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1、According to the assessment requirements of party conduct and clean government,combined with the five regulations and five new requirements of state-owned Enterprise leaders integrity and self-discipline为了规范事业单位聘用关系,建立和完善适应社会主义市场经济体制的事业单位工作人员聘用制度,保障用人单位和职工的合法权益无创正压通气治疗的护理无创正压通气治疗的护理廖红梅According to t
2、he assessment requirements of party conduct and clean government,combined with the five regulations and five new requirements of state-owned Enterprise leaders integrity and self-discipline为了规范事业单位聘用关系,建立和完善适应社会主义市场经济体制的事业单位工作人员聘用制度,保障用人单位和职工的合法权益 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
3、指经鼻面罩进行的正压通气。According to the assessment requirements of party conduct and clean government,combined with the five regulations and five new requirements of state-owned Enterprise leaders integrity and self-discipline为了规范事业单位聘用关系,建立和完善适应社会主义市场经济体制的事业单位工作人员聘用制度,保障用人单位和职工的合法权益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
4、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。According to the assessment requirements of party conduct and clean government,combined with the five regulations and five new requirements of state-owned Enterprise leaders integrity and self-discipline为了规范
5、事业单位聘用关系,建立和完善适应社会主义市场经济体制的事业单位工作人员聘用制度,保障用人单位和职工的合法权益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;According to the assessment requirements of party conduct and clean government,com
6、bined with the five regulations and five new requirements of state-owned Enterprise leaders integrity and self-discipline为了规范事业单位聘用关系,建立和完善适应社会主义市场经济体制的事业单位工作人员聘用制度,保障用人单位和职工的合法权益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
7、竭。According to the assessment requirements of party conduct and clean government,combined with the five regulations and five new requirements of state-owned Enterprise leaders integrity and self-discipline为了规范事业单位聘用关系,建立和完善适应社会主义市场经济体制的事业单位工作人员聘用制度,保障用人单位和职工的合法权益 NIPPV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
8、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。According to the assessment requirements of party conduct and clean government,combined with the five regulations and five new requirements of state-owned Enterprise leaders integrity and self-discipline为了规范事业单位聘用关系,建立和完
9、善适应社会主义市场经济体制的事业单位工作人员聘用制度,保障用人单位和职工的合法权益 NIPPV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According to the assessment requirements of party conduct and clean government,combined with the five regulations and five new requirements of state-owned Enterprise leaders integrity and self-d
10、iscipline为了规范事业单位聘用关系,建立和完善适应社会主义市场经济体制的事业单位工作人员聘用制度,保障用人单位和职工的合法权益 NIPPV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According to the assessment requirements of party conduct and clean government,combined with the five regulations and five new requirements of state-owned Enterprise lead
11、ers integrity and self-discipline为了规范事业单位聘用关系,建立和完善适应社会主义市场经济体制的事业单位工作人员聘用制度,保障用人单位和职工的合法权益 NIPPV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PH7.20近期上腹部手术后严重肥胖上气道机械阻塞According to the assessment requirements of party conduct and clean government,combined with the five regulations and five new require
