cpap5cmH2o是指氧什么？ 引起急性呼吸窘迫综合征和多器官衰竭的重要原因是核算阳性吗
\u547c\u5438\u673a\u6700\u57fa\u672c\u76844\u4e2a\u53c2\u6570\u56db\u5927\u53c2\u6570\uff1a\u6f6e\u6c14\u91cf\u3001\u538b\u529b\u3001\u6d41\u91cf\u3001\u65f6\u95f4
\u7b80\u4ecb\uff1a
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\u539f\u7406\uff1a
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\u4e3b\u8981\u7c7b\u578b\uff1a
1\u3001\u5b9a\u538b\u578b\u547c\u5438\u673a
\u5438\u6c14\u65f6\uff0c\u547c\u5438\u673a\u5411\u6c14\u9053\u6cf5\u5165\u4e00\u5b9a\u538b\u529b\u7684\u6c14\u4f53\uff0c\u4f7f\u80ba\u6ce1\u81a8\u80c0\uff0c\u6c14\u9053\u538b\u529b\u6e10\u5347\uff0c\u8fbe\u5230\u9884\u5b9a\u538b\u529b\u65f6\uff0c\u6c14\u6d41\u7ec8\u6b62\uff0c\u8f6c\u4e3a\u547c\u6c14\u76f8\u3002\u6b64\u7c7b\u547c\u5438\u673a\u7684\u6f6e\u6c14\u91cf\uff0c\u4e0e\u547c\u5438\u673a\u9884\u7f6e\u7684\u538b\u529b\u3001\u5438\u6c14\u65f6\u95f4\u3001\u6d41\u901f\u7b49\u6709\u5173\u3002\u5982\u6d41\u901f\u4f4e\uff0c\u5438\u6c14\u65f6\u95f4\u77ed\uff0c\u9884\u5b9a\u538b\u529b\u4f4e\uff0c\u6f6e\u6c14\u91cf\u5219\u5c0f\uff0c\u53cd\u4e4b\u5219\u6f6e\u6c14\u91cf\u589e\u5927\u3002\u82e5\u80ba\u987a\u5e94\u6027\u4e0b\u964d\u6216\u652f\u6c14\u7ba1\u75c9\u631b\u4f7f\u6c14\u9053\u963b\u529b\u589e\u52a0\u5747\u53ef\u4f7f\u6f6e\u6c14\u91cf\u4e0b\u964d\u3002
\u6b64\u7c7b\u547c\u5438\u673a\u7684\u7f3a\u70b9\u662f\u6c14\u9053\u538b\u529b\u589e\u52a0\u65f6\uff0c\u6f6e\u6c14\u91cf\u5f97\u4e0d\u5230\u4fdd\u969c\uff0c\u4f18\u70b9\u662f\u6c14\u9053\u6709\u6f0f\u6c14\u65f6\uff0c\u5b83\u4e5f\u5fc5\u987b\u4fdd\u6301\u4e00\u5b9a\u538b\u529b\uff0c\u4e5f\u80fd\u7ef4\u6301\u9002\u5f53\u901a\u6c14\uff0c\u7b80\u8a00\u4e4b\uff0c\u6b64\u7c7b\u547c\u5438\u673a\u4fdd\u538b\u529b\u4e0d\u4fdd\u5bb9\u91cf\u3002
2\u3001\u5b9a\u5bb9\u578b\u547c\u5438\u673a
\u547c\u5438\u673a\u5c06\u56fa\u5b9a\u7684\u5bb9\u79ef\u6c14\u4f53\u6cf5\u5165\u75c5\u4eba\u6c14\u9053\u53ca\u80ba\u90e8\uff0c\u4ea7\u751f\u5438\u6c14\u547c\u6c14\u7684\u52a8\u4f5c\u3002\u6b64\u7c7b\u547c\u5438\u673a\u7684\u4f18\u70b9\u662f\u5728\u5b89\u5168\u538b\u529b\u8303\u56f4\u5185\uff0c\u5bc6\u95ed\u7684\u6c14\u9053\u72b6\u6001\u4e0b\u80fd\u4fdd\u8bc1\u4e00\u5b9a\u7684\u6f6e\u6c14\u91cf\u3002\u7f3a\u70b9\u662f\u6c14\u9053\u6f0f\u6c14\u65e0\u6cd5\u8865\u507f\uff0c\u6c14\u9053\u538b\u529b\u8fc7\u5927\u540c\u6837\u53ef\u53d1\u751f\u901a\u6c14\u4e0d\u8db3\u3002\u7b80\u8a00\u4e4b\uff0c\u6b64\u7c7b\u547c\u5438\u673a\u4fdd\u5bb9\u91cf\u4e0d\u4fdd\u538b\u529b\u3002
