Initiation of Mechanical Ventilators
老外的机械通气
Use of Airway Pressures
Decreased Pk:
System air leak: Tubing disconnection, cuff leak Rx: Manual inflation, listen for leak Hyperventilation: Enough negative intrathoracic pressure to pull air into lungs may drop Pk.
.
Indications for Mechanical Ventilation
1. “Thinking” of Intubation: elective v/s emergent
2. “Act of weakness?” 3. Endotracheal tubes are not a disease and
ventilators are not an addiction 4. And the usual elective and emergent
indications that you all know!
.
Objectives of Mechanical Ventilation
Improve pulmonary gas exchange
Alter pressure-volume relations
Prevent and reverse atelectasis Improve Compliance Prevent further injury
Permit lung and airway healing Avoid complications
Reverse hypoxemia and Relieve acute respiratory acidosis
机械工程学专业词汇英语翻译（I）2
initial phase 初始相位 initial position 初始位置 initial pressure 初压⼒ initial speed 初速度 initial state 初态 initial state quantity 初态量 initial strain 初应变 initial stress 初应⼒ initial stress matrix 起始应⼒矩阵 initial tension 初张⼒ initial thrust 起始推⼒ initial torque 起动转矩 initial unbalance 初始不平衡 initial value 初值 initial velocity 初速度 initial vortex 初始涡旋 initial wave 初⽣波 initiation of fracture 断裂的引发 injection 注⼊ injection molding 注模 injection pressure 喷射压⼒ injury 损伤 inlet angle 进⼝⾓ inlet edge 前缘 inlet pressure 进⽓压⼒ inlet temperature ⼊⼝温度 inlet velocity 进⼝速度 inner energy 内能 inner friction 内摩擦 inner gimbal 内框架 inner orbit 内轨道 inner potential 内势 inner stress 内部应⼒ inplane shear ⾯内剪切 input 输⼊ input power 输⼊ input resistance 输⼊阻抗 instability 不稳定性 instability constant 不稳定常数 instability criterion 不稳定性判据 instability stress 不稳定应⼒ instable equlibrium 不稳定平衡 instable motion 不稳定运动 installation 装置 instantaneous 瞬时的 instantaneous acceleration 瞬时加速度 instantaneous angular velocity 瞬时⾓速度 instantaneous angular velocity vector 瞬时⾓速度⽮ instantaneous axis 瞬轴 instantaneous axis of rotation 转动瞬轴 instantaneous breakdown 瞬时破裂 instantaneous center 瞬时中⼼ instantaneous center of accelerations 瞬时加速中⼼ instantaneous center of rotation 瞬时转动中⼼ instantaneous center of velocities 瞬时速度中⼼ instantaneous flow 瞬时量 instantaneous force 瞬时⼒ instantaneous frequency 瞬时频率 instantaneous load 瞬时装载 instantaneous motion 瞬时运动 instantaneous orbit 瞬时轨道 instantaneous orbital plane 瞬时轨道⾯ instantaneous perturbation 瞬时扰动 instantaneous power 瞬时功率 instantaneous rotation 瞬时转动 instantaneous space 瞬时空间 instantaneous strain 瞬时应变 instantaneous system of coordinates 瞬时坐标系 instantaneous value 瞬时值 instantaneous variable structure 瞬时可变结构 instantaneous velocity 瞬时速度 instrumental error 仪企差 insulant 绝缘材料 insulation 防振 insulator 绝缘体 intake pressure 进⽓压⼒ intake valve 进给阀 integrability condition 可积条件 integral of motion 运动积分 integral principle 积分原理 integral theorem of fourier 傅⾥叶积分公式 integrated flux 积分通量 integrated intensity 累积强度 integrating gyroscope 积分陀螺仪 integration method of velocity measurement 速度测量的积分法 intense explosion 强爆炸 intensification 加强 intensity 强度 intensity of continuous load 持续负载强度 intensity of distributed load 负载强度 intensity of emission 发射强度 intensity of load 负载强度 intensity wave 强度波 