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1、.,1,郭凤梅东南大学附属中大医院重症医学科,人机不同步 关注呼吸机设置,.,2,人机不同步,概念：机械通气与患者自主呼吸不同步的现象 分类：吸气触发 吸气呼气切换 吸气潮气量,.,3,Asynchrony during non-invasive ventilation,6 ICUS60 acute respiratory failure patientsEMGdi was measured,Intensive Care Med,2009;35(5):840-6.,44%患者存在严重人机不同步,.,4,Time asynchrony during invasive MV,Pats 62 ACV
2、和PSV MV24h监测食道压力、流速压力波形30分钟内无效触发、双触发的次数不同步指数不同步事件次数/患者所有吸气努力次数24患者人机不同步指数10%(严重人机不同步),Thille AW,Intensive Care Med 2006;32:15151522,.,5,Asynchrony-ventilation induced lung injury,N Engl J Med,2010;363:1107-1116.,.,6,Consequence of asynchrony,N Engl J Med,2010;363:1176-1180,.,7,N Engl J Med,2010;363:
3、1176-1180,.,8,Consequence of asynchrony,Thille AW,Intensive Care Med 2006;32:15151522,镇静、肌松剂使用增多改变自主呼吸形式机械通气时间延长,.,9,触发延迟延长机械通气时间,Asynchrony index：defined as the number of asynchrony events divided by the total RR,Intensive Care Med 2006;32:15151522,.,10,分 类,吸气触发：吸气呼气切换：吸气潮气量：,.,11,Auto trigger,Poss
4、ible ReasonspatientCardiogenic oscillatorsVentilatorLower triggeringCircuit leaksWater in circuit,.,12,Ventilator waveforms,Trigger asynchrony,Ineffective effort,Thille AW,Clinical Pulmonary Medicine 2007;14:350-359,.,13,触发延迟,Am J Respir Crit Care Med 2005;172:12831289,.,14,-1cmH2O,.,15,-2cmH2O,.,16
5、,-3cmH2O,-3cmH2O,.,17,Double trigger,Possible ReasonspatientStrong and prolonged inspiratory effortVentilatorReduce mechanical inflation time,ALI patient with ACV,.,18,Flow asynchrony,pressure trace is dished out,Critical Care Nurse.2009;29:41-55.,Intensive Care Med.2006;32:3447.,.,19,Cycle-off asynchrony,Critical Care Nurse.2009;29:41-55.,premature termination,delayed termination,.,20,Thank you for your attention!,