12、ments of state-owned Enterprise leaders integrity and self-discipline为了规范事业单位聘用关系,建立和完善适应社会主义市场经济体制的事业单位工作人员聘用制度,保障用人单位和职工的合法权益 NIPPV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According to the assessment requirements of party conduct and clean government,combined with the five regulations and five new req
13、uirements of state-owned Enterprise leaders integrity and self-discipline为了规范事业单位聘用关系,建立和完善适应社会主义市场经济体制的事业单位工作人员聘用制度,保障用人单位和职工的合法权益 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According to the assessment requirements of party conduct and clean government,combined with the f
14、ive regulations and five new requirements of state-owned Enterprise leaders integrity and self-discipline为了规范事业单位聘用关系,建立和完善适应社会主义市场经济体制的事业单位工作人员聘用制度,保障用人单位和职工的合法权益 BiPAP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According to the assessment requirements of party conduct and clean
15、 government,combined with the five regulations and five new requirements of state-owned Enterprise leaders integrity and self-discipline为了规范事业单位聘用关系,建立和完善适应社会主义市场经济体制的事业单位工作人员聘用制度,保障用人单位和职工的合法权益 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
16、布或纸巾垫起,预防周围的皮肤受压、充血、水肿、破溃等According to the assessment requirements of party conduct and clean government,combined with the five regulations and five new requirements of state-owned Enterprise leaders integrity and self-discipline为了规范事业单位聘用关系,建立和完善适应社会主义市场经济体制的事业单位工作人员聘用制度,保障用人单位和职工的合法权益 鼻罩与鼻面罩的优缺点鼻罩
17、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。According to the assessment requirements of party conduct and clean government,combined with the five regulations and five new requirements of state-owned Enterprise leaders integrity
18、 and self-discipline为了规范事业单位聘用关系,建立和完善适应社会主义市场经济体制的事业单位工作人员聘用制度,保障用人单位和职工的合法权益 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。According to the assessment requirements of party conduct and clean government,combined with the five regulations and five new requirements of sta
19、te-owned Enterprise leaders integrity and self-discipline为了规范事业单位聘用关系,建立和完善适应社会主义市场经济体制的事业单位工作人员聘用制度,保障用人单位和职工的合法权益 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。According to the assessment requirements of party conduct and clean government,combined with
20、the five regulations and five new requirements of state-owned Enterprise leaders integrity and self-discipline为了规范事业单位聘用关系,建立和完善适应社会主义市场经济体制的事业单位工作人员聘用制度,保障用人单位和职工的合法权益 BiPAP呼吸机模式的选择S模式T模式S/T模式According to the assessment requirements of party conduct and clean government,combined with the five regul
21、ations and five new requirements of state-owned Enterprise leaders integrity and self-discipline为了规范事业单位聘用关系,建立和完善适应社会主义市场经济体制的事业单位工作人员聘用制度,保障用人单位和职工的合法权益 BiPAP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
22、率超过预设频率时,则又从T模式切换到S模式。According to the assessment requirements of party conduct and clean government,combined with the five regulations and five new requirements of state-owned Enterprise leaders integrity and self-discipline为了规范事业单位聘用关系,建立和完善适应社会主义市场经济体制的事业单位工作人员聘用制度,保障用人单位和职工的合法权益 S/T模式参数的设置通气的压力必
23、须从低水平开始,通常吸气压IPAP从810cmH2O、呼气压从45cmH2O开始,经过520分钟逐渐增加到满意的通气水平或患者可能忍受的最高通气支持水平。后备频率BPM设置为患者自主呼吸频率-2-3次/分,一旦患者出现中枢性呼吸暂停,维持有效通气,降低呼吸做功,让呼吸肌得到最大程度的休息。According to the assessment requirements of party conduct and clean government,combined with the five regulations and five new requirements of state-owned
