无创通气治疗护理课件

Accordingtotheassessmentrequirementsofpartyconductandcleangovernment,combinedwiththefiveregulationsandfivenewrequirementsofstate-ownedEnterpriseleaders'integrityandself-discipline无创正压通气治疗的护理廖红梅Accordingtotheassessmentrequirementsofpartyconductandcleangovernment,combinedwiththefiveregulationsandfivenewrequirementsofstate-ownedEnterpriseleaders'integrityandself-discipline无创正压通气•无创正压通气（NIPPV）是指不经气管插管或气管切开而增加肺泡通气的一系列方法的总称，主要是指经鼻面罩进行的正压通气。Accordingtotheassessmentrequirementsofpartyconductandcleangovernment,combinedwiththefiveregulationsandfivenewrequirementsofstate-ownedEnterpriseleaders'integrityandself-discipline无创呼吸机的治疗原理•无创呼吸机是一种为呼吸功能不全的为重病人提供呼吸支持的治疗装置，可将新鲜空气或氧气压入肺泡进行血气交换，以治疗呼吸功能障碍。无创呼吸机的应用可改善患者通气、缓解患者呼吸肌疲劳，消除呼吸困难，有利于呼吸和循环功能的恢复。Accordingtotheassessmentrequirementsofpartyconductandcleangovernment,combinedwiththefiveregulationsandfivenewrequirementsofstate-ownedEnterpriseleaders'integrityandself-discipline无创呼吸机的治疗原理•无创呼吸机工作模式可分为持续气道正压通气（CPAP）和双水平气道正压通气（BiPAP）两类。BiPAP是一种对有自主呼吸但呼吸不足的患者最常用的通气模式，具有流量触发和漏气补偿功能，可提供两个正压辅助通气，一个较高的吸气压（IPAP）作为压力支持通气，减少呼吸做功和耗氧量，对患者呼吸肌疲劳的恢复起重要作用；Accordingtotheassessmentrequirementsofpartyconductandcleangovernment,combinedwiththefiveregulationsandfivenewrequirementsofstate-ownedEnterpriseleaders'integrityandself-discipline无创呼吸机的治疗原理•一个较低的呼气压（EPAP），相当于呼气末正压（PEEP）作用，可以对抗内源性呼气末正压，增加功能残气量，防止肺萎缩，改善气体在肺内的不均匀分布，增加肺泡通气量，提高PaO2，降低PaCO2，改善氧合，从而有效地治疗呼吸衰竭。Accordingtotheassessmentrequirementsofpartyconductandcleangovernment,combinedwiththefiveregulationsandfivenewrequirementsofstate-ownedEnterpriseleaders'integrityandself-disciplineNIPPV的目标•短期目标：缓解呼吸困难、改善患者的舒适度、降低呼吸功、改善或维持其他的交换、降低并发症、防止气管插管或延缓气管插管。•长期目标：改善症状、改善或维持气体交换、增加睡眠的时间和质量、改善生活质量、改善呼吸功能、延长生命。Accordingtotheassessmentrequirementsofpartyconductandcleangovernment,combinedwiththefiveregulationsandfivenewrequirementsofstate-ownedEnterpriseleaders'integrityandself-disciplineNIPPV的适应症•COPD急性加重期和缓解期•有创通气提前拔管前之序贯治疗•急、慢性心功能不全•睡眠呼吸暂停综合征（OSAS）•低通气等Accordingtotheassessmentrequirementsofpartyconductandcleangovernment,combinedwiththefiveregulationsandfivenewrequirementsofstate-ownedEnterpriseleaders'integrityandself-disciplineNIPPV的禁忌症•心跳呼吸停止•自主呼吸微弱、昏迷•误吸可能性高•合并其他器官功能衰竭•胸腹部手术后或创伤•面部创伤、手术或畸形•不合作Accordingtotheassessmentrequirementsofpartyconductandcleangovernment,combinedwiththefiveregulationsandfivenewrequirementsofstate-ownedEnterpriseleaders'integrityandself-disciplineNIPPV相对禁忌症•气道分泌物多或排痰障碍•严重感染•极度紧张•严重低氧血症氧分压＜45mmHg•严重酸中毒PH＜7.20•近期上腹部手术后•严重肥胖•上气道机械阻塞Accordingtotheassessmentrequirementsofpartyconductandcleangovernment,combinedwiththefiveregulationsandfivenewrequirementsofstate-ownedEnterpriseleaders'integrityandself-disciplineNIPPV的并发症•恐惧•漏气•口咽干燥•鼻面罩压迫鼻梁皮肤受损•胃肠胀气•漏气•低氧血症•排痰障碍Accordingtotheassessmentrequirementsofpartyconductandcleangovernment,combinedwiththefiveregulationsandfivenewrequirementsofstate-ownedEnterpriseleaders'integrityandself-discipline终止NIPPV的指征•不合作•因疼痛不能耐受鼻面罩•气体交换无改善呼吸困难加重•出现呕吐、上消化道出血•气道分泌物增多引流困难•出现低血压、严重心律失常Accordingtotheassessmentrequirementsofpartyconductandcleangovernment,combinedwiththefiveregulationsandfivenewrequirementsofstate-ownedEnterpriseleaders'integrityandself-disciplineBiPAP呼吸机的使用•人-机连接的选择•连接方式•鼻罩与鼻面罩•体位要求连接顺序•模式选择•S/T模式参数的设定•常见并发症及解决方法•使用中的注意事项Accordingtotheassessmentrequirementsofpartyconductandcleangovernment,combinedwiththefiveregulationsandfivenewrequirementsofstate-ownedEnterpriseleaders'integrityandself-discipline人-机连接的选择•鼻罩和鼻面罩均可用于无创通气，选择哪一种应根据病情及患者的耐受情况而定。•应根据患者的脸型及胖瘦选择大小合适的鼻（面）罩，固定时应调整固定带的松紧度，头带松紧以伸入两指为宜。受压的部位要用棉垫或纱布或纸巾垫起，预防周围的皮肤受压、充血、水肿、破溃等Accordingtotheassessmentrequirementsofpartyconductandcleangovernment,combinedwiththefiveregulationsandfivenewrequirementsofstate-ownedEnterpriseleaders'integrityandself-discipline鼻罩与鼻面罩的优缺点•鼻罩•优点：死腔小；发音、进食、咳嗽不受影响；呕吐时不易误吸；轻症呼衰患者首选。•缺点：张口呼吸时易漏气，疗效降低。•鼻面罩•优点：漏气较小；血气改善较快；重症呼衰患者首选•缺点：死腔大；发音、进食、咳痰需脱开呼吸机；呕吐时易误吸；易发生胃肠胀气。Accordingtotheassessmentrequirementsofpartyconductandcleangovernment,combinedwiththefiveregulationsandfivenewrequirementsofstate-ownedEnterpriseleaders'integrityandself-discipline体位要求•协助患者采取舒适体位，可取平卧位或半卧位，头稍后倾，保持头、颈、肩在同一平面上以打开气道，避免枕头过高使呼吸道受压狭窄影响气流通过而降低疗效。Accordingtotheassessmentrequirementsofpartyconductandcleangovernment,combinedwiththefiveregulationsandfivenewrequirementsofstate-ownedEnterpriseleaders'integrityandself-discipline连接顺序•调试好呼吸机设置之后，暂停呼吸机。•在吸氧状态下将鼻或面罩相连接，调整好头带松紧度后再接到呼吸机。不能将呼吸机与罩连接后再接到患者，使患者在连接过程中由于漏气而感到明显的不适。Accordingtotheassessmentrequirementsofpartyconductandcleangovernment,combinedwiththefiveregulationsandfivenewrequirementsofstate-ownedEnterpriseleaders'integrityandself-disciplineBiPAP呼吸机模式的选择•S模式•T模式•S/T模式Accordingtotheassessmentrequirementsofpartyconductandcleangovernment,combinedwiththefiveregulationsandfivenewrequirementsofstate-ownedEnterpriseleaders'integrityandself-disciplineBiPAP呼吸机的使用•S模式：意为同步触发，呼吸机和患者呼吸同步。•T模式：为呼吸机按预设的压力，呼吸频率及呼吸比完全控制患者的呼吸。•S/T模式：为S和T模式的组合。即病人自主呼吸稳定时以S模式与病人呼吸同步。如果病人呼吸停止或不稳定低于预设安全频率时自动跳到T模式；若病人呼吸恢复稳定自主频率超过预设频率时，则又从T模式切换到S模式。Accordingtotheassessmentrequirementsofpartyconductandcleangovernment,combinedwiththefiveregulationsandfivenewreq