使用呼吸器病患與呼吸器不同步的介紹及改善方式

Introduction and Management of Patient-Ventilator Asynchrony

歐芷瑩(Chih-Ying Ou) ； 陳昌文(Chang-Wen Chen) ； 張漢煜(Han-Yu Chang)

《內科學誌》 20卷6期 (2009/12) Pp. 497-505

https://doi.org/10.6314/JIMT.2009.20(6).04

摘要

減少呼吸作功是給予病人機械換氣的最主要原因。爲了讓吸氣肌肉減輕最大的負擔，呼吸器應該要和病人自主呼吸的節奏同步。然而，在接受輔助式機械換氣時常常會發生病人和呼吸器不協調的情形；因此直接評估呼吸器的波形可以用來指引醫師如何採取適當的步驟來改善不協調的一個工具。無法達到病人和呼吸器同步的目標將會導致各種不同的後遺症，而這些後遺症包括延後拔管和延長住院天數等等。這一篇文章介紹呼吸週期中四個不同時期所發生的不同步，並且闡明如何藉由壓力和流速兩種傳統呼吸器波形去判讀不同步。另外文章也統整了各種不同步的波形表現和臨床改善的方法。

關鍵字

病人與呼吸器 ； 不同步 ； 呼吸器波形

並列摘要

The most frequent reason for instituting mechanical ventilation is to decrease a patient's work of breathing. For the most effective unloading of the inspiratory muscles, the ventilator should cycle in synchrony with the activity of a patient's own respiratory rhythm. However, imperfect patient-ventilator interaction is common during assisted ventilation and direct evaluation of ventilator graphics may serve as a tool to guide the physicians to take the appropriate action to improve the asynchrony. Failure to achieve this synchrony may cause various complications including prolonged weaning and longer hospital stay. The present article introduces asynchrony relative to the 4 phases of a breath and illustrates how asynchrony can be identified with two conventional ventilatory waveforms: pressure and flow. Besides, it also reviews different illustrations of waveforms and clinical management to improve asynchrony.

並列關鍵字

Patient-ventilator ； Asynchrony ； Ventilator graphics