interacting field 相互酌场 interaction 相互酌 interaction cross section 相互酌截⾯ interaction force 相互酌⼒ interaction law 相互酌定律 interaction potential 相互酌势 interaction space 相互酌空间 interaction strength 相互酌强度 interatomic force 原⼦间⼒ interception 截击 interchange 交换 interchange coefficient 交换系数 interchange deformation 互换型变形 interchange diffusion 交换扩散 interchange instability 交换不稳定性 intercrystalline boundary 晶粒间边界 intercrystalline brittleness 晶间脆性 interdiffusion 相互扩散 interface 界⾯ interface layer 界⾯层 interface normal 界⾯法线 interface reaction 界⾯反应 interface region 边界层区域 interface wave 界⾯波 interfacial diffusion 界⾯扩散 interfacial disturbance 界⾯扰动 interfacial mass transfer 界⾯传质 interfacial tension 界⾯张⼒ interfacial viscosity 界⾯粘性 interference ⼲涉 interference fringe ⼲涉条纹 interference phenomenon ⼲涉现象 interference ring ⼲涉环 interference vortex ⼲涉涡 interfering energy ⼲扰能量 interferometer ⼲涉仪 interferometry ⼲涉法 intergranular crack 晶间裂纹 interior boundary value problem 内边值问题 interior force 内⼒ interlacement 交错 interlacing 交错 interlock 联销 intermediary orbit 中间轨道 intermediate axis 中间轴 intermediate coupling 中间耦合 intermediate layer 中间层 intermediate pressure 中间压⼒ intermediate wave 中间波 intermittent motion 间歇运动 intermittent wind tunnel 间歇式风洞 intermolecular bond 分⼦间键 intermolecular force 分⼦间⼒ intermolecular potential 分⼦间势 intermolecular tension 分⼦间张⼒ internal aerodynamics 内琳⽓动⼒学 internal combustion engine 内燃机 internal constraint 内部约束 internal crack 内部裂缝 internal diameter 内径 internal disturbance 内部⼲扰 internal effect 内效应 internal efficiency 内部效率 internal energy 内能 internal field 内场 internal flow 内流 internal force 内⼒ internal friction 内摩擦 internal friction factor 内擦系数 internal friction of rotor 转⼦内摩擦 internal magnetic field 内磁场 internal potential energy 内势能 internal pressure 内压⼒ internal resistance 内阻⼒ internal rotation 内旋转 internal rupture 内破裂 internal stress 内部应⼒ internal structure 内部结构 internal surface 内表⾯ internal variable 内变量 internal wave 内波 internal work 内功 international standard atmosphere 国际标准⼤⽓ interphase 界⾯ interpolating function 内插函数 interpolation 内插法 interrupted wave 斩波 intersection 交叉 intersection line 交叉线 intersection point 交叉点 interstitial fluid 间隙液体 interstitial pressure 渗压⽑细⽔压 interstitial water 间隙⽔ interval 区间 intihyperbolic cosine 反双曲余弦 intraatomic force 原⼦内⼒ intramolecular force 分⼦内⼒ intrinsic 内倌 intrinsic coordinates 内蕴坐标 intrinsic defect 固有缺陷 intrinsic displacement 内位移 intrinsic energy 内能 intrinsic equation 内蕴⽅程 intrinsic magnetic moment 内倥矩 intrinsic property 固有性质 intrinsic variable 固有变量 intrinsic viscosity 固有粘度 invariable 不变的 invariable plane 不变平⾯ invariable system 不变系 invariance 不变性 invariant 不变量 invariant function 不变函数 invariant plane 不变平⾯ invariant system 不变系 invariant theory 不变量理论 inverse ballistic problem 反弹道问题 inverse calculation 回代 inverse collision 逆碰撞 inverse hyperbolic cosine 反双曲余弦 inverse laplace transformation 拉普拉斯逆变换 inverse method 逆解法 inverse problem 逆问题 inverse transformation 逆变换 inversion 反演 inversion formula 反演公式 inverted arch 仰拱 inverter 逆变器变换器 inviscid fluid ⾮粘性铃 ion bombardment 离⼦轰击 ion cyclotron frequency 