无创正压通气在AECOPD科学应用ppt课件.ppt

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1、NoninvasivePositivePressureVentilationinAcuteExacerbationofCOPD无创正压通气在AECOPD的应用YounsuckKoh,M.D.DepartmentofPulmonaryandCriticalCareMedicine,AsanMedicalCenter,UniversityofUlsanCollegeofMedicine,Seoul,KoreaTongjiMechanicalVentilationForumNoninvasivePressureVentilation无创正压通气Anyformofventilatorysuppo

2、rtappliedwithouttheuseofanendotrachealtube任何形式的无气管插管的机械通气支持Negative/Positivepressureventilation负压/正压通气Mode:CPAPwithorwithoutpressuresupport,volume-andpressure-cycledsystems.proportionalassistventilation(PAV).模式：有或无压力支持的CPAP容量控制/压力控制支持通气HillNS.Lancet2009;374:250-259InterfacesforNPPVEarly1960s:IPPV

3、withmouthpiece/facialmaskLate1960s:MVwithETI1989:NPPVwithPSVinCOPDpatients(MeduriGU,etal.Chest1991:100;445)BrandNew?EurRespirJ2008;31:874Timecourseofpublishedreferencesonnoninvasive(NIV)mechanicalventilation(■),andNIVmechanicalventilationandacuterespiratoryfailure(■).Source:PubMed.Update:December

4、,2007.关于无创机械通气及其与急性呼吸衰竭的文章逐年增多HillNS.RespCare2009;54:62-70院前家庭治疗病房长期急救后续治疗科室急诊室NoIntubationTube不插管-Communication交流-VAPincidence呼吸机相关性肺炎:14-28%AdvantageofNPPVNPPV的优点Easytoperform易操作Easymonitoring易监护sedation镇静Comfortness舒适Easytowean易脱机Lessnosocomialinfections减少院内感染AdvantageofNPPV(2)NPPV的优点Frequenc

5、yofNosocomialInfectionsinthe2Groups两组患者院内感染的发生率Girou,E.etal.JAMA2000;284:2361-2367Subjects:ThepatientswithacuteexacerbationofCOPDorsevereCPE对象：AECOPD或严重肺气肿NPPVisnotreplacingintubation.NPPV无需更换气管插管First2hmonitoringiscriticalafterinitiationofNPPV采取NPPV最初的2小时的密切监测十分关键EssentialFactsofNPPVNPPV的基本特征Det

6、ectofapt,whoneedventilatorysupport.鉴别患者是否需要机械通气Choicearightcandidate选择合适的对象Preparerightequipments&Rightsetting准备合适的设备及适当的设置3StepsofNPPVNPPV的三个步骤Cooperative合作的Fewersecretion分泌物少的Lesssick病情较轻的Limitedmaskleak面罩漏气量少的RightCandidate合适的对象IntensiveCareMed2008;34:2248PhysiologicBenefittoUseNPPV从生理学角度分析使用N

7、PPV的益处AcuteExacerbationofCOPD（AECOPD）Mean(±SE)forthePaO2andPaCO2duringtheFirst12Hoursinthe32PatientsSuccessfullyTreatedwithNPPV.Pvaluescomparedwiththebase-linevalues.通过NPPV成功治疗后32例患者在最初12小时内氧分压、二氧化碳分压的变化。RCT,42withstan