激的时间,从而降低气道并发症发生率;同时,不同长度气管套管使用安全,值得临床推广应用。     

便携式呼吸机的研制及应用

便携式呼吸机的设计采用了先进的传感器、计算机、气动控制等技术,使其具有压力支持、同步间歇指令通气,反比通气等多种先进的通气方式,计算机机控制下的自动应急操作功能,使便携式呼吸机适用于多种病症的求治,携带和使用特别方便,不仅适应于野战、家庭。也适用于医院临床、手术室等。解决了以便携式呼吸机功能单一的缺陷。     

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。     

Clinical pulmonary function tests as predictors of work performance during respirator wear

The Occupational Safety and Health Administration (OSHA) mandate requiring medical information for respirator users provides the physician with little or no guidance as to what objective criteria may be valuable in assessing the worker's ability to use a respirator safely. Therefore, the purpose of this study is to use the results of clinical pulmonary function testing to predict performance time on maximal- and endurance-type exercise tests. Respirator mask wear reduced clinical pulmonary function measures from 7%-15% from mouthpiece controls. The resistances of the mask reduced forced vital capacity by an average of 11.6% (0.65 L); forced expiratory volume in 1 sec by 7.3% (0.33 L); and maximum voluntary ventilation in 15 sec by 7.4% (12.4 L/min). Stepwise linear regression analysis was used to determine the clinical pulmonary function measures that were the best predictors of work performance. The MVV.25 with the respirator was determined to be the best predictor of maximal exercise performance both with and without the respirator. The difference in peak inspired flow with and without the respirator was the best predictor of performance time with the respirator during the endurance walk to exhaustion. Recommendations are made to the physician for procedures for determining a worker's pulmonary capacity and calculating the effect of the respirator in reducing that capacity. This information then will allow the physician to determine safe levels of ventilation for a particular work task.