离⼦回旋频率 ion cyclotron heating 离⼦回旋加热 ion cyclotron resonance 离⼦回旋共振 ion diffusion 离⼦扩散 ion electron emission 离⼦电⼦发射 ion exchange bed 离⼦交换层 ion exchange membrane 离⼦交换膜 ion flux 离⼦流 ion heating 离⼦加热 ion impact 离⼦碰撞 ion orbit 离⼦轨道 ion path 离⼦轨道 ion plasma frequency 离⼦等离⼦体频率 ion slip 离⼦滑移 ion sound speed 离⼦声速 ion sound velocity 离⼦声速 ion trajectory 离⼦轨道 ionic deformation 离⼦形变 ionic equilibrium 离⼦平衡 ionic friction 离⼦摩擦 ionic liquid 离⼦液体 ionic plasma 电离等离⼦体 ionic solid 离⼦固体 ionization 电离 ionization balance 电离平衡 ionization energy 电离能 ionization equilibrium 电离平衡 ionization frequency 电离频率 ionization pressure 电离压⼒ ionization state 电离状态 ionized gas 电离⽓体 ionizing capacity 电离本领 ionizing collision 电离碰撞 ionizing power 电离本领 ionizing shock 电离碰撞 ionosphere 电离层 ionospheric wave 电离层波 irregularity of flow 怜⾮正规性 irreversibility 不可逆性 irreversible 不可逆的 irreversible process 不可逆过程 irreversible reaction 不可逆反应 irreversible thermodynamics 不可逆过程热⼒学 irrotational field ⽆旋场 irrotational flow ⽆旋流 irrotational motion ⽆旋运动 irrotational vector ⽆旋⽮ irrotationality ⽆旋涡性 irwin orowan theory 欧⽂奥罗万理论 isallobaric wind 等变压风 isanemone 等风速线 isenthalpic change 等焓变化 isentrope 等熵线 isentropic change 等熵变化 isentropic flow 等熵怜 isentropic process 等熵过程 isentropic surface 等熵⾯ isentropy 等熵 isoallobaric wind 等变压风 isobar 等压线 isobaric 等压的 isobaric change 等压变化 isobaric compressibility 等压压缩性 isobaric expansion 等压膨胀 isobaric expansion coefficient 等压膨胀系数 isobaric heat capacity 等压热容 isobaric process 等压过程 isobaric surface 等压⾯ isobath 等深线 isochore 等容线 isochoric change 等容变化 isochromatic curve 等⾊线 isochromatic line 等⾊线 isoclinic line 等斜线 isoclinic method 等倾法 isocurlus 等旋涡强度线 isodensitometer 等密度计 isodynam 等磁⼒线 isodynamic change 等⼒变化 isodyne 等⼒线 isoenergetic surface 等能量⾯ isoflux 等通量 isogels 等凝胶 isohypse line 等⾼线 isokatabase 等降压线 isolated system 孤⽴系 isolated vortex 孤⽴涡 isomorphic mapping 同构映射 isomorphism 同构 isopach 等厚线 isopachyte 等厚线 isoparametric element 等参数元 isoperimetric problem 等周问题 isophase 等相 isophase surface 等相⾯ isopiestic 等压的 isopiestic process 等压过程 isopiestic specific heat 恒压⽐热 isopotential curve 等势线 isopotential line 等势线 isopotential surface 等势⾯ isorotation theorem 等旋定理 isostasy 地壳均衡 isostatic surface 均衡⾯ isotac 同时解冻线 isotach 等速线 isothermal annealing 等温退⽕ isothermal change 等温变化 isothermal compression 等温压缩 isothermal deformation 等温形变 isothermal elastic potential 等温弹性势 isothermal equilibrium 等温平衡 isothermal expansion 等温膨胀 isothermal flow 等温怜 isothermal line 等温线 isothermal modulus of elasticity 等温弹性模量 isothermal process 等温过程 isothermal speed of sound 等温声速 isothermal surface 等温⾯ isotropic body 蛤同性体 isotropic curve 蛤同性线 isotropic elasticity 蛤同性弹性 isotropic material 蛤同性材料 isotropic medium 蛤同性介质 isotropic plane 蛤同性⾯ isotropic stress 蛤同性应⼒ isotropic turbulence 蛤同性湍流 isotropic vector 蛤同性⽮量 isotropism 蛤同性 isotropy 蛤同性 isovector 等⽮量 isovector resonance 等⽮量共振 isovelocity 等速线 iteration 迭代 iterative method 迭代法 ixodynamics 粘滞动⼒学。
咪达唑仑在高龄患者机械通气初期的应用效果及护理
China &Foreign Medical Treatment 中外医疗在现代医学中,机械通气的作用非常显著,而多数患者采取机械通气时,其需接镇痛、镇静,这样既可提升患者机械通气安全感、气管插管舒适度,又能减轻其紧张、焦虑等心理[1-3]。
