重症医学资质培训-急性呼吸衰竭.ppt

弥散功能障碍弥散面积减少肺泡毛细血管膜增厚血液流经肺毛细血管的时间太短肺毛细血管弥散血量减少急性呼吸衰竭的处理原则病因治疗呼吸支持疗法控制感染维持循环稳定营养支持预防并发症建立通畅的气道氧疗机械通气体外膜肺氧合呼吸支持疗法建立通畅的气道无论何种原因引起的呼吸衰竭，保持气道通畅是最基本、首要的治疗措施，是进行各种呼吸支持治疗的必要条件。如气道因痰液、异物或人工气道故障完全阻塞，则无论采取什么方法增加吸氧浓度、进行人工通气都无济于事。人工气道气管插管气管切开经皮气管切开经皮气管切开规格6.0/7.0/7.5/8.0/8.5/9.0/10.0气管套管建立通畅的气道氧疗机械通气体外膜肺氧合呼吸支持疗法?氧疗的方法提高吸入氧浓度注意供氧装置与患者的需求相匹配高浓度与低浓度的供氧系统高流量与低量的供氧系统氧疗装置*Hypoventilationmayresultfrompathologyanywhereintheneuromuscularpathwaycontrollingrespirationfromthebrainstemthroughthespinalcord,nerveroots,phrenicnerve,neuromuscularjunctiontomuscleorfromincreasedresistanceordecreasedcomplianceofairways,lung,pleuraorchestwall.*Normallyventilationandperfusionarereasonablywellmatched*Itisaformofventilation-perfusionmismatchinwhichalveoliwhicharenotventilated(egduetocollapseorpusoroedemafluid)arestillperfused.Becausethealveoliarenotventilatedbloodperfusingthesealveoliremainspoorlyoxygenated,withtheresultthatbloodleavingthelungsisnotfullysaturated.*Furthermoreoxygentherapyhasrelativelylittleeffectonhypoxiaduetoshunting.Increasingtheinspiredoxygenconcentrationcannotfurtherincreasethesaturationofbloodleavingnormallyventilatedalveoliasitisalready100%saturatedandthehigheroxygenconcentrationdoesnotreachnon-ventilatedalveoli*Causesofintrapulmonaryshuntingincludepneumonia,pulmonaryoedema,atelectasis,collapseandpulmonaryhaemorrhageorcontusionShuntingcanalsooccuratanintra-cardiaclevelbutthisisanunusualcauseofhypoxaemiaintheICU.AnycauseofpulmhyptensionegARDSwithpatentforamenovalecanleadtorighttoleftshunting.*Thisoccurswhenalveoliareventilatedbutnotperfused*弥散面积减少：肺实变、肺不张、肺切除术后肺泡毛细血管膜增厚：肺纤维组织增生、肺水肿血液流经肺毛细血管的时间太短：肺气肿时肺毛细血管随肺泡壁破坏而?肺毛细血管弥散血量减少：贫血、血容量过低、肺血管收缩急性呼吸衰竭前言急性呼吸衰竭（acuterespiratoryfailureARF）尽管近年来，在诊断、检测和治疗手段方面有许多技术进步，急性呼吸衰竭依然是重症监护病房