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ID:52461820
大小:8.05 MB
页数:52页
时间:2020-04-07
《医、技学院(华盛顿医疗手册培训-重症监护).ppt》由会员上传分享,免费在线阅读,更多相关内容在教育资源-天天文库。
1、TheWashingtonManualofMedicalTherapeutics--CriticalCAreDepartmentofCriticalCareCuiWeiContentsRespiratoryFailureShockRespiratoryFailureGeneralPrinciplesHypercapnicrespiratoryfailuremayproducearespiratoryacidosis(pH<7.35).Hypoxicrespiratoryfailurecanresultinhypoxemia(arterialoxygentension[P
2、aO2]<60mmHgorarterialoxygensaturation[SaO2]<90%).Theacuterespiratorydistresssyndrome(ARDS)isaformofhypoxicrespiratoryfailurecausedbyacutelunginjury.Thecommonendresultisdisruptionofthealveolarcapillarymembrane,leadingtoincreasedvascularpermeabilityandaccumulationofinflammatorycellsandprot
3、ein-richedemafluidwithinthealveolarspace.TheAmerican-EuropeanConsensusConferencehasdefinedARDSasfollows:(a)acutebilateralpulmonaryinfiltrates,(b)ratioofPaO2toinspiredoxygenconcentration(FIO2)<200,and(c)noevidenceforheartfailureorvolumeoverloadastheprincipalcauseofthepulmonaryinfiltrates(
4、NEJM2000;342:1334).PathophysiologyHypercapnicRespiratoryFailure↑CO2production↑Deadspace↓MinutevolumeFever,Sepsis,LungdiseaseCOPD,asthma,scolisisNerve,muscle,overdosePathophysiologyHypoxicRespiratoryFailureShuntV/Qmismatch↓Ventilation↓oxygenDiffusionimpairment↓SvO2Causesofshuntsandhypoxic
5、respiratoryfailureCardiaogenicpulmonaryedemaAMILVfaulureMitralregurgitationMitralstenosisDiastolicdisfunctionNon-cardiogenicepulmonaryedemaAspirationSepsisMultipletraumaPancreatitisPneumoniaMixedpulmonaryedemaMyocardialischemiaHigh-latitudeexposureOtherpulmonaryedemaUpperairwayobstructio
6、nNeurogeniccauseLungreexpansionNoninvasiveoxygentherapyNasalprongVenturimaskNonrebreathingmaskCPAPmaskBiPAPAirwaymanagementHeadandjawpositioningAirwaymanagementOralandnasopharyngealtubeAirwaymanagementOralandnasopharyngealtubeAirwaymanagementLaryngealmaskairwayAirwaymanagementMask-to-fac
7、eVentilationEndotrachealintubationIndicationInitiationofmechanicalventilationAirwayprotectionInadequateoxygenationusinglessinvasivemethodsPreventionofaspirationandallowingforthesuctioningofpulmonarysecretionsHyperventilationforthetreatmentofincreasedintracranialpressureEn
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