而作为一种水溶性镇静药物,咪达唑仑是苯二氮卓类中枢神经抑制剂,其具有半衰期短、起效快、给药方便、不良反应少等特点,且具有较好的抗惊厥、肌肉松弛、抗焦虑、催眠、镇静等作用,广泛DOI:10.16662/ki.1674-0742.2018.23.135咪达唑仑在高龄患者机械通气初期的应用效果及护理白雪莲中国航天科工集团七三一医院呼吸内科,北京100074[摘要]目的研究与分析咪达唑仑在高龄患者机械通气初期的应用效果及护理方法。
方法方便选取该院2017年1月—2018年3月收治的行机械通气高龄患者100例为对象进行研究,利用计算机随机法将其随机分为对照组和观察组,各50例。
机械通气初期对照组未给予任何药物,而观察组给予咪达唑仑。
比较分析两组动脉血气、血压、心率、呼吸频率等水平以及不良反应。
结果观察组氧分压(42.34±6.62)mmHg、二氧化碳分压(41.87±9.08)mmHg、心率(118.13±25.19)次/min、呼吸频率(23.86±4.56)次/min 等水平与对照组(52.48±5.32)mmHg、(50.43±15.36)mmHg、(145.32±29.14)次/min、(34.53±5.21)次/min 相比均显著较低,差异有统计学意义(t =6.9619、2.7973、4.1160、8.9859,P=000);而两组舒张压、收缩压等水平对比差异无统计学意义(P>0.05)。
结论高龄患者机械通气初期应用咪达唑仑,可有效提升其气管插管耐受性,并最大限度降低患者氧耗,而通气治疗期间对患者加强针对性护理干预,可有效避免各种不良情绪,因此值得推广应用。
螺旋环阻尼器在航空发动机锥齿轮减振中的应用
2023年第47卷第12期Journal of Mechanical Transmission螺旋环阻尼器在航空发动机锥齿轮减振中的应用王艳丰郜伟强徐勇强欧代松（中国航空发动机集团有限公司四川燃气涡轮研究院，四川成都610500）摘要针对某型航空发动机中央传动从动锥齿轮振动应力超出齿轮许用应力的问题，介绍了一种应用于锥齿轮的螺旋环摩擦阻尼器。
在齿轮轮缘内侧开一个凹槽，将螺旋阻尼环旋入凹槽中；工作时，齿轮轮缘和螺旋阻尼环因周向变形不协调而产生相互摩擦，从而消耗振动能量。
将这种阻尼器应用于某型航空发动机锥齿轮减振方案中，试验结果表明，螺旋环阻尼器能够有效降低锥齿轮的振动应力水平；阻尼器安装前后该型锥齿轮的4节径1阶后行波共振应力降幅比高达70.7%，3节径1阶前行波共振应力降幅比为53.4%，减振后的齿轮振动应力水平低于齿轮的许用应力。
此外，该型阻尼器还具有安装拆卸方便、附加不平衡量小等优点，在航空发动机齿轮减振中具有广阔的应用前景。
关键词锥齿轮螺旋环阻尼器摩擦阻尼减振振动应力Application of Spiral Ring Dampers in Vibration Reduction of Aeroengine Bevel GearsWang Yanfeng Gao Weiqiang Xu Yongqiang Ou Daisong(AECC Sichuan Gas Turbine Establishment, Chengdu 610500, China)Abstract In view of the problem that the vibration stress of the axle driven bevel gear of an aeroengine exceeds the permissible stress, a spiral ring friction damper is designed for the bevel gear. In detail, a concave groove is fabricated on the inside rim of gear wheels, in which the designed spiral damping ring is embedded. The circumferential deformation of the spiral damping ring is inconsistent with the gear rim under working conditions; thus the mutual friction is induced and the vibration energy could be consumed. The designed spiral damper is applied to the vibration reduction scheme of an aeroengine bevel gear. The test results show that the spiral damping ring can effectively reduce the vibration stress level of the bevel gear.The vibration reduction efficiency of the first-order, 4-pitch diameter backward traveling wave resonant vibration is about 70.7%, and that of the first-order, 3-pitch diameter forward traveling wave resonant vibration is about 53.4%. Then the vibration stress level of the gear after vibration reduction satisfies the allowable stress. Moreover, the spiral damper enjoys convenience in installation and disassembly, and possesses small additional imbalance, which leads to a promising and broad application for vibration reduction of aeroengine gears.Key words Bevel gear Spiral ring damper Friction damping Vibration reduction Vibration stress0 引言航空发动机传动系统锥齿轮是发动机设计关键件，为发动机各油泵及飞机系统输出必要的传动功率，维持发动机及飞机的正常运转。
institution of mechanical engineer
