I. Lub ntsiab siv tshuab tshuab hluav taws xob
(Kuv) sib quas ntus muaj kev kub siab (IPPV): Kev ua kom zoo nyob rau theem thiab xoom siab hauv cov theem tas sij hawm. 1. Ua haujlwm ua haujlwm: Lub tshuab ua pa hluav taws xob ua kom muaj zog hauv lub ntsws, thiab cov pa hluav taws xob nce mus rau hauv lub ntsws, thiab cov pa hluav taws xob tau qhib, thiab lub ntsws ua kom sov. 2. Cov ntawv thov cov neeg mob: ntau yam kev ua pa rau kev ua pa raws li kev ua pa, xws li tub ceev xwm.
(II) Cov kev sib tshooj siab tsis zoo thiab tsis zoo nyob twj ywm (IPNPV): Kev ua kom zoo nyob rau theem thiab siab tsis zoo hauv cov theem ntxim nyiam. 1. Ua haujlwm ua haujlwm: Lub dav hlau tuaj yeem ua haujlwm hauv ob theem kev ua tiav. 2. Cov ntawv thov cov chaw kuaj mob: qhov tsis zoo hauv cov theem ntxim nyiam tuaj yeem ua cov alveolar vau thiab iatrogen atelectasis.
(III) Nruam txuas ntxiv zoo txoj kev ua pa siab (CPAP): yog hais txog cov ntawv thov cuav rau tus neeg mob lub sijhawm tag nrho ua pa ntawm cov kev ua pa. 1. Ua haujlwm ua haujlwm: Nruam khoom txuas ntxiv raug tshem tawm thaum lub sijhawm ua haujlwm tsis txaus siab, yog li cov theem kev tawm tsam hauv ob theem kev tshoov siab thiab tas li siab dua li cov cua tshuab siab. 2. Cov txiaj ntsig: kev txuas ntxiv zoo siv cua tshuab cua ua pa tau ntau dua li cov neeg mob airflow, uas txuag tau tus mob siab, nce qib siab, thiab tiv thaiv kev ua pa thiab alveolar vau. Nws tuaj yeem siv rau kev cob qhia ua ntej weaning los ntawm lub tshuab. 3. Qhov tsis zoo: Muaj kev cuam tshuam loj nrog kev mob taug kev thiab kev ua kom hnyav dua rau lub ntsws.
(IV) Cov khoom siv sib txawv uas yuav tsum tau ua cua thiab cov tshuab ua pa tawm, thiab lub sijhawm ua pa tawm, thiab lub sijhawm ua pa tawm hauv lub voj voog ua pa tsis tu ncua. 2. Simv: nrog cov khoom siv synchronization, lub tshuab ua pa muab ua pa rau tus neeg mob yuav tsum ua pa rau cov pa ua ntej siv txhua feeb. Tus neeg mob yuav ua pa tau li cas tsis muaj kev cuam tshuam los ntawm lub tshuab raj. 3. Cov txiaj ntsig: nws tuaj yeem tsim nyog tau lub peev xwm los tswj kev ua pa thaum weaning; Nws tsis tshua muaj kev cuam tshuam rau kev ncig mus thiab lub ntsws dua li IPPV; Nws txo cov kev siv sedatives mus rau qee yam. 4. Daim ntawv thov: Nws yog feem ntau suav tias yog siv thaum weaning. Thaum r <5 zaug / min, nws tseem tseem tswj hwm lub xeev cov pa oxygenation zoo thiab tuaj yeem raug txiav txim siab rau kev sib tw. Feem ntau, PSV ntxiv kom tsis txhob ua pa ua pa ua pa.
(V) Yuav tsum tau tso pa tawm feeb (MMV) 1. Preset feeb tsis ua kom qhov chaw nres nkoj, tab sis tsuas yog muab kev nce siab tas li. 2. Thaum muaj ua pa rau sab nrauv
(VII) ntim txhawb cov cua (VSV): Txhua ua pa tau ua rau tus neeg mob cov ua pa zoo li qub. Tus neeg mob tseem tuaj yeem ua pa tsis muaj kev txhawb nqa thiab ncav cuag cov kev xav TV thiab MV qib. Lub tshuab ua pa yuav tso cai rau tus neeg mob ua pa tau li cas, uas tseem siv tau los npaj ua ntej weaning.
