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相關文獻
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頁籤選單縮合
題名 | 病人與呼吸器的互動=Patient Ventilator Interactions |
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作 者 | 陶宏洋; | 書刊名 | 中華民國重症醫學雜誌 |
卷期 | 2:1 2000.01[民89.01] |
頁次 | 頁35-43 |
專輯 | 胸腔重症專題 |
分類號 | 415.415 |
關鍵詞 | 機械呼吸; 控制型機械呼吸; 輔助型機械呼吸; 病人與呼吸器的互動; 病人與呼吸器配合不良; 呼吸肌; 非同步解離式呼吸; Mechanical ventilation; Controlled mechanical ventilation; Assisted mechanical ventilation; Patient ventilator interaction; Fighting the ventilator; Respiratory muscles; Patient ventilator asynchrony; |
語文 | 中文(Chinese) |
中文摘要 | 臨床使用呼吸器輔助呼吸的病患基本上可分成兩類:控制型機械呼吸及輔助型機械呼吸。前者並無病人與呼吸器的互動問題,後者因病患仍有自發性呼吸,機械呼吸的綜合輸出將由病患及呼吸器共同參與決定,此時病人與呼吸器的互動問題就必須要考慮了。基於避免控制型機械呼吸可能導致呼吸肌萎縮,過量之鎮定劑及神經肌肉阻斷劑之使用或是不適當之換氣量所引起之酸鹼度異常變化,臨床上若病人有自發性呼吸仍建議以輔助型機械呼吸為主。即允許病患呼吸與呼吸器輔助呼吸同時並存,因此病患與呼吸器將彼此交互影響,且衍生出一系列之相關問題。Fighting the ventilator是臨床常見的問題之一,雖然多肇因於病患緊張焦躁,輔助呼吸不足或呼吸道阻塞等因素,但病人與呼吸器互動不良也是原因之一。臨床常見病患呼吸相位與呼吸器輔助呼吸相位不同,當病患吸氣起始時呼吸器輔助吸氣尚未啟動,甚至於病患吸氣動作無法適當啟動呼吸器輔助吸氣,產生病患自發性呼吸次數大於呼吸器輔助呼吸次數,或是呈現倍數的變化,產生所謂的非同步解離式呼吸。此互動不良可影響輔助型機械呼吸的品質,嚴重時可降低氣體交換,破壞呼吸之協調性及舒適性,增加病患呼吸功及呼吸器使用之併發症,甚至於危及病患的生命。臨床呼吸照護工作者必須能深入了解病人與呼吸器的互動問題,如此才可提供最佳的呼吸照護。 |
英文摘要 | During controlled ventilation, with the absence of any effective muscle action, there is essentially no interaction between patient and ventilator. On the other hand, during assisted ventilation the respiratory system is simultaneously under the influence of two pumps, the patient's own (respiratory muscles) and the ventilator. To the extent that the output of either pump can influence the output of the other, there is considerable interaction between patient and ventilator. All modern mechanical ventilators possess sensing mechanisms so that their output can be coordinated with the patient's inspiratory effort. Ineffective triggering of ventilator refers to the phenomenon of a mechanically ventilated patient failing to trigger the ventilator adequately in an assist mode. The causes of ineffective triggering may include: 1. Trigger threshold is lowered, becoming less sensitive; 2. A large tidal volume to be exhaled; 3. The expiratory gas flow is restricted with auto-PEEP exist. In mild form, the delay between the initiation of the patient's inspiratory effort and the onset of assisted breath is prolonged, its is called "inspiratory response delay". In severe form, the inspiratory response delay exceeds a critical value, the ventilator is unable to detect every inspiratory effort by the patient. The machine rate is then less than the patient's respiratory rate. During inspiratory response delay, the patient's inspiratory effort is not supported by the ventilator. Patient ventilator asynchrony was identified by observing uncoupling of the patient's respiratory muscle efforts and onset of ventilator-assisted breaths. The purpose of this review is to summary the physiology, pathophysiology, clinical implications and management of patient ventilator asynchrony. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。