3\u3001\u5b9a\u65f6\u578b\u547c\u5438\u673a
\u4e3a\u5b9a\u65f6\u3001\u9650\u538b\u6052\u6d41\u578b\u547c\u5438\u673a\uff0c\u547c\u5438\u673a\u4ea7\u751f\u6c14\u6d41\uff0c\u8fdb\u5165\u6c14\u9053\u8fbe\u5230\u9884\u5b9a\u65f6\u95f4\uff0c\u5438\u6c14\u505c\u6b62\uff0c\u4ea7\u751f\u547c\u6c14\u3002\u5728\u547c\u6c14\u76f8\uff0c\u6c14\u9053\u5185\u4ecd\u6709\u4f4e\u538b\u529b\u6c14\u6d41\u901a\u8fc7\u3002\u5176\u5438\u6c14\u65f6\u95f4\u3001\u547c\u5438\u9891\u7387\u3001\u5438/\u547c\u6bd4\u503c\u3001\u5438\u5165\u6c14\u6c27\u6d53\u5ea6\u53ef\u4ee5\u8c03\u8282\u3002
\u4ee5\u4e0a\u5206\u578b\u662f\u57fa\u4e8e\u5438\u6c14\u76f8\u4e0e\u547c\u6c14\u76f8\u8f6c\u6362\u800c\u5206\u7c7b\u7684\u3002\u4ea6\u6709\u6309\u63a7\u5236\u65b9\u5f0f\uff08\u7535\u52a8\u3001\u6c14\u52a8\uff09\u3001\u7528\u9014\u5206\u7c7b\u3002\u8fd8\u6709\u4e00\u7c7b\u4e3a\u9ad8\u9891\u901a\u6c14\u547c\u5438\u673a\uff0c\u5176\u7279\u70b9\u662f\u9ad8\u547c\u5438\u9891\u7387\uff0c\u4f4e\u6f6e\u6c14\u91cf\uff0c\u975e\u5bc6\u95ed\u6c14\u8def\u8fd0\u884c\u3002
\u4e00\u3001ARDS\u7684\u67cf\u6797\u5b9a\u4e49\uff1a
1\u3001\u8d77\u75c5\u65f6\u95f4\uff1a\u5df2\u77e5\u4e34\u5e8a\u75c5\u56e0\u540e1\u5468\u4e4b\u5185\u6216\u65b0\u53d1/\u539f\u6709\u547c\u5438\u75c7\u72b6\u52a0\u91cd\uff1b
2\u3001\u80f8\u90e8\u5f71\u50cf\uff1a\u5373\u80f8\u7247\u6216CT\u626b\u63cf\uff0c\u53ef\u89c1\u53cc\u4fa7\u9634\u5f71\u4e14\u4e0d\u80fd\u5b8c\u5168\u7528\u80f8\u8154\u79ef\u6db2\u89e3\u91ca\u3001\u80ba\u53f6/\u80ba\u840e\u9677\u3001\u7ed3\u8282\uff1b
3\u3001\u80ba\u6c34\u80bf\uff1a\u5176\u539f\u56e0\u4e0d\u80fd\u901a\u8fc7\u5fc3\u8870\u6216\u6c34\u8d1f\u8377\u589e\u591a\u6765\u89e3\u91ca\u7684\u547c\u5438\u8870\u7aed\uff0c\u5982\u679c\u6ca1\u6709\u5371\u9669\u56e0\u7d20\uff0c\u5c31\u9700\u8981\u5ba2\u89c2\u8bc4\u4f30\u6392\u9664\u9759\u6c34\u538b\u6c34\u80bf\uff1b
4\u3001\u7f3a\u6c27\u7a0b\u5ea6\uff1a