24、Enterprise leaders integrity and self-discipline为了规范事业单位聘用关系,建立和完善适应社会主义市场经济体制的事业单位工作人员聘用制度,保障用人单位和职工的合法权益BiPAP呼吸机常见的问题及解决方法呼吸困难症状不改善或加重同步不良低氧血症改善不明显二氧化碳潴留改善不明显According to the assessment requirements of party conduct and clean government,combined with the five regulations and five new requirements
25、of state-owned Enterprise leaders integrity and self-discipline为了规范事业单位聘用关系,建立和完善适应社会主义市场经济体制的事业单位工作人员聘用制度,保障用人单位和职工的合法权益 呼吸困难症状不改善或加重常见原因:精神紧张、吸入氧过低、支持压力不足、肯能存在未发现的禁忌症解决方法:加强病人的辅导和训练、仔细查体排除禁忌症、适当调整呼吸机参数According to the assessment requirements of party conduct and clean government,combined with the
26、five regulations and five new requirements of state-owned Enterprise leaders integrity and self-discipline为了规范事业单位聘用关系,建立和完善适应社会主义市场经济体制的事业单位工作人员聘用制度,保障用人单位和职工的合法权益 同步不良常见原因:精神紧张、漏气过大(病人张口呼吸)、机器故障解决方法:对病人耐心辅导训练、提醒病人闭口呼吸或更换面罩、维修机器。According to the assessment requirements of party conduct and clean go
27、vernment,combined with the five regulations and five new requirements of state-owned Enterprise leaders integrity and self-discipline为了规范事业单位聘用关系,建立和完善适应社会主义市场经济体制的事业单位工作人员聘用制度,保障用人单位和职工的合法权益 低氧血症改善不明显常见原因:EPAP、氧源、氧流量或吸入氧浓度、分泌物、暂时停通气的间歇期或进食时未吸氧或面罩、治疗时间解决方法:适当提高EPAP,同时提高IPAP、提高吸入治疗时间、将治疗护理相对集中处置,减少暂停
28、通气的次数和时间、延长治疗时间、调整其他治疗措施。According to the assessment requirements of party conduct and clean government,combined with the five regulations and five new requirements of state-owned Enterprise leaders integrity and self-discipline为了规范事业单位聘用关系,建立和完善适应社会主义市场经济体制的事业单位工作人员聘用制度,保障用人单位和职工的合法权益 二氧化碳潴留改善不明显常见
29、原因:支持压力、漏气量、EPAP、分泌物、治疗时间。解决方法:增大压差、适当增大漏气量,打开鼻罩的所有开口,或适当松动面罩,在鼻罩处接入45L/min的氧流量提高EPAP,抵消PEEPi。调整其他治疗措施。According to the assessment requirements of party conduct and clean government,combined with the five regulations and five new requirements of state-owned Enterprise leaders integrity and self-disc
30、ipline为了规范事业单位聘用关系,建立和完善适应社会主义市场经济体制的事业单位工作人员聘用制度,保障用人单位和职工的合法权益心理护理无创通气需要患者的配合,因此,加强与患者的交流与沟通非常重要。首先要消除患者恐惧心理,有的患者对面罩通气不了解,认为罩上面罩后会加重呼吸困难,有的患者认为使用呼吸机说明自己病情危重,在接受治疗前均有恐惧心理,勉强罩上面罩后有窒息感,不能达到人机同步,有的甚至拒绝治疗。因此,应耐心细致的做好解释工作,让患者了解无创通气的目的是改善呼吸功能,有利于疾病早日康复。指导患者有规律地放松呼吸,发现漏气或其他不适及时告诉医护人员。According to the asse
31、ssment requirements of party conduct and clean government,combined with the five regulations and five new requirements of state-owned Enterprise leaders integrity and self-discipline为了规范事业单位聘用关系,建立和完善适应社会主义市场经济体制的事业单位工作人员聘用制度,保障用人单位和职工的合法权益言语沟通障碍的护理由于患者要戴面罩通气治疗,语言表达会受到一定限制。要教会患者用手势、摇头、点头或写字板等进行沟通,从而
32、更好配合治疗。According to the assessment requirements of party conduct and clean government,combined with the five regulations and five new requirements of state-owned Enterprise leaders integrity and self-discipline为了规范事业单位聘用关系,建立和完善适应社会主义市场经济体制的事业单位工作人员聘用制度,保障用人单位和职工的合法权益严密观察病情1、一般生命体征:神志、心率、血压等2、呼吸系统症状
33、和体征:呼吸系统症状和体征3、呼吸机通气参数4、血氧饱和度和血气分析指标According to the assessment requirements of party conduct and clean government,combined with the five regulations and five new requirements of state-owned Enterprise leaders integrity and self-discipline为了规范事业单位聘用关系,建立和完善适应社会主义市场经济体制的事业单位工作人员聘用制度,保障用人单位和职工的合法权益保持呼
34、吸道通畅COPD所致呼吸衰竭的患者气道内分泌物多,需经扣背、雾化吸入、机械排痰等措施促进痰液排出。尤其是保持充分的呼吸道湿化非常重要。鼓励患者有效排痰。According to the assessment requirements of party conduct and clean government,combined with the five regulations and five new requirements of state-owned Enterprise leaders integrity and self-discipline为了规范事业单位聘用关系,建立和完善适应社
