无创机械通气临床应用 机械通气是藉助呼吸机建立气道口与肺泡之间压力差，形成肺泡通气的动力和提供不等氧浓度，增加通气量、改善换气，降低呼吸功，达到改善或纠正缺氧、CO2潴留和酸碱失衡，防治多脏器功能损害。机械通气给呼吸衰竭（呼衰）患者予以呼吸支持，维持生命，为基础疾病治疗、呼吸功能改善和康复提供条件。机械通气机械通气无创有创呼吸衰竭呼吸骤停手术麻醉定义无创机械通气（noninvasiveventilation）是指不经人工气道进行的机械通气。历史1832年约翰•达尔齐尔（JohnDalziel)提出设想密封箱1928年德林克（Drinker)第一台有临床价值的电动铁肺1935年贝拉克(Barach)面罩CPAP1940's负压通气大量使用1952年拉森(Lassen)证明正压通气更有效1970's—鼻(面)罩正压通气1989年BiPAP呼吸机1980's—负压通气重新崛起无创机械通气的类型负压通气各种躯体通气机(铁肺、胸甲式、茄克衫式等）间歇腹部加压通气正压通气经鼻(面)罩容量控制、压力控制、压力支持通气等高频通气高频胸壁压迫震动通气经鼻(面)罩正压机械通气技术基础1、呼吸机触发和工作性能容量/压力触发流量触发流量补偿功能2、鼻、面罩性能
材料
关于××同志的政审材料调查表环保先进个人材料国家普通话测试材料农民专业合作社注销四查四问剖析材料
橡胶硅胶气垫充气式自封式固定方法3、呼吸机工作模式持续气道正压(ContinnousPositivepressure,CPAP)压力支持(PressureSurpportVentilation,PSV)间歇正压通气(IntermittentPositivePressureVentilation,IPPV)双水平气道正压(Bi-levelPositiveAirwayPressure,BiPAP)比例辅助通气(ProportionalAssistVentilation,PAV)PEEP的生理作用PEEP与肺肺水肿并不减少肺水肿的水肿量防止大潮气量所致的肺损伤、水肿抵消水肿区的重量，防止基底区肺泡的萎陷肺容量增加FRC肺泡复张可复张肺泡区可用中等PEEP改善，基底区肺泡需高水平PEEP肺顺应性可引起肺顺应性的增加、减低或保持不变PVPEEP与心脏减低前负荷，减少心输出量(与肺的弹性负相关)降低左心跨壁压,减低后负荷对心肌收缩力无直接影响(除外原有心脏基础疾病)PEEP与V/Q减少心输出量，减少分流Q，总体V/Q不变PaO2肺泡复张，改善V/Q，PaO2PEEP与PEEPi肺泡肺泡内压(PEEPi)肺泡内压(PEEPi)上游段下游段气道压临界压临界压PEEP肺泡复张肺泡过度扩张(气压伤)改善PaO2心输出量减少（氧输送量减少）保护肺免受通气机肺损伤吸气肌用力减少减少吸气功减少脑血流灌注改善肺顺应性需加强监护辅助左心室支撑稳定胸壁驱动远端气道分泌物益处害处PEEP益处与害处之间的平衡CPAP有PEEP的各种优点与类似并发症CPAP有自主呼吸，平均胸内压低，心输出量影响小。无创正压通气的应用适应证与禁忌证适应证1、任何中重度呼衰无禁忌证者2、各种呼衰无指证或拒绝有创通气者3、预防呼衰：如外科术后支持4、康复治疗，家庭机械通气禁忌证1、病情需要保证气道安全2、非高碳酸血症所致神志改变3、频繁呕吐、严重腹胀、近期胃部损伤4、急性面部损伤5、心血管情况不稳定通气模式选择压力：CPAPBiPAP(PSV+PEEP)呼吸转换：TSS/T鼻/面罩选择鼻罩：清醒、配合病人保留上呼吸道加温、加湿作用保留开口死腔小面罩：不清醒、不能配合的病人鼻道阻力>5cmH2O/L/S漏气少不能开口，必要时需加胃管夜眠时压力设置根据疾病与病人情况一般<30cmH2O婴儿<25cmH2O（上段食道括约肌张力3312cmH2O）EPAP52cmH2O最舒适++CO2排泄有持续气流冲洗高PCO2可在面罩开单向口、PEEP适当减小可允许高碳酸血症监护面罩舒适度，漏气，气道分泌物，神志，呼吸频率，脉氧，血压，心率，血气，呼出气潮气量，腹部膨胀，面部皮肤60分钟后配合良好可不需始终床旁监护中断
标准
excel标准偏差excel标准偏差函数exl标准差函数国标检验抽样标准表免费下载红头文件格式标准下载
1、不能耐受面罩2、不能改善气体交换或呼吸困难3、需气管插管来处理分泌物或保护气道4、血流动力学不稳定5、心电图不稳定，有心肌缺血迹象或显著室性心律失常6、因CO2潴留而神志不清病人，治疗30分钟后神志无改善疗效的预估高CO2病人1、不能根据基础病的严重性或治疗前的血气来预估治疗的反应和插管的需要。2、治疗1–2h内PaCO2下降、pH上升，预示治疗时间较短。3、面罩漏气影响治疗效果。低O2病人与治疗开始前低O2程度、治疗开始后的反应有关撤机逐步减低压力到5~8cmH2O，改鼻导管、面罩吸氧。部分病人不需持续治疗。优点1、无创：应用方便、保留口腔2、避免插管的气流阻力3、避免插管并发症4、并发症发生率低（结膜炎、胃胀、肺炎、分泌物潴留、面部皮肤坏死）5、节约费用缺点（无人工气道）1、起效慢、耗时长2、漏气：眼刺激、低PO23、胃胀、面部皮肤坏死4、深部分泌物不能吸引、易误吸常见疾病应用睡眠呼吸暂停综合症（SAS）CPAP8~12cmH2O多导睡眠仪监测下设定工作压力少数种病人或CPAP耐受差的病人可改用BiPAP，多有良好效果。COPD克服PEEPi占呼吸功的43%5%PEEPi稳定期2.41.6cmH2O急性期6.52.5cmH2OPaCO2>75mmHg可进行治疗+++CPAP以CPAP