\u2460\u8f7b\u5ea6\uff1a200mmHg<PaO2/FiO2\u2264300mmHg\uff0cPEEP\u6216CPAP\u22655cmH2O\uff0c\u8f7b\u5ea6ARDS\u7ec4\u4e2d\u53ef\u80fd\u91c7\u7528\u65e0\u521b\u901a\u6c14\uff1b
\u2461\u4e2d\u5ea6\uff1a100mmHg<PaO2/FiO2\u2264200mmHg\uff0cPEEP\u22655cmH2O\uff1b
\u2462\u91cd\u5ea6\uff1aPaO2/FiO2\u2264100mmHg\uff0cPEEP\u22655cmH2O\uff0c\u8bf4\u660e\uff1a\u5982\u679c\u6240\u5728\u5730\u533a\u7eac\u5ea6\u9ad8\u4e8e1000\u7c73\uff0c\u5e94\u5f15\u5165\u6821\u6b63\u56e0\u5b50\u8ba1\u7b97\uff1a[PaO2/FiO2(\u6c14\u538b/760)]\u3002
\u6025\u6027\u547c\u5438\u7a98\u8feb\u7efc\u5408\u5f81
\u8d77\u75c5\uff1a\u65b0\u53d1\u6216\u8005\u539f\u6709\u547c\u5438\u9053\u75c7\u72b61\u5468\u5185\u8fdb\u884c\u6027\u52a0\u91cd\u3002
\u80f8\u90e8\u5f71\u50cf\u5b66\u68c0\u67e5\uff08\u80f8\u90e8X\u7247\uff0cCT\u3001\u80ba\u90e8\u8d85\u58f0\uff09\uff1a\u53cc\u80ba\u78e8\u73bb\u7483\u5f71\uff08\u4e0d\u80fd\u5b8c\u5168\u7531\u80ba\u79ef\u6db2\u3001\u5927\u53f6\u6027\u6e17\u51fa\u3001\u80ba\u4e0d\u5f20\u6216\u80ba\u90e8\u7ed3\u8282\u89e3\u91ca\uff09\u3002
\u80ba\u6c34\u80bf\u539f\u56e0\uff1a\u4e0d\u80fd\u7528\u5fc3\u8870\u6216\u8005\u6db2\u4f53\u8d85\u8d1f\u8377\u89e3\u91ca\u7684\u547c\u5438\u8870\u7aed\u3002\u5982\u679c\u65e0\u5176\u4ed6\u5371\u9669\u56e0\u7d20\u7684\u8bdd\uff0c\u5219\u9700\u8981\u5ba2\u89c2\u8bc4\u4ef7\u6307\u6807\uff08\u5982\u5fc3\u810f\u8d85\u58f0\uff09\u6765\u6392\u9664\u5176\u4ed6\u8840\u6d41\u52a8\u529b\u5b66\u5f02\u5e38\u5f15\u8d77\u7684\u80ba\u6c34\u80bf\u3002
\u6c27\u5408\u72b6\u6001\uff08\u6210\u4eba\uff09\uff1a
\u8f7b\u5ea6ARDS\uff1a200mmHg < PaO2/FiO2 \u2264 300mmHg(PEEP\u6216\u8005CPAP \u2265 5cmH2O\u6216\u8005\u975e\u673a\u68b0\u901a\u6c14\u72b6\u6001)\u3002
\u4e2d\u5ea6ARDS\uff1a100mmHg < PaO2/FiO2 \u2264 200mmHg(PEEP \u2265 5cmH2O\u6216\u8005\u975e\u673a\u68b0\u901a\u6c14\u72b6\u6001)\u3002
\u91cd\u5ea6ARDS\uff1aPaO2/FiO2 \u2264 100mmHg\uff0cPEEP \u2265 5cmH2O\u6216\u8005\u975e\u673a\u68b0\u901a\u6c14\u72b6\u6001)
\u65e0PaO2\u6570\u636e\u65f6\uff0cPaO2/FiO2 \u2264 315\u63d0\u793aARDS\uff08\u5305\u62ec\u975e\u673a\u68b0\u901a\u6c14\u60a3\u8005\uff09\u3002
\u6c27\u5408\u72b6\u6001\uff08\u513f\u7ae5\uff0cOI=\u6c27\u5408\u6307\u6570\uff0c
