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瑕佷簡(jiǎn)瑙ｅ懠鍚告満錛屽氨闇�瑕佷簡(jiǎn)瑙ｅ懠鍚告満鐨勫洓涓弬鏁幫細(xì)娼皵閲忋�佸帇鍔涖�佹祦閲忋�佹椂闂?鍖呮嫭鍛煎惛棰戠巼銆佸懠鍚稿懠鍚告瘮)銆?/span>
娼皵閲忥細(xì)娼皵閲忓繀欏婚珮浜庝漢浣撶郴緇熸疆姘旈噺6~10ml/kg錛屽懠鍚告満鐨勬箍姘旈噺鍙互杈懼埌10~15ml/kg錛屼竴鑸槸鐢熺悊娼皵閲忕殑1~2鍊嶃�傛牴鎹鉤鎴胯搗浼忥紝鍙岃偤榪涙皵鍚瘖錛屽弬鑰冩皵鍘嬭〃銆?/span>
鍛煎惛棰戠巼錛氭帴榪戠敓鐞嗗懠鍚擱鐜囥�傛柊鐢熷効姣忓垎閽?0~50嬈★紝濠村効姣忓垎閽?0~40嬈★紝澶ч緞鍎跨姣忓垎閽?0~30嬈★紝鎴愪漢姣忓垎閽?6~20嬈°�傚懠鍚擱鐜?鍛煎惛棰戠巼=姣忓垎閽熼�氭皵閲?/span>
鍛煎惛姣斾緥錛氫竴鑸?:1.5~2銆傞樆濉為�氶闅滅鍙互璋冭妭涓?.5銆?3鎴栨洿闀跨殑鍛煎惛鏃墮棿錛岀害鏉熸�ч�氭皵闅滅鍙互璋冩暣涓?:1銆?/span>
鍘嬪姏錛氫竴鑸寚姘旈亾宄板�煎帇鍔涖�?PIP)銆傚綋鑲洪儴閫傚簲姝ｅ父鏃訛紝鍛煎惛宄板帇涓�鑸負(fù)10~20cmH2O錛岃偤閮ㄧ梾鍙樿緝杞伙細(xì)20~25cmH2O銆傦紱錛涗腑搴︼細(xì)25~30mm姘存祦錛涗弗閲嶇▼搴︼細(xì)瓚呰繃30cm姘存祦錛屽懠鍚哥獦榪患鍚堝緛杈懼埌60cm姘存祦錛岃偤鍑鴻銆?/span>
搴旂敤IPPVPEEP涓�鑸粰鍑篜EEP2~3cm姘存祦錛岀鍚堢敓鐞嗘潯浠躲�傚鏋滃嚭鐜頒弗閲嶇殑閫氶闅滅(RDS銆佽偤閮ㄥ嚭琛�)鏃訛紝搴旀彁楂楶EEP錛屼竴鑸負(fù)4~10cm姘存祦錛屼弗閲嶈�呭彲杈?5cm浠ヤ笂錛岀敋鑷?0cm姘存祦銆?/span>
濡傛灉鍔ㄨ剦姘у垎鍘嬩粛灝忎簬80mmhg錛屽垯搴旀彁楂楶EEP錛岀洿鑷沖姩鑴夋哀鍒嗗帇瓚呰繃80mmhg錛屽綋姘ф祿搴﹁秴榪?0%(FiO2瓚呰繃0.6)鏃訛紝PEEP姣忓鍔犳垨鍑忓皯1~2mm姘存祦錛岄兘浼?xì)瀵硅姘т駭鐢熷緢澶у獎(jiǎng)鍝嶏紝鍑犲垎閽熷唴灝變細(xì)鍑虹幇銆侾EEP搴旇閫愭笎鍑忓皯錛屽茍鐩戞祴琛�姘у彉鍖栥�侾EEP鍊煎彲浠ヤ粠姘斿帇琛ㄦ寚閽堢殑鍛兼皵鏈鍙栥�?/span>
嫻侀噺錛氭瘡鍒嗛挓鑷沖皯閫氭皵2嬈★紝涓�鑸負(fù)4~10鍗?鍒嗛挓銆?/span>
鏍規(guī)嵁琛�姘斿垎鏋愯繘涓�姝ヨ皟鏁達(dá)細(xì)棣栧厛媯�(gè)鏌ュ懠鍚擱亾鏄惁欏虹晠錛屾皵綆″綆＄殑浣嶇疆錛屽弻鑲鴻繘姘旀槸鍚﹁壇濂斤紝鍛煎惛鏈烘槸鍚︽甯革紝鏄惁鏈夋紡姘斻�?/span>
甯歌鐨勫懠鍚告満鍩烘湰璋冭妭鏂規(guī)硶
1.1.褰損ao2榪囦綆鏃訛細(xì)(1)鎻愰珮姘ф皵嫻撳害(2)鎻愰珮PEEP鍊?3)濡傛灉閫氭皵閲忎笉瓚籌紝鍙鍔犳瘡鍒嗛挓閫氭皵閲忥紝澧炲姞鍚告皵鏃墮棿錛屽眬闄愪簬鍛煎惛鍚庢湡絳夈�?/span>
2.褰?銆侾ao2榪囬珮錛?1)闄嶄綆姘ф皵嫻撳害錛?2)PEEP鍊奸�愭笎涓嬮檷銆?/span>
3.PaCO_2榪囬珮鏃?(1)澧炲姞鍛煎惛棰戠巼(2)澧炲姞娼皵閲?瀹氬鍨嬪彲鐩存帴璋冭妭錛屽畾鍘嬪瀷鍙鍔犻璁懼帇鍔涳紝鎸夋椂鍨嬪彲澧炲姞嫻侀噺鍜屽帇鍔涖�?/span>
4.褰?銆侾aCO2澶綆:(1)鍑忕紦鍛煎惛棰戠巼銆傚懠姘斿拰鍚告皵鐨勬椂闂村彲浠ュ悓鏃跺鍔狅紝浣嗗懠鍚告椂闂磋浠ュ鍔犱負(fù)涓伙紝鍚﹀垯浼?xì)閫傚緱鍏跺弽銆備綘鍙互鐢↖MV浠ｆ浛瀹冦�?2)闄嶄綆娼皵閲?瀹氬寮忓彲浠ョ洿鎺ヨ皟鑺傦紝瀹氬帇寮忓彲浠ラ檷浣庨璁懼帇鍔涳紝鎸夋椂寮忓彲浠ラ檷浣庢祦閲忓拰鍘嬪姏闄愬埗銆?/span>