1、null8 null Y H k T 王金祥 北京潞河医院呼吸科(北京null 101149) null null / = 1 n b Y = k M b = M Y ( - )a i b( )a q l ,7 O M _ a # v . bk M 9 8 = v 5 k 3 Y b (CHF)a E k % h ( COPD)ak W k 5 h M k % h , = k M | 3 1 Y b r B H , = B V CO b V Y V null / F ? 4 0 , # M Y n 9 F b Y H a A V h ,+ Y 1 PEEP H b Y H , Y V h =
2、9 F Y b T 1 ( ? z , V W u Y a Y ( CPAP) = b 0 4 J 0 ,E P 5 f 4 0 b ? s V 0 , # 5 l 4 h y H k 9 F P 9 F ,9 F . P i , k ; i P i W P M , P i f b K C z b 8 v y A P i $ H , r A b Tyberg 3 i P i * Q r (bellownulllike fashion),P i t M , t i f , t i W ( P i f - i f )M P i f t C ( LVEDPTM), t i W LVEDPTM b C
3、HF , k / , # 7 K i # k 6 H , i P i 8 , i f n , 9 F = a 5 f 4 b h 5 P P i f , ( V P i f CO 9 F b a t h 3 H q / Y k 5 r 1null E k % h :COPDi = PEEP (PEEPi), PEEPi i ,k # = 9 , d 3 T bPEEPi P = 6 , h ,k 5 E k % 5 s 9 F , i 9 F , i f ? p bCOPD k a = 9 F P P i f s K ,k 5 E 9 F ,P h ,P i h , P ? 3 Y b ! ,
4、 1 ! PEEP(PEEPe),E 5 / Y , PEEPe CPAP V F PEEPi,9 F bV PEEPe CPAP T ,7 V PEEPe CPAP5 F k V b H q ! H V S PEEPi, PEEPe M 80% PEEPi V b n * A b , 5 f 4 b 2nullP i ? : 7 Y $ P i ? b T 0 s , w 0 w CPAP BiPAP V 9 F , P i ? ,h 5 5 q b Y ? Y V 9 F = ,h P i - , Y P ? b ? , CO - G , Y V P CO b CHF H , CO G -
5、 , Y Y V P i t C 7 P i ? 4b P i ? k H = 9 F b k W k ,k , E 9 F , H J _ 9 F , P 9 F ,9 F # - b Y Y V k null316null S S 2006 M 7 5 4 null Chin J Respir Crit CareMed, July 2006, Volnull5, Nonull4 E , P H J _ h l b Y B Z Y V k 5 F T , r P k 5 E 6 ; 6 B Z Y V h k , , r P k 5 E / , Z r P k 5 E A M / 6 5b
6、7 Y H , PEEP V , P y k 7 ) k f k 7 b k ,k FRC h i b1982 M Grace 6 21 P ? 7 Y H ? C PEEP V P ? , P CO 6 ,K D PEEP ( 3null9 cmH2Ob 3null$ E : 8 8 $ E n y s , M 1 0 ? 5 u b y V P = $ / , = v J ,V v = P P i 9 F , k b k 5 l ak % 5 6 by N , $ E 1 Y , ,A 1 H 5 M 7 a J , O 5 = O a $ 5 5 Y $ n b $ E ? # 2 _
7、, $ P bv 50% $ E 1 Y i PEEP, e = ,h k , 7b0 U 4 a K A 8 b 4nullk : k Y H 1 E F k 5 l y , a ak f k V M b Y H k FRC,E k v o PVR 9 F ,d a k 3 8 b B V V I k b 9 , Y H 3 r d , h L Y H ,1 s h 3 / k T ,Y V , aR ,A 1 H 5 0 0 Z E Y k 5 d m Y ,E h Y H 3 k r b null I null null D 1null Shekerdmemian L, Bohn D.
8、cardiovascular effects of mechanical ventilation.Arch Dis Child,1999; 80:475 480 2null Acosta B, Dibenedetto R, Rahimi A, et al.Hemodynamic effects of noninvasive bilevel positive airway pressure on patients with chronic congestiveheart failure with systolicdysfunction.Chest, 2000;118:1004 1009 3nul
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10、 response to PEEP in patients with cardiac dysfunction.Crit CareMed,1982; 10:358 360 7null Lang SA, Duncan PG, Shephard DA, et al.Pulmonary oedema associated with airway obstruction. Can J Anaesth, 1990; 37: 210 218 ( l : 2006null02null22) (上接第314页) 24null Morley TF,Giaimo J,Maroszan E,et al.Use of
11、capnography for assessment of the adequacy of alveolar ventilation duringweannull ing from mechanical ventilation. Am Rev Respir Dis, 1993; 148:339 344 25null Takano Y, Sakamoto O,Kiyofuji C, et al. A comparison of the endnulltidal CO2 measured by portable capnometer andthe arterial PCO2 in spontane
12、ously breathing patients. Respir Med, 2003; 97:476 481 26null Dubin A,Murias G,Estenssoro E,et al. Endnulltidal CO2 pressure determinants during hemorrhagic shock. Intensive Care Med, 2000; 26:1619 1623 27null Romero PV,Lucangelo U,Lopez Aguilar J,et al. Physiollgically based indices of volumetric capnography in patients receiving mechanical ventilation.Eur Respir J,1997;10:1309 1315 28null F letcher R. Deadspace, invasive and nonnullinvasive. Br J Anaesth,1985; 57:245 249 ( l : 2006null05null22) null317null S S 2006 M 7 5 4 null Chin J Respir Crit Care Med, July 2006,Volnull5, Nonull4