(VIII) Kev Tiv Thaiv Siab-Tswj Xyuas Ntim Tswj
(Ix) biphasic lossis ob theem siab muaj cua daj cua dub 1. Ua haujlwm sib luag, P2 yog sib npaug rau kev tshoov siab lub sijhawm, thiab T2 yog sib npaug. 2. Cov ntawv thov kev kho mob: (1) Thaum P {8}}}}}} Cov sijhawm so, nws yog sib npaug rau IPPV. (2) Thaum P {13}} peep, t {14}} infinity, p}}}}} o, nws yog sib npaug rau CPAP. (3) Thaum P 1=Kev tshoov siab siab, t {19}}}}} tso cai tswj kev ua pa, nws yog sib npaug rau Simv.
Ii. Lub ntsiab haujlwm ntawm kev hloov tshuab cua
(Kuv) xaus-ua pa zuaj 1. Tom qab qhov kawg ntawm kev tshoov siab thiab ua ntej lub tshuab pa hluav taws xob tsis tau raug kaw rau lub sijhawm kom muaj kev mob siab rau theem. 2. Chaw soj ntsuam cov ntaub ntawv: (1) ntev lub sijhawm kev tshoov siab, uas tau txais txiaj ntsig rau kev faib roj. (2) Saib xyuas cov kev sib cais ntawm cov roj (3) Kev txhawb nqa cov khoom xa tawm thiab kev sib txawv ntawm cov tshuaj tsis nqus tshuaj hauv lub ntsws. 3. Yuav tuaj yeem nce lub nra rau lub siab.
(II) Qhov xaus zoo-thaum kawg ntawm kev tso tawm qhov cua daj cua dub 1. Thaum kawg ntawm kev tso tawm, cov hlab cua siab tsis poob rau theem siab siab. 2. Cov ntawv thov chaw kuaj mob: Siv rau Hypoxemia tshwm sim los ntawm kev ua haujlwm Alveulmonary, thiab pab txhawb kev sib tsoo Alveoli ntau dua li ntawm cov alveoli thiab cov pa taws. (3) Kev nce qib nce zuj zus nce alveolar-arterial oxygen ib nrab siab, uas yog conducion ntawm oxygen ntawm oxygen ntawm oxygen ntawm oxygen ntawm oxygen ntawm cov pa roj oxygen. Alveoli ib txwm nyob rau hauv lub xeev ntawm kev nthuav dav, uas tuaj yeem nce cov diffusion thaj tsam ntawm alveoli. (4) nce ntxiv qib alveolar tuaj yeem nce siab ntsws ua ntej thiab txo cov kev ua pa.
4. Cov kev mob tshwm sim tseem ceeb ntawm kev dag (1) kev cuam tshuam rau ntawm kev hem Nws txo cov ntshav ntawm cov ntshav ntws thiab tej zaum yuav ua kom muaj kev phom sij tsis muaj txiaj ntsig. (4) nws tuaj yeem txo alvear seeb.
5. Selection of optimal PEEP: The lowest PEEP level that can make PaO2>60 hmov thaum tswj hwm fio2<60%. 6. Endogenous PEEP: Due to too short exhalation time or too high respiratory resistance, gas is trapped in the alveoli, which can keep the alveolar pressure positive throughout the exhalation cycle, which is equivalent to the effect of PEEP. It can be caused by disease or artificially caused by the use of ventilators. (III) Prolonged exhalation and breath holding at the end of exhalation: Suitable for patients with COPD and carbon dioxide retention. (IV) Sighing: 1-3 deep inhalations equivalent to 1.5-2 times the tidal volume are performed in every 50-100 breathing cycles, in order to expand the alveoli at the bottom of the lungs that are prone to collapse at a fixed time, improve gas exchange in these parts, and prevent atelectasis. (V) Inverse ratio ventilation (IRV) 1. Advantages: Prolonging the inhalation time is beneficial to the diffusion and distribution of gas, and is beneficial to correcting hypoxia. 2. Disadvantages: Great interference with circulation and great barotrauma to lung tissue.
Hom thiab cov haujlwm ntawm cov tshuab ua pa
Dec 15, 2024
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