OSI=SpO2\u8ba1\u7b97\u7684\u6c27\u5408\u6307\u6570\uff09\uff1a
\u53cc\u6c34\u5e73\u65e0\u521b\u901a\u6c14\u6216\u8005\u9762\u7f69\u7ed9\u6c27\u4e0b\u6301\u7eed\u6b63\u538b\u901a\u6c14\u2265 5cmH2O\uff1bPaO2/FiO2 \u2264 300mmHg\u6216PaO2/FiO2 \u2264 264
\u8f7b\u5ea6ARDS\uff08\u4fb5\u5165\u6027\u63d2\u7ba1\uff09\uff1a4\u2264OI<8\u6216\u80055\u2264OIS<7.5
\u4e2d\u5ea6ARDS\uff08\u4fb5\u5165\u6027\u63d2\u7ba1\uff09\uff1a8\u2264OI<16\u6216\u80057.5\u2264OIS<12.3
\u91cd\u5ea6ARDS\uff08\u4fb5\u5165\u6027\u63d2\u7ba1\uff09\uff1aOI\u226516\u6216\u8005OIS\u226512.3
\u7f29\u5199\uff1aFiO2\uff0c\u5438\u5165\u6c27\u6d53\u5ea6\uff1bOI\uff0c\u6c27\u5408\u6307\u6570\uff1bOSI\uff0c\u4f7f\u7528SpO2\u8ba1\u7b97\u6c27\u5408\u6307\u6570\uff1bPaO2\uff0c\u6c27\u5206\u538b\uff1bPEEP\uff0c\u547c\u6c14\u672b\u6b63\u538b\uff1bSIRS\u5168\u8eab\u708e\u75c7\u53cd\u5e94\u7efc\u5408\u5f81\uff1bSpO2\u8840\u6c27\u9971\u548c\u5ea6\u3002\u5982\u679c\u6d77\u62d4\u9ad8\u4e8e1000\u7c73\uff0c\u90a3\u4e48\u4fee\u6b63\u7cfb\u6570\u8ba1\u7b97\u5982\u4e0b\uff1aPaO2/FiO2 \u00d7\u5927\u6c14\u538b/760\u3002
\u4e8c\u3001ARDS\u7684\u9274\u522b\u8bca\u65ad\uff1a
\u57282019-nCoV\u611f\u67d3\u60a3\u8005\u4e2d\uff0c\u9700\u8981\u4e0eARDS\u9274\u522b\u7684\u75be\u75c5\u5305\u62ec\uff1a\u91cd\u75c7\u80ba\u708e\u3001\u5fc3\u529f\u80fd\u4e0d\u5168\u3001\u80ba\u52a8\u8109\u6813\u585e\u3001\u8865\u6db2\u8fc7\u91cf\u7b49\uff1b\u7531\u4e8e\u8fd9\u4e9b\u75be\u75c5\u90fd\u5b58\u5728\u547c\u5438\u7a98\u8feb\u4e0e\u4f4e\u6c27\u8840\u75c7\u7b49\u75c7\u72b6\uff0c\u6545\u5176\u9274\u522b\u8bca\u65ad\u5c1a\u9700\u4f9d\u9760\u75c5\u53f2\u3001\u4f53\u683c\u68c0\u67e5\u3001\u5b9e\u9a8c\u5ba4\u68c0\u67e5\u4ee5\u53ca\u5f71\u50cf\u5b66\u68c0\u67e5\u3002
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绛旓細CPAP 5 cmH2O 鎸囩殑鏄父鍘嬪懠姘旀寔缁樆濉炴不鐤楋紙Continuous Positive Airway Pressure锛夛紝鍏朵腑 5 cmH2O 鎸囨皵鍘嬩负 5 鍘樼背姘存煴銆傝繖绉嶆不鐤楁柟娉曠敤浜庢不鐤楃潯鐪犲懠鍚告殏鍋滅患鍚堝緛锛圤bstructive Sleep Apnea锛夈
绛旓細鍛煎惛鏀寔娌荤枟鏄牳蹇冮儴鍒嗭紝鍖呮嫭姘х枟鍜屾満姊伴氭皵銆傛哀鐤楄嚦鍏抽噸瑕侊紝閫氬父閲囩敤鎸佺画姘旈亾姝ｅ帇(Continuous Positive Airway Pressure, CPAP)鍚告哀锛屽繀瑕佹椂鍙兘闇鍊熷姪鏈烘閫氭皵銆傚綋姘楗卞拰搴(SaO2)浣庝簬90%涓斿惛鍏ユ哀娴撳害(FiO2)澶т簬0.6锛屽嵆浣縋aO2灏忎簬8kPa(60mmHg)鏃讹紝閫氬父浼氶噰鐢ㄥ懠姘旀湯姝ｅ帇閫氭皵(PEEP)涓轰富鐨勭患鍚堢枟娉曘傛満姊伴...