institution of mechanical engineerThe Institution of Mechanical Engineers (IMechE) is a professional engineering institution that represents mechanical engineers across the United Kingdom and overseas. Founded in 1847, it is one of the oldest and largest engineering institutions in the world, with over 180,000 members.IMechE's mission is to promote and advance the science and practice of mechanical engineering. It does this by providing a range of services and activities to its members, including professional development courses, technical meetings and conferences, and a comprehensive library of technical resources. The institution also works to set and maintain the highest standards of engineering practice and ethics, and represents the interests of its members to government and industry bodies.One of IMechE's most important roles is to provide certification for mechanical engineers in the UK. The institution offers a range of certifications, including professional engineering memberships and fellowships, which are awarded to individuals who demonstrate the required level of expertise and experience in mechanical engineering. These certifications are recognized by government and industry bodies as evidence of an engineer's professional status and competence.In addition to its membership services and certifications, IMechE also carries out research and development work in various areas of mechanical engineering. This work is funded by grants from government agencies, industry bodies, and by members' subscriptions. The institution's research activities cover a wide range of topics, including energy generation and storage, manufacturing processes, materials science, and robotics.The Institution of Mechanical Engineers plays a crucial role in the field of mechanical engineering, representing the interests and needs of its members, promoting the science and practice of the discipline, and setting standards for engineering practice.。
呼吸治疗之呼吸治疗师(英文介绍)
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Respiratory therapist
Definition
Respiratory therapists are specialists and educators in cardiology and pulmonology. Respiratory therapists are clinicians trained in advanced airway management; establishing and maintaining the airway during management of trauma, intensive care, and may administer anaesthesia for surgery or conscious sedation.
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Respiratory therapist
Definition
In the outpatient setting Respiratory Therapists work as educators in asthma clinics, ancillary clinical staff in pediatric clinics, and sleep-disorder diagnosticians in sleep-clinics. They also serve as clinical providers in cardiology clinics and cath-labs.
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Clinical practice
Outpatient clinical practice
Respiratory therapists are also primary clinicians in conducting tests to measure lung function and teaching people to manage asthma, chronic obstructive pulmonary disorder among other cardiac and lung functions. Internationally, Respiratory Therapists that provide lung function testing are termed respiratory scientists, but in North America, they may be a Respiratory Therapist or may also be a certified pulmonary function technician in the United States.