0(PSV+PEEP)具有两者长处，高度有效避免插管>80%改善血气>95%存活>90%压力调定EPAP=2~4cmH2OIPAP=8~10cmH2O,升高1cmH2O/15~30min直至10~15cmH2O可间断治疗>6h/d有充血性心力衰竭或肺沿者IPAP20~25cmH2O，50%反应差、需插管可作为拔管后支持不能纠正气体交换也不必然导致插管可进行家庭治疗首选呼吸支持方法哮喘持续状态小气道阻塞大气道阻塞PEEPi9~19cmH2OV/Q失调呼吸肌疲劳FEV1<25%预计值CO2产生>排出CPAP作用扩张支气管，降低气道阻力萎陷肺复张，促进气道分泌物清除抵消PEEPi，吸气肌休息减少胸腔负压对血流动力学的不良影响CPAP压力62cmH2O初期症状好转，血气无明显改善+BiPAPEPAP42cmH2OIPAP145cmH2O气体交换更迅速可配雾化器吸入药物++低水平CPAP即有确切作用BiPAP作用更迅速对致命性恶化无大宗成功报道心源性肺水肿肺顺应性减低，呼吸功增加，胸内负压升高，左室跨壁压、后负荷增加，心输出量减少CPAP,BiPAP1、减轻、抵消胸腔负压促进肺静脉回流(前负荷)减小左室跨壁压(后负荷)增加CO2、增加肺顺应性PaO2减低呼吸功，O2耗3、肺膨胀、迷走兴奋、心率下降4、静脉回流减少CPAP8~12cmH2O迅速改善各项指标<30minRPaCO2pHHRPaO2/FiO2CPAP无效可改BiPAPEPAP5cmH2OIPAP20cmH2O需持续使用，待解除原发病，面罩优于鼻罩严重血流动力学障碍不适合ARDS少数报道成功，PEEP要求高>10cmH2O仅个别不宜插管者考虑使用创伤可有效纠正创伤后低氧血症连痂胸可避免插管颅底骨折禁用肺不张通过侧枝孔道使肺复张，有助排出分泌物CPAP103cmH2O+总结无创、安全、有效、依从性好、需密切监护避免延缓插管时机SAS首选COPD显效哮喘持续状态有效低氧血症有效2005年63
题
快递公司问题件快递公司问题件货款处理关于圆的周长面积重点题型关于解方程组的题及答案关于南海问题
2006年71题2007年45题,50题2008年45题,49题近几年广东省
高考
地理事物空间分布特征语文高考下定义高考日语答题卡模板高考688高频词汇高考文言文120个实词
阅读理解主旨大意题:1).主题型(topic、subject、mainidea、generalidea)主旨大意题的题干表现形式:Themainideaofthepassageis…Thepassageismainlyabout…Whichofthefollowingstatementsbestexpressesthemainideaofthepassage?Whatisthepassagemainlyabout?2).目的(purpose)类主旨大意题Thepassageismeantto….Thepurposeofthisarticleisto…3).标题(topic或title)类主旨大意题Thebesttitleforthepassagemightbe…TypesOfParagraphStructurestypeThepositionofthetopicAtthebeginningAttheendInthemiddleNocleartopicsentence1<70words>Smokingcigarettesisharmfultoyourhealth.Experimentsshowthatcigarettesmokingcancausecancer.Besidesthemostseriousandterribledisease(illness),cancer,cigarettesmokingalsocancauseotherhealthproblems.Forexample,itcangiveonea“smoker’scough”.Finally,studieshaveshownitiseasyforcigarettesmokerstocatchcolds.Whetheryougetanunimportantcoldorterriblekiller,cancer,smokingisharmful.Isitworthit?.2<52words>Oftennoonelooksmoreguiltythantheinnocent.Ontheotherhand,nobodymaylookmoreinnocentthanaprofessi--onalcriminal.Andthemanwhoknows“everything”mayreallyonlybetryingtohidehisownweakness.So,itisfoolishtotrytojudgeapersononlybyhisappearance3<113words>Ifyouwereplanningtobuyatelevisionset,thefollowingadvertisementwouldcertainlydrawyourattention:“ColorTV.Only＄79.Twodayssale.Hurry.”However,whenyougotothestorereadytobuy.Youmaydiscoverthattheyaresoldout.Buttheshopassistantisquicktotellyouthathehasanothermodel.Amuchbettersetwhichis“justrightforyou”Itcosts＄395.Thissalesmethodiscalled“baitandswitch”.Buyersarebaitedwithasalesadvertisement,andthentheyareswitchedtoanothermoreexpensiveone.Buyingthingsonsaleneedscarefulconsiderationofthegoodsandthereasonforthesale.Theparagraphcouldbeentitled_________.A.BuyingATVSetB.ASellingMethodC.BuyerBewareD.TVOnSale(detail)(detail)(detail)4<50words>TomstudiedfouryearsattheUniversityofParisanddecidedtoleavebeforehisgraduation.HetransferredtotheUniversityofBerlinandgraduatedwithhonors.HarvardLawSchooland,later,BostonCollegeprovidedhimwithanexcellentlegalbackground.HeispresentlyacorporationlawyerinMiami,Florida.Themainideaofthisparagraphisthat______.A.Tom,whohadstudiedatParisUniversitiesforfouryears,movedtoanotheruniversity.B.TombecamealawyersincehisgraduationfromHarvardLawSchoolandlaterfromBostonCollege.C.TomwasanexcellentstudentwhenhestudiedatBerlinuniversity.D.Tomreceivedanexcellenteducation.detaildetaildetail干扰项具有如下五个特点：1. 以偏概全。干扰项只阐述了文章的一部分内容，也就是文章的局部信息。 2. 断章取义。干扰项常常以文章中的个别信息或个别字眼作为选项的设置内容，或者以次要的事实或细节冒充全文的主要观点。3. 主题扩大。干扰项所归纳、概括的范围过大，超过文章实际所讨论的内容。4. 张冠李戴。命题者有意地把属于A的特征放在B的身上，构成一个干扰项。考生不注意的情况下，会造成错选答案。5. 无中生有，似是而非。有的干扰项中的关键词语好似在文章中谈到了，但认真
分析
定性数据统计分析pdf销售业绩分析模板建筑结构震害分析销售进度分析表京东商城竞争战略分析
之后你会发现这类干扰项的内容与文章的内容毫无联系。如何做主旨大意题?做此类题目时，首先要搞清是问某一段还是全文的大意，可利用文中主要信息来把握文脉，进行综合归纳，概括文章的主题。如有标题，标题中的蕴含的信息往往是关键信息。另外，任何一篇文章都是围绕某个主题展开的，因此，许多文章中最明显的特点之一是有一个反复出现的中心词，即高频词，也叫做主题词。抓住了它，便容易抓住文章的中心。在做主题型试题时，可先寻找主题句。一般情况下，主题句出现在文章的开头或结尾。但有时也可能不会出现主题句，需要读者自己去概括或归纳。在确定文章的标题(title)的时候，我们要以文章的中心为依托。但应注意的是，中心大意不完全等同于标题。文章的中心较为详细地陈述文章的内容，而文章的标题则通常情况下较为简明，而且通常是名词或名词短语。