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頁籤選單縮合
題 名 | Ventilation Strategies in Pediatric Patients=兒科病人的呼吸器使用策略 |
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作 者 | 王瑞祥; 謝凱生; | 書刊名 | 中華民國重症醫學雜誌 |
卷 期 | 5:1 2003.01[民92.01] |
頁 次 | 頁47-54 |
分類號 | 417.53 |
關鍵詞 | 呼吸衰竭; 壓力控制型; 體積控制型; 控制模式; 輔助控制模式; 協調性間些強制型模式; 高頻震盪式呼吸器; Respiratory failure; CO[feaf]elimination; O[feaf]uptake; Volume-controlled mode; Pressure-controlled mode; Barotrauma; Volutrauma; Ventilator synchrony; Lung-protective conventional strategy; |
語 文 | 英文(English) |
中文摘要 | 對兒科病人來說,呼吸衰竭是主要的致死原因。適當的氣管插管與呼吸器應用,以挽救回不少的生命。但伴隨而來的,是使用呼吸器所導致的各種併發症。我們應當瞭解呼吸器的運作機轉,慎選操作模式與密切的臨床監測,以期將可能的傷害降至最低。 呼吸器所提供的功能,主要是為了供給病人氧氣並排除二氧化碳。其中對二氧化碳的消除率來說,受到有效通氣總量與肺泡二氧化碳的通透能力的影響。氧氣的吸收,則與呼吸道的氧氣分壓和肺泡的氣體交換能力有關。氧氣分壓由FiO₂,PIP,PEEP所構成,可由呼吸器來調節。呼吸器可由其作用的模式來加以分類。最常使用的為,壓力控制型與體積控制型。壓力控制型為呼吸器提供正壓氣體,等達到限定壓力時,即改為吐氣端。其優點為呼吸器限定最高壓力,我們可藉此避免氣胸,中膈積氣等併發症。缺點為,應用在適應性差的肺部(如肺炎等),少許的通氣量會造成氣道壓力的大改變。若礙於壓力高不敢增加,則會有通氣量不足的現象。體積控制型強調的是足夠的通氣量,對於肺部適應性差的病人,可維持需要的通氣量。隨著治療結果,肺部的狀況改善,此時即使在原固定的通氣量下,氣道壓力會逐漸下降,可減少氣壓性創傷的機會。缺點是,不適當的通氣量設定仍然會有體積性創傷的機會。 呼吸器與自發性呼吸的協調與否,關係到呼吸治療的好壞,病人呼吸功的增加,與拔管的成功機會。關於協調性方面機器的設定有幾種模式,控制模式、輔助/控制模式、協調性間些強制型模式等。其自發性呼吸可由氣流、壓力變化、與腹壁肌肉運動所帶動。適當的設定可減少呼吸作功,避免呼吸肌耗損,以利於早日拔管。 高頻震盪式呼吸器是一種特別的設計,高頻率與低震盪體積的設計,可有效的移除二氧化碳,並減少因呼吸器所導致併發症的發生。 今後的趨勢,主要是在著眼於機器的設計與臨床使用設定上,使呼吸器帶動與病人的自發性呼吸能夠協調。對於使用呼吸器病人能有適當的監測,利用圖形變化來分析現況。臨床醫師並應該瞭解各種相關併發症的產生機轉,與適當的處理方法,以期使病人能早日脫離呼吸器。 |
英文摘要 | Respiratory failure causes severe morbidity and mortality in pediatric patients. Optimal endotracheal intubation with mechanical ventilation is a life-saving procedure. However, many adverse effects will follow along with the use of mechanical ventilation. Therefore it is of great importance to choose a matched ventilator operation mode, which minimized the potential side effects. The function of the ventilator is mainly to uptake oxygen and eliminates CO₂. The CO₂ elimination is contributed by total tidal volume delivered and CO₂ diffusion capacity between alveolar space and capillary membrane. The oxygen uptake is influenced by O₂ partition pressure and gas exchange between alveolar space and capillary membrane. We can control the O₂ partition pressure by adjusting FiO₂, PIP, and PEEP. A ventilator can be categorized according to its mode of action. The most frequently used mode is positive pressure ventilation with pressure-cycled or time-cycled. In pressure-controlled mode, high peak inspiratory pressure should be avoided to prevent barotraumas. On the other hand, the volume-controlled mode generates the exact amount of tidal volume the patient needs, but it may lead to volume trauma with inappropriate setting. High frequency oscillatory ventilation is designed as low strike volume with high frequency. It facilitates CO₂ elimination with low risk for barotraumas and volume trauma. Ventilator synchrony is another topic of concern. The patient-ventilator interaction (synchrony or asynchrony) exists during three phases of a mechanical-assisted breath (trigger, cycle, limit). Asynchrony will impose the respiration work and lead to weaning difficulty. Ventilation synchrony and lung-protective conventional strategy are the current trends in conventional mechanical ventilation. We must be careful in differentiating the causes of patient-ventilator dys-synchrony and develop an interventional ventilator management system to facilitate synchronous spontaneous breathing. Improved monitoring capabilities and airway graphic analysis facilitates the assessment of ventilator performance and better patient management. The clinician must know the mechanisms for ventilator associated injury (VAI) and minimize the possible damage. We should make efforts to wean the ventilator as soon as possible without complication. |
本系統中英文摘要資訊取自各篇刊載內容。