机械通气临床应用指南(中华重症医学分会2024)
机械通气临床应用指南中华医学会重症医学分会（2024年）引言重症医学是探讨危重病发生发展的规律，对危重病进行预防和治疗的临床学科。
器官功能支持是重症医学临床实践的重要内容之一。
机械通气从仅作为肺脏通气功能的支持治疗起先，经过多年来医学理论的发展及呼吸机技术的进步，已经成为涉及气体交换、呼吸做功、肺损伤、胸腔内器官压力及容积环境、循环功能等，可产生多方面影响的重要干预措施，并主要通过提高氧输送、肺脏爱护、改善内环境等途径成为治疗多器官功能不全综合征的重要治疗手段。
机械通气不仅可以依据是否建立人工气道分为“有创”或“无创”，因为呼吸机具有的不同呼吸模式而使通气有众多的选择，不同的疾病对机械通气提出了具有特异性的要求，医学理论的发展及循证医学数据的增加使对呼吸机的临床应用更加趋于有明确的针对性和规范性。
在这种条件下，不难看出，对危重病人的机械通气制定规范有明确的必要性。
同时，多年临床工作的积累和多中心临床探讨证据为机械通气指南的制定供应了越来越充分的条件。
中华医学会重症医学分会以循证医学的证据为基础，采纳国际通用的方法，经过广泛征求看法和建议，反复仔细探讨，达成关于机械通气临床应用方面的共识，以期对危重病人的机械通气的临床应用进行规范。
重症医学分会今后还将依据医学证据的发展及新的共识对机械通气临床应用指南进行更新。
指南中的举荐看法依据2024年ISF提出的Delphi分级标准(表1)。
指南涉及的文献依据探讨方法和结果分成5个层次，举荐看法的举荐级别依据Delphi分级分为A E级，其中A 级为最高。
表1 Delphi分级标准举荐级别A 至少有2项I级探讨结果支持B 仅有1项I级探讨结果支持C 仅有II级探讨结果支持D 至少有1项III级探讨结果支持E 仅有IV级或V探讨结果支持探讨课题分级I 大样本，随机探讨，结果清楚，假阳性或假阴性的错误很低II 小样本，随机探讨，结果不确定，假阳性和/或假阴性的错误较高III 非随机，同期比照探讨IV 非随机，历史比照和专家看法V 病例报道，非比照探讨和专家看法危重症患者人工气道的选择人工气道是为了保证气道通畅而在生理气道与其他气源之间建立的连接，分为上人工气道和下人工气道，是呼吸系统危重症患者常见的抢救措施之一。
胡必杰-医院内肺炎(重点为VAP)的预防与控制
水 肿 或 慢 性 阻 塞 6、咳嗽
性 肺 疾 病 ） 患 者 ，7、心运过缓（＜100次/min）或心动过速（＞170次/min）
一 次 明 确 （ 肯 定 ）1岁以上，≤12岁患儿，至少具备以下任3项
的 放 射 学 改 变 是 1、发热（＞）或低体温（＜）无其他原因解释。
可以接受的
2 、 白 细 胞 减 少 （ ＜ 4000WBC/mm3 ） 或 白 细 胞 增 多 （≥15000WBC/mm3）
（ 肯 定 ） 的 放 射 学 改 7、咯血
变是可以接受的。 8、胸膜炎的胸痛
“肺炎”报告说明
在主要部位肺炎内有特定部位分类的级别，即使 患者符合多个特定部位的标准，只报告一个：
1、如果患者符合PNU1和PNU2，报告PNU2； 2、如果患者符合PNU2和PNU3，报告PNU3； 3、如果患者符合PNU1和PNU3，报告PNU3。
迫综合征、支气管肺发育 变或呼吸道分泌增加，或需 （如革兰染色）≥5%的细胞含
不良、肺水肿或慢性阻塞 吸痰次数增加
有细胞内细菌。
性肺疾病）患者，一次明 2、新出现的咳嗽或咳嗽加剧 5、病理组织学检查发现至少
确（肯定）的放射学改变 或呼吸困难或呼吸急促
以下肺炎证据之一
是可以接受的
3、湿罗音或支气管呼吸音 （1）坏死形成或融合病变中
– Temperature >38°C or <36°C OR white blood cell count ≥12,000 cells/mm3 or ≤ 4,000 cells/mm3 and
– A new antimicrobial agent is started and continued for ≥ 4 calendar days
机械通气对肺部感染患者外周血B型脑钠肽水平的影响及其与患者预后的关系分析
机械通气对肺部感染患者外周血B 型脑钠肽水平的影响及其与患者预后的关系分析周燕【摘要】目的探讨无创机械通气对肺部感染患者外周血，型脑钠肽（BNP)水平的影响及其与患者预后 的关系分析。
方法纳人我院2015年1月至2017年4月期间收治的120例肺部感染患者为研究对象，随机分 为对照组(60例）和机械通气组(60例），对照组给予常规治疗，机械通气组给予无创机械通气+常规治疗，比较 两组外周血BNP 水平并分析其与患者预后的关系。
结果治疗72 h 后，两组患者心率（H R )、呼吸频率（RR )、 BAP 水平均显著下降(！ <0. 05)，两组患者动脉血氧分压（P ?])、动脉二氧化碳分压（P ?〇2)均显著上升（！ < 0. 05 )，且机械通气组上述指标变化幅度均大于对照组(！ <0. 05);两组动脉血&H 值均恢复正常，且无显著差异 (! > 0. 05);机械通气组平均住院时间（12. 65 g 3. 52) d ，显著短于对照组的（15. 29 ± 4 38) d (! < 0. 05);机械通 气组存活率显著高于对照组(96. 67%与86. 67%，！ <0. 05);心功能衰竭组和死亡组BNP 水平显著高于心功能 正常组(！ <0. 05)，死亡组BNP 水平显著高于心力衰竭组(！ <0. 05)。
结论无创机械通气能有效改善肺部感 染患者病情，降低外周血BNP 水平，改善预后，缩短住院时间和提高患者存活率，外周血BNP 水平与患者预后有 关，治疗中应予以监测。
【关键词】机械通气;肺部感染'B 型脑钠肽;预后Influence of mechanical v entilation on peripheral blood B-type brain natriuretic peptide levels in patients with pulmonary infection a n d its relationship withprognosisZ H O U Y a nP e n g z h o u H o s p ita l o f T r a d itio n a l C h in e seM e d ic in e ，P e n g z h o u ，S ic h u a n611930，C h in a【Abstract 】 Objective To investigate the influence of noninvasive mechanical ventilation on peripheral