Everyonebecomesalittlemoreforgetfulastheygetolder,butmen'smindsdeclinemorethanwomen's,accordingtotheresultsofaworldwidesurvey. Certaindifferencesseemtobeinherentinmaleandfemalebrains:Menarebetteratmaintaininganddealingwithmentalimages(usefulinmathematicalreasoningandspatialskills),whilewomentendtoexcel(擅长)atrecallinginformationfromtheirbrain'sfiles(helpfulwithlanguageskillsandrememberingthelocationsofobjects)....Q:Theauthoraimstotellusthat__________. A.women’smindsperformbetterthanmen’s B.men’smindsdeclinemorewithage C.everyonebecomesalittlemoreforgetfulastheygetolder D.asurveyonhuman’sminddeclinewasdonerecently.Itseemsthatpoliticiansaroundtheworldarethinkingaboutthehealthoftheircountries.WhileinChina,ChenZhuhasannouncedhisplansforauniversalhealthserviceandreformacrosshealthservices.GordonBrown,theUKPrimeMinister,hasalsoannouncedheisplanningtomakesomechangesinourhealthservice. ThecruxofMr.Brown'sproposalsarerelatedtogivingtheNHS(NationalHealthService)agreaterfocusonprevention,ratherthanjustcuringpatients. Heisplanningtointroduceincreasedscreeningforcommondiseases...Q:Theauthorofthispassageintendstotellus______. A.theNHSshouldbereformedrightaway. B.moreandmorepeoplearedyingfromdiseases. C.theplantoreformtheNHSintheUK. D.thecriticismofMr.Brown'sproposals.Inthe1930s,alotofpeopleintheUSAwereoutofwork.AmongthesepeoplewasamannamedAlfredButts.Healwayshadaninterestinwordgamesandtofillhistimeheplannedagamewhichhecalled“Lexico”.However,hewasnotcompletelysatisfiedwiththegame,sohemadeanumberofchangestoitandchangeditsnamefrom“Lexico”to“Alph”andthento“CrissCross”.Hewantedtomakesomemoneyfromhisnewgamebuthedidn’thaveanyrealcommercial(商业性的)success.Q:Thetextismainlyabout________.A.LexicoB.ThreemenC.AwordgameD.AlfredButts.3一.文首找主题句,提炼文章标题;新闻报道,说明文,议论文二.文尾找主题句,提炼标题或归纳大意;议论文总--分--总三.首尾呼应展现主题句,瞻前顾后归纳大意;四.整合每一段的主题句,归纳大意.五.从段落中归纳要点抓大意.有些文章或段落无明显的主题句,只是暗示性地体现主题.这就要求考生在阅读过程中根据文中所叙述的事实或提供的线索来概括总结主旨大意。记叙文Passage1Readingisthekeytoschoolsuccessand,likeanyskillitTakespractice.Achildlearnstowalkbypracticinguntilhenolongerhastothinkabouthowtoputonefootinfrontoftheother.Agreatathletepracticesuntilhecanplayquickly,accurately(精确),withoutthinking.Tennisplayerscallthat“being”inthezone.”Educatorscallit“automaticity’(自动性).Q:Thefirstparagraphtellsus_______.A.whatautomaticityisB.howaccuracyisacquired(获得)C.howachildlearnstowalkD.howanathleteistrained.Passage2Boston----ThievesdressedaspoliceenteredamuseumearlySundayandstole11paintings,includingmajorworksbyRembrandt,Dagas,ManetandVermerr,FBI(美国联邦调查局)andthemuseumofficialssaid.Thefirstjudgmentplacedvalueofatleast$100millionontheworksstolenfromtheIsabellaGardenerMuseum,saidBostonpolicespokes-manJimTordan.