35、会主义市场经济体制的事业单位工作人员聘用制度,保障用人单位和职工的合法权益常见并发症的预防护理无创通气的常见不良反应有恐惧、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、排痰障碍等。According to the assessment requirements of party conduct and clean government,combined with the five regulations and five new requirements of state-owned Enterprise leaders integrity and self-disci
36、pline为了规范事业单位聘用关系,建立和完善适应社会主义市场经济体制的事业单位工作人员聘用制度,保障用人单位和职工的合法权益漏气是最常见的问题,几乎所有的NPPV质量过程中都会遇到。与面罩位置不当、固定带过松鹤面罩与患者脸型不适合等因素有关。调整面罩的位置、在兼顾舒适度的基础上适当增加固定带的拉力可减少或消除漏气。According to the assessment requirements of party conduct and clean government,combined with the five regulations and five new requirements o
37、f state-owned Enterprise leaders integrity and self-discipline为了规范事业单位聘用关系,建立和完善适应社会主义市场经济体制的事业单位工作人员聘用制度,保障用人单位和职工的合法权益压迫性损伤调整鼻面罩的位置和固定带的张力,间歇松开鼻面罩或轮换试用不同类型的鼻面罩或气垫面罩,避免长期压迫同一位置,可以避免此并发症。According to the assessment requirements of party conduct and clean government,combined with the five regulations
38、 and five new requirements of state-owned Enterprise leaders integrity and self-discipline为了规范事业单位聘用关系,建立和完善适应社会主义市场经济体制的事业单位工作人员聘用制度,保障用人单位和职工的合法权益排痰障碍原因为痰液黏稠、咳痰无力引起痰液潴留。应加强气道湿化,湿化罐内加入蒸馏水至水位线,保持室内相对湿度在60%左右。每2h翻身拍背1次。鼓励患者多饮水,给予雾化吸入,充分湿化痰液,促进痰液排出,保持呼吸道通畅。According to the assessment requirements of p
39、arty conduct and clean government,combined with the five regulations and five new requirements of state-owned Enterprise leaders integrity and self-discipline为了规范事业单位聘用关系,建立和完善适应社会主义市场经济体制的事业单位工作人员聘用制度,保障用人单位和职工的合法权益胃肠胀气主要是由于反复的吞气或者上气道内压力超过是到喷门括约肌的压力,使气体直接进入胃肠所致,多见于张口呼吸和通气压力较高的患者。解决的方法是在保证疗效的前提下避免通气
40、压力过高(小于25cmH2O),提醒患者尽量闭紧用鼻呼吸,带机期间尽量不说话,防止吸入大量气体引起胀气。腹胀明显者可行胃肠减压或使用胃动力药。According to the assessment requirements of party conduct and clean government,combined with the five regulations and five new requirements of state-owned Enterprise leaders integrity and self-discipline为了规范事业单位聘用关系,建立和完善适应社会主义市场
41、经济体制的事业单位工作人员聘用制度,保障用人单位和职工的合法权益口咽干燥多见于是用鼻罩又有经口漏气时,避免漏气、湿化和间隙饮水能缓解症状。无创呼吸机湿化温度设定以低于体表温度2为最佳温度。According to the assessment requirements of party conduct and clean government,combined with the five regulations and five new requirements of state-owned Enterprise leaders integrity and self-discipline为了规
42、范事业单位聘用关系,建立和完善适应社会主义市场经济体制的事业单位工作人员聘用制度,保障用人单位和职工的合法权益营养支持COPD患者营养支持不当时呼吸肌产生疲劳的原因之一。COPD患者又有兵器迁延不愈,反复发作,进食少,长伴有低蛋白血症性营养不良。上机期间应重视饮食管理,鼓励患者进食,给予高蛋白、高热量、高维生素易消化的食物。According to the assessment requirements of party conduct and clean government,combined with the five regulations and five new requiremen
43、ts of state-owned Enterprise leaders integrity and self-discipline为了规范事业单位聘用关系,建立和完善适应社会主义市场经济体制的事业单位工作人员聘用制度,保障用人单位和职工的合法权益刺激性角膜炎是由于鼻梁根部漏气刺激双眼,导致双眼球结膜充血干燥,故要防止面罩鼻梁根部漏气,如出现角膜炎可使用抗生素眼药水滴眼。According to the assessment requirements of party conduct and clean government,combined with the five regulations
44、 and five new requirements of state-owned Enterprise leaders integrity and self-discipline为了规范事业单位聘用关系,建立和完善适应社会主义市场经济体制的事业单位工作人员聘用制度,保障用人单位和职工的合法权益 BiPAP呼吸机使用中的注意事项漏气口不开堵塞,不可直对着病人。湿化器及时加水,不可干烧。避免交叉感染:定期更换消毒呼吸机管理7天/次;清洗过滤海绵1次/周。According to the assessment requirements of party conduct and clean government,combined with the five regulations and five new requirements of state-owned Enterprise leaders integrity and self-discipline为了规范事业单位聘用关系,建立和完善适应社会主义市场经济体制的事业单位工作人员聘用制度,保障用人单位和职工的合法权益谢谢 谢!谢!