blood B-type brain natriuretic p eptide (BNP) levels in patients with pulmonary infection and its relationship with prognosis.Metliods A total of 120 patients witli lung infection treated in our hosjDital from January 2015 to April 2017 were selected as study subjects，and they were randoNy divided into the control group (60 cases) and the mechanica ventilation goup (60 cases). The control g roup was given conventional treatment，while the mechanical ventilation group was given noninvasive mechanical ventilation combined with conventional treatment. BNPlevels in peripheral blood were compared between the two groups，andthe relationshipbetween the levels andthe prognosis was h after treatment，their heart rate ( H R )，respiratory r ate ( RR) and BNP levels decreased significantly，while the arterial partialpressure ofoxygen( Pa 〇2) and arterialpartial pressureofcarlDondioxidethe two groups ( all P < 0. 05 )，and the changes were more pronounced in the mechanical ventilation group than in the control group ( P < 0. 05 ) . The pH value of arterial blood in the two groups returned to normal，and there was no significant diference bet^veen the two groups ( P > 0. 05 ). The average duration of hospital stay was significantly shorter in the mechanical ventilation group[( 12. 65 ± 3. 52) d] than in the control group[( 15. 29 ±4. 38) d] (P <0. 05 )，and the survival rateofthemechanicalventilation g roup was significantlyhigherthanthat of86. 67%，P < 0. 05 ). BNP level in the heart failure group and the death group was significantly higher than those in the normal cardiac function group ( P < 0. 05 )，and BNP level in the death group was significantly higher than that in the heart failure group ( P < 0.05 ) . Conclusion Noninvasivemechanicalventilation c an effectiveof patients with pulmonary infection，reducetheperipheral bloodBNP level，improve theprognosis，shortention of hosjDital stay andimprove thesurviva rate.BNP level in peripheral bloodisclosely rpatients，which should be monitored during treatment.【Key words 】 mechanical ventilation; pulmonary infection; B-type brain natriuretic peptide ； prognosis密切相关，肺部感染是肺部疾病常见的多发病之一， 严重者可伴有心力衰竭，同时肺部也是多器官功能障 碍的始动器官，肺部感染是影响患者健康和生命安全 的危险因素[1_2]。
呼吸衰竭诊断指标及救治措施 高建苑
• Disadvantages
• Requires frequent adjustments to maintain adequate VE • Pt with noncompliant lungs may require alterations in inspiratory times to achieve adequate TV
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Pressure ventilation vs. volume ventilation
Pressure-cycled modes deliver a fixed pressure at variable volume (neonates) Volume-cycled modes deliver a fixed volume at variable pressure (adults)
The iron lung created negative pressure in abdomen as well as the chest, decreasing cardiac output.
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Iron lung polio ward at Rancho Los Amigos Hospital in 1953.