绛旓細BiPAP鍙傛暟璋冭妭鍘熷垯锛欼PAP/EPAP鍧囦粠杈冧綆姘村钩寮濮嬶紝寰呮偅鑰呰愬彈鍚庡啀閫愭笎涓婅皟锛岀洿鍒拌揪鍒版弧鎰忕殑閫氭皵鍜姘鍚堟按骞筹紝鎴栬皟鑷虫偅鑰呭彲鑳借愬彈鐨勬渶楂樻按骞炽侭iPAP妯″紡閫氭皵鍙傛暟璁剧疆鐨勫父鐢ㄥ弬鑰冨煎涓嬭〃鎵绀恒傝〃2鍙屾按骞虫ā寮忓弬鏁拌缃父鐢ㄥ弬鑰冨煎弬鏁板父鐢ㄥ糏PAP/娼皵閲10锝25cmH2O/7锝15ml/kgEPAP3锝5cmH2O锛堚厾鍨嬪懠鍚歌“绔椂鐢...
绛旓細涓村簥琛ㄧ幇澶氬憟鎬ユц捣鐥呫佸懠鍚哥獦杩佷互鍙婇毦浠ョ敤甯歌姘х枟绾犳鐨勪綆姘ц鐥囩瓑銆傛ユу懠鍚哥獦杩患鍚堝緛锛圓RDS锛夋槸鐢辫偤鍐呭師鍥犲拰/鎴栬偤澶栧師鍥犲紩璧风殑锛屼互椤藉浐鎬т綆姘ц鐥囦负鏄捐憲鐗瑰緛鐨勪复搴婄患鍚堝緛锛屽洜楂樼梾姝荤巼鑰屽嶅彈鍏虫敞銆傛ユу懠鍚哥獦杩患鍚堝緛鐨勭梾鍥犵箒澶氾紝涓嶅悓鐥呭洜鎵鑷存ユу懠鍚哥獦杩患鍚堝緛鍙戠梾鏈哄埗涔熷悇鏈変笉鍚屻傚浗闄呬笂澶氶噰鐢ㄢ...
绛旓細2.鏃╂湡鍚堢悊姘х枟 鍦ㄥ彂鐢熶弗閲嶈偤姘磋偪鎴栨ユу懠鍚哥獦杩患鍚堝緛鏃讹紝鍙粰浜堥蓟銆侀潰缃╂寔缁鍘嬮氭皵锛CPAP锛夋垨鍛煎惛鏈鍘嬮氭皵锛圥EEP锛夌枟娉曘傚懠姘旀湯鍘嬪姏涓嶅疁瓒呰繃0.49kPa锛5cmH2O锛夈備篃鍙敤楂橀鍠峰皠閫氭皵鐤楁硶锛堥氭皵棰戠巼涓80锝100娆/min锛岄┍鍔ㄥ帇鍦40锝58kPa锛夈傛澶栧彲鑰冭檻鑲哄缁姘锛屽搴旂敤鍏夐噺瀛愯鐤楁硶銆3.鑲句笂鑵虹硸鐨川...
