Incze F
Anaesthesiologiai és Intenzív Betegellátó Osztálya, Szent Rókus Kórház és Rendelöintézet, Budapest.
Orv Hetil. 1993 Oct 31;134(44):2421-6.
The indication of mechanical ventilation is either a failing ventilatory function of the thorax or a failing gas exchange function of the lung. The ventilation affects every organ function in more or less degree. The starting point of long term ventilation is debated, arbitrary. Some ventilatory devices are simulating the natural intrapleural negative pressure principle, but most of them applies intermittent positive pressure into the lung. For improving oxygenation, a moderate level of positive end expiratory pressure, eventually inversed or 1:1 inspiratory:expiratory ratio can be applied. The computerized electronic ventilators offer a big selection of assisting and controlling ventilatory modes, according to the requirements of the patients. For routine use, in ventilatory failure, pressure cycled controlled ventilation, in gas exchange failure, the combination of synchronized intermittent mandatory ventilation, positive end-expiratory pressure and pressure support can be recommended. For special tasks there are existing special ventilatory or other supportive means. In most of the cases some sedation of the ventilated patients is appropriate, muscle paralysing is restricted to a few situations. It is important to humidify the inhaled air. The detailed monitoring of the patients is essential during ventilation. The weaning of the patients from the ventilator is a complex procedure, which involves ventilatory, nutritional, pharmacologic and psychologic interventions.
机械通气的指征要么是胸廓通气功能衰竭,要么是肺气体交换功能衰竭。通气或多或少会影响每个器官的功能。长期通气的起始点存在争议,具有随意性。一些通气设备模拟自然胸腔内负压原理,但大多数设备是向肺内施加间歇正压。为改善氧合,可应用适度水平的呼气末正压,最终可采用反比通气或1:1吸气:呼气比。电脑化电子通气机根据患者需求提供多种辅助和控制通气模式。对于常规使用,在通气衰竭时,可推荐压力控制通气;在气体交换衰竭时,可推荐同步间歇指令通气、呼气末正压和压力支持的联合应用。对于特殊任务,有现有的特殊通气或其他支持手段。在大多数情况下,对接受通气的患者进行适当的镇静是合适的,肌肉松弛仅限于少数情况。对吸入空气进行湿化很重要。通气期间对患者进行详细监测至关重要。患者脱机是一个复杂的过程,涉及通气、营养、药物和心理干预。