• Oxygenation in context of ICU
• V/Q mismatching • Patient position (supine) • Airway pressure, pulmonary parenchymal disease, smallairway disease • Adjustments: FiO2 and PEEP
第四军医大学第一附属医院 惠宾病房 高建苑
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Increased Airway Resistance:
secretions, mucosal edema, bronchoconstriction, foreign body Lung Tissue Involvement: interstitial pulmonary fibrotic diseases
Initiation of Mechanical Ventilation
Indications
Acute Respiratory Failure (ARF)
Acute Hypercapnic Respiratory Failure (Type II)
Neuromuscular Disorders Paralytic Disorders: Myasthenia Gravis, GuillainBarre´, ALS, poliomyelitis, etc. Paralytic Drugs: Curare, nerve gas, succinylcholine, insecticides
Acute life-threatening or vital organthreatening tissue hypoxia
Initiation of Mechanical Ventilation
Indicationsபைடு நூலகம்
Acute Respiratory Failure (ARF)
Clinical Presentation of Severe Hypoxemia Tachypnea
Initiation of Mechanical Ventilation
Indications
Acute Respiratory Failure (ARF)
Acute Hypercapnic Respiratory Failure
Increased Work of Breathing (cont.) Lung Tissue Involvement: interstitial pulmonary fibrotic diseases, aspiration, ARDS, cardiogenic PE, drug induced PE
surgery, prolonged shock, smoke injury
Ventilatory support is instituted to:
Decrease the WOB Minimize O2 consumption and hypoxemia Reduce cardiopulmonary stress Control airway with sedation
Respiratory activity is inadequate or is insufficient to
maintain adequate oxygen uptake and carbon dioxide clearance.
and pH acceptable levels
Inability of a patient to maintain arterial PaO2, PaCO2, PaO2 < 70 on an O2 >0.6 (PaO2/FiO2 <200) PaCO2 > 55 mm Hg and rising pH 7.25 and lower
Acute Respiratory Failure Prophylactic Ventilatory Support Hyperventilation Therapy
Initiation of Mechanical Ventilation
Indications
Acute Respiratory Failure (ARF)
Drugs that affect neuromuscular transmission;
calcium channel blockers, long-term adenocorticosteroids, etc. Impaired Muscle Function: electrolyte imbalance, malnutrition, chronic pulmonary disease, etc.
Partial Ventilatory Support (PVS) Provides less than total amount of work of breathing
Common during weaning SIMV at lower rates (usually <8 -10 BPM) PSV Bi-PAP
Dyspnea Central cyanosis Tachycardia Hypertension Irritability, confusion Loss of consciousness Coma
Initiation of Mechanical Ventilation
Initiation of Mechanical Ventilation
Prophylactic Ventilatory Support
Clinical conditions in which there is a high risk of future respiratory failure
Examples: Brain injury, heart muscle injury, major
Indications
Acute Respiratory Failure (ARF)
Acute Hypercapnic Respiratory Failure (Type II)
CNS Disorders
Reduced Drive To Breathe: depressant drugs,
Initiation of Mechanical Ventilation
Initial Ventilator Settings
Mode
Full Ventilatory Support (FVS)
Assumes essentially all the work of breathing Majority initially require FVS Assist Control (A/C) SIMV if rate is 12 BPM or higher (Chang)
Initiation of Mechanical Ventilation
Indications
Acute Respiratory Failure (ARF)
Hypoxic lung failure (Type I)
Ventilation/perfusion mismatch Diffusion defect Right-to-left shunt Alveolar hypoventilation Decreased inspired oxygen
brain or brainstem lesions (stroke, trauma, tumors), hypothyroidism Increased Drive to Breathe: increased metabolic rate (CO2 production), metabolic acidosis, anxiety associated with dyspnea
Acute head injury
Initiation of Mechanical Ventilation
Contraindications
Untreated pneumothorax
Relative Contraindications
Patient’s informed consent Medical futility Reduction or termination of patient pain and suffering
Initiation of Mechanical Ventilation
Indications
Acute Respiratory Failure (ARF)
Acute Hypercapnic Respiratory Failure
Increased Work of Breathing
Pleural Occupying Lesions: pleural
Initiation of Mechanical Ventilation
Initial Ventilator Settings
Minute Ventilation
The primary goal of volume ventilation (VV) is to
achieve a desired minute ventilation ( ) that matches the patient’s metabolic needs and accomplishes adequate gas exchange
Principles of Mechanical Ventilation
RET 2284 Module 4.0 Initiation of Mechanical Ventilation