绛旓細4.姘ф皵涓嶈冻姘村钩 钀藉樊杞诲井锛200mmHg<PaO2/FiO2鈮300mmHg锛孭EEP鎴CPAP鈮5cmH2O锛岃交寰瓵RDS缁勯噷鍙兘閫夌敤鏃犲垱閫氭皵锛涜鍘嬭交涓害锛100mmHg<PaO2/FiO2鈮200mmHg锛孭EEP鈮5cmH2O锛涜娑蹭腑閲嶅害锛歅aO2/FiO2鈮100mmHg锛孭EEP鈮5cmH2O锛岃〃鏄庯細鍋囧鎵灞炲湴鍩熺浉瀵归珮搴﹂珮杩1000绫筹紝搴斿鍏ユ牎姝ｅ洜瀛愭祴绠楋細[PaO2/FiO2(鏍囧噯姘斿帇/...
绛旓細PEEP涓0.49kPa(5cmH2O)鏃讹紝FRC鍙鍔500ml銆傞殢鐫闄烽棴鐨勮偤娉″寮狅紝鑲哄唴闈欏姩琛鍒嗘祦闄嶄綆锛岄氭皵/琛娴佹瘮渚嬪拰寮ユ暎鍔熻兘浜﹀緱鍒版敼鍠勶紝骞跺鑲鸿绠″姘磋偪鍒嗗槒浜х敓鏈夊埄褰卞搷锛屾彁楂樿偤椤哄簲鎬э紝闄嶄綆鍛煎惛鍔熴侾aO2鍜孲aO2闅廝EEP鐨勫鍔犱笉鏂彁楂橈紝鍦ㄥ績鎺掑嚭閲忎笉鍙楀奖鍝嶄笅锛屽垯鍏ㄨ韩姘杩愯緭閲忓鍔犮傜粡鍔ㄧ墿瀹為獙璇佹槑锛孭EEP浠庨浂澧炶嚦...
绛旓細锛堝洓锛塒EEP姘村钩鐨勯檷浣嶢RDS鎮ｈ呭鐥呮儏绋冲畾锛岀鍚堜笅鍒楁爣鍑嗗彲缂撴參闄嶄綆PEEP锛氣憼鏃犳劅鏌撲笖鎰熸儏绋冲畾锛涒憽鍚告哀娴撳害<50%锛涒憿PaO2楂樹簬10.7kPa(80mmHg)宸插湪12h浠ヤ笂锛涒懀PEEP闄嶄綆0.490kPa(5cmH2O) 鏃堕棿涓3min锛孭aO2涓嬮檷灏忎簬20%銆備簲銆CPAP鐨浣跨敤 CPAP鍙湪鍚告皵鐩稿強鍛兼皵鐩稿潎淇濇寔棰勫畾鐨勫帇鍔涳紝浣嗗懠鍚告満涓嶄富鍔ㄨ繘琛屾鍘嬮氭皵...
绛旓細PEEP鎴CPAP鈮5cmH2O锛岃交搴RDS缁勪腑鍙兘閲囩敤鏃犲垱閫氭皵锛涒憽涓害锛100mmHg<PaO2/FiO2鈮200mmHg锛孭EEP鈮5cmH2O锛涒憿閲嶅害锛歅aO2/FiO2鈮100mmHg锛孭EEP鈮5cmH2O锛岃鏄庯細濡傛灉鎵鍦ㄥ湴鍖虹含搴﹂珮浜1000绫筹紝搴斿紩鍏ユ牎姝ｅ洜瀛愯绠楋細[PaO2/FiO2(姘斿帇/760)]銆傛敞锛欶iO2锛氬惛鍏姘娴撳害锛汸aO2锛氬姩鑴夋哀鍒嗗帇锛汸EEP锛氬懠鍚告湯姝ｅ帇锛汣PAP...
绛旓細姘鍚堢姸鎬侊紙鎴愪汉锛夛細杞诲害ARDS锛200mmHg < PaO2/FiO2 鈮 300mmHg(PEEP鎴栬CPAP 鈮 5cmH2O鎴栬呴潪鏈烘閫氭皵鐘舵)銆備腑搴RDS锛100mmHg < PaO2/FiO2 鈮 200mmHg(PEEP 鈮 5cmH2O鎴栬呴潪鏈烘閫氭皵鐘舵)銆傞噸搴RDS锛歅aO2/FiO2 鈮 100mmHg锛孭EEP 鈮 5cmH2O鎴栬呴潪鏈烘閫氭皵鐘舵)鏃燩aO2鏁版嵁鏃讹紝PaO2/FiO2 鈮 315...
