查詢結果分析
來源資料
頁籤選單縮合
題 名 | 呼吸器使用之新策略=New Strategy in Mechanical Ventilation |
---|---|
作 者 | 吳清平; | 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28-34 |
專 輯 | 胸腔重症專題 |
分類號 | 415.415 |
關鍵詞 | 人工呼吸器; 新策略; 新型呼吸器; Mechanical ventilation; New strategy; New ventilator; |
語 文 | 中文(Chinese) |
中文摘要 | 呼吸器使用的新策略,在本文分成四項介紹,分別是肺部保護策略,病患與呼吸器之配合,新型呼吸器之介紹及慢性呼吸器使用患者病房之規劃。肺部保護策略主要是在適度減低肺部擴張的壓力及容量,及維持肺部張開,以減少肺損傷的程度。病患與呼吸器之配合,強調的是病患的舒適度。如果病患與呼吸器的互動不良時,應該以吸氣期的順序找出問題,確實解決。在吸氣早期,吸氣啟動不好時,應該測試是否有Auto PEEP,如果有,可以外加PEEP,如果是感應不足,可以改用Flow trigger。在吸氣中期,氣流太快或太慢,病患都很難過,應該適時做個調整。而在吸氣末期,只有使用"壓力支持型呼吸"(PSV),病患才能主導吸氣的結束,其他傳統的呼吸模式都要病患聽命於呼吸器,當然不會太舒服。吸氣量或每分鐘通氣量太高,代表的是發燒,敗血症,焦慮,酸中毒,...等等病況,臨床上的處理,應該是依病況處理,而非一昧的調整呼吸器。新型呼吸器之設計,在給氣方式,吸氣啟動,吸氣氣流的調整,吐氣靈敏度,容量保證及呼吸模式,都以病患的舒適度為依據,盡量保留自行呼吸並改善原有的缺點,使病患與呼吸器的互動,達到完善的境界。至於長期呼吸器使用患者將依病情變化,規劃到不同等級的病房,以改善急性病床一床難求,呼吸器一臺難求的現象並使得病患得到應有的照顧且減少不必要的浪費。 |
英文摘要 | The introduction of new strategy of mechanical ventilation in 2000 includes four topics, such as lung protection strategy, patient-ventilator synchrony, new ventilator design, and chronic ventilator ward. The purpose of lung protective strategy is trying to decrease ventilator induced lung injury in ARDS patient by reduction of tidal volume and alveolar distention pressure. The adjustment of PEEP level by detection of low inflection point in pressure-volume curve is helpful to keep the lung open and prevent snap-open phenomenon. Patient-ventilator synchrony is the main issue to assure patient's comfort while using mechanical ventilation. The approach of patient-ventilator asynchrony is to watch the breathing pattern in the inspiratory phase (early, middle and late) and the need of minute ventilation. The delay triggering of inspiration means poor sensitivity of ventilator or presence of auto-PEEP. The inappropriate flow pattern may causes the asynchrony in the middle of inspiration. The end of inspiration is determined by the design of cycling in the machine. There is only "flow cycling" in pressure support ventilation can allow patient stop inspiration by their own willing. The other ventilator modes will stop inspiration by time cycling, pressure cycling or volume cycling, but independent of patient's demand. The new ventilator design has been focused on patient's comfort by preserving spontaneous breathing and improving the defects in old style, such as the gas supply system, inspiratory trigger system, flow adjustment, expiratory sensitivity, volume assurance, and new breathing mode. The chronic ventilator ward has been introduced to our country in recent 3 years. To transfer the ventilator dependent patient out of acute intensive care unit to step-down facilities such as respiratory care center or respiratory care ward will decreases unnecessary cost. Improve ICU bed utilization, and assure appropriate medical care quality. |
本系統中英文摘要資訊取自各篇刊載內容。