,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,呼 吸 功 能 监 测,呼吸功能是人体最重要的基本生理功能之一。,据报道因麻醉并发症导致病人死亡的病例中、,大约60%和呼吸有关。,呼 吸 功 能 监 测呼吸功能是人体最重要的基本生理功能之一,1,不用监护仪的临床常规呼吸功能监护,一 皮肤粘膜颜色的观察,二 呼吸运动的观察,三 扣诊,四 听诊,不用监护仪的临床常规呼吸功能监护一 皮肤粘膜颜色的观察,2,麻醉状态下呼吸功能的监测,一 呼气末 CO2 浓度监测,二 肺通气功能的监测,呼吸环的监测,麻醉状态下呼吸功能的监测一 呼气末 CO2 浓度监测,3,呼气末 CO,2,浓度监测,呼气末 CO,2,分压是重要的生命指标之一，不仅可监测通气，而且也可反映循环和肺血流情况。,1991年1月，美国麻醉医师学会已规定呼气末 CO,2,浓度监测为麻醉期间的基本监护项目。,呼气末 CO2 浓度监测呼气末 CO2 分压是重要的生命指标,4,呼气末 CO,2,监测办法,介绍主流型红外线分析仪,原理：,将气体送入测试室，由传感器一侧光源发 生的红外线对其进行照射；另一侧感受器检测红外线衰减程度。(CO,2,吸收波长4.3um的红外线)再转换为电信号送给微电脑进行处理。,注意事项：,1，监测头不能摔。,2，防止水蒸汽干扰。,呼气末 CO2 监测办法介绍主流型红外线分析仪,5,CO,2,曲线图分析及临床意义,（一）正常的,CO,2,曲线图,正常的 CO,2,曲线呈矩形，一般分为四段：,I 相：AB段，位于基线零点，为吸气末至呼气前。,II相：BC段，曲线上升型，为呼气开始。,III相：CD段，呈水平线，为呼气平台。气道阻力通过此段反映。,IV相：DE段，曲线陡直下降至基线，代表吸气开始。,II相与III相之间的夹角称,a 角，可间接反映 V/Q,的比例。当 a 角增大时，,提示死腔量增多。,0,40,D,A,B,C,A B,E,mmHg,CO2 曲线图分析及临床意义（一）正常的 CO2 曲线图,6,常见的异常CO,2,曲线图,（一）高CO,2,血症,低通气量,高代谢、抽搐,恶性高热的早期诊断,0,40,（一）低CO,2,血症,过度通气,肺血流低灌注（肝门阻断、栓塞）,麻醉深度加深、低温,0,40,mmHg,mmHg,常见的异常CO2 曲线图 （一）高CO2血症04,7,常见的异常CO,2,曲线图,（三）机械通气中存在自主呼吸,肌松药时效过了，还有残余,病人快醒了,按压病人胸部,0,40,mmHg,（四）CO,2,重复吸入,钠石灰耗竭（基线升高）,环路中呼气活瓣关闭不全,0,mmHg,40,常见的异常CO2 曲线图（三）机械通气中存在自主呼吸040m,8,常见的异常CO,2,曲线图,（五）监护仪测不出CO,2,导管脱落、采样管堵塞,机械通气障碍、暂停,气管导管误入食道（发现的比从脉搏氧饱和度早）,0,40,mmHg,（六）呼气平台陡峭,病人气道梗阻（支气管痉挛、,哮喘、上呼吸道梗阻、COPD）,气管导管部分阻塞,0,40,mmHg,常见的异常CO2 曲线图（五）监护仪测不出CO2040mmH,9,常见的异常CO,2,曲线图,（七）完全自主呼吸的判断,掌握早期拔管指征,减少拔管时应激烦躁,最好还能在麻醉气体监护下,口咽通气道的应用,0,40,mmHg,常见的异常CO2 曲线图（七）完全自主呼吸的判断040mmH,10,呼末CO2 与脉氧饱和度,监测的反应时间比较,临床情况,P,ET,CO,2,S,P,O,2,气管导管误入食道,呼吸停止或接头脱落,钠石灰耗竭/重复吸入,恶性高热,通气不足,通气过度,栓塞,快,快,快,快,快,快,快,慢,慢,慢,慢,呼末CO2 与脉氧饱和度临床情况PETCO,11,PFT:TLC,FEV1,FVC,FEV1/FVC,and VC.,LOOPS!,LOOPS,PFT:TLC,FEV1,FVC,FEV1/FVC,12,呼吸功能监测(呼末CO2-与呼吸环)ppt课件,13,Curve,Volume controlled,constant flow,CurveVolume controlled,14,Pressure-time,pressure controlled,Curve,Pressure-timeCurve,15,Curve,Flow-time,Curve Flow-time,16,Curve,Volume oriented,CurveVolume oriented,17,Curve,Pressure oriented,CurvePressure oriented,18,Changes in compliance,Interpretation of curve pattern,Changes in complianceInterpret,19,Interpretation of curve patterns,Changes in inspiratory,airway resistance,Interpretation of curve patte,20,Interpretation of curve patterns,Spontaneous breathing,Interpretation of curve patter,21,Interpretation of curve patterns,Adaptation of the flow curve,Interpretation of curve patter,22,Flow,Paw,in,ex,fixed,flow,inspiration,closed,expiration,closed,经典定容通气模式,FlowPawinexfixedflowinspiratio,23,呼吸功能监测(呼末CO2-与呼吸环)ppt课件,24,Interpretation of curve patterns,Insufficient inspiration time,Interpretation of curve patter,25,Interpretation of curve patterns,Insufficient expiration time,Interpretation of curve patter,26,Interpretation of curve patterns,Increased expiratory resistance,Interpretation of curve patter,27,PV-Loop,Super-syringe method,（静态）,PV-Loop Super-syringe method（,28,PV-Loop,with upper/lower inflection point,PV-Loopwith upper/lower infle,29,PV-Loop,PV-Loop,30,PV-Loop,PV-Loop,31,Interpretation of PV loop in ventilation,Volume controlled,Constant flow,Interpretation of PV loop in v,32,Pressure-controlled ventilation(decelerating flow),Curve,Pressure-controlled ventilatio,33,Interpretation of PV loop in ventilation,Pressure-controlled,Interpretation of PV loop in v,34,CPAP spontaneous breathing,CPAP spontaneous breathing,35,CPAP with ASB/PSV,CPAP with ASB/PSV,36,Compliance changes,Compliance changes,37,Resistance changes,Resistance changes,38,Lung over-extension,Lung over-extension,39,PV Loop in ASB/PSV,PV Loop in ASB/PSV,40,PV Loop in CPAP,PV Loop in CPAP,41,PV Loop in CPAP,PV Loop in CPAP,42,PV Loop in CPAP,PV Loop in CPAP,43,Assistance from PSV,Assistance from PSV,44,Flow-volume loop,Flow-volume loop,45,谢谢各位专家！,谢谢各位专家！,46,Respiratory Function During Anesthesia,1,.,Effect of Anesthetic Depth on Respiratory Pattern,2.Effect of Anesthetic Depth on Spontaneous Minute,ventilation,3.Effect of Preexisting Respiratory Dysfunction on the,Respiratory Effects of Anesthesia,4.Effect of Special Intraoperative Condition on the,Respiratory Effects of Anesthesia,5.Mechanisms of Hypoxemia During Anesthesia,Respiratory Funct,47,