………WilliamBobinson,ofHardvardUnivercity’sFoggelMuseum,calledtheobjectsstolen“majorworks.”Q:Whatisthebestheadlineforthisnewspaperarticle?ATheftTookPlaceinBostonArtworksstolenbyThievesC.MajorWorksD.InvestigationintotheTheft Passage3Aspricesandbuildingcostskeeprising,the“do-it-yourself”(DIY)trendintheU.S.continuestogrow.……JohnandJimarenotunusualpeople.Mostfamiliesinthecountryaredoingeverythingtheycantosavemoneysotheycanfightthehighcostofliving.Ifyouwanttobecomea“do-it-yourself’,youcangotoDIYclasses.Andforthosewhodon’thavetimetotakeacourse,therearebooksthattellyouhowyoucandothingsyourself.Q:Whatwouldbethebesttitleforthetext?A.TheJoyofDIYB.YoucanDoitToo!C.WelcometoOurDIYCourse!D.RossandHatfield:BelieversinDIYPassage4Youdreameachnight,eventhoughyoumaynotrememberyourdreams.Whileyoudreamyoureyesmoveandyourheartbeatsfaster.Evenyourbrain-wavepatternchanges.Somescientiststhinkthatdreamingisimportantforthesakeofhealth.Theyclaimthatwithoutdream,peoplewouldgocrazy.Q:Whatdoesthepassagemainlytellus?HowpeoplestayhealthyHowsleepisnecessaryC.WhydreamsareimportantD.WhenpeopleremembertheirdreamsPassage5InAmericawehaveHalloween.InMexicotheyhaveTodosSantos,whichmeans“AllSaints”.Thisisthedayinwhichpeoplerememberfamilyandfriendswhohavedied.Theyvisitthecemeteryinsteadofgoingouttotrick-or-treat.Buttheydohavepicturesofskeletonsandghostshangingaround.Theyalsohavemanycandyskullstoeat.Q:Whatdoesthestorymainlytell?WhatholidaysarelikeWhatHalloweenislikeinMexicoC.WhathappensduringTodosSantosD.WhatwedoonHalloweenSomethinginchocolatecouldbeusedtostopcoughsandleadtomoreeffectivemedicines,sayUKresearchers.Theirstudyfoundthattheobromine,foundincocoa,wasnearlyathirdmoreeffectiveinstoppingcoughsthancodeine,whichwasconsideredthebestcoughmedicineatpresent.TheImperialCollegeLondonresearcherswhopublishedtheirresultsonlinesaidthediscoverycouldleadtomoreeffectivecoughtreatment.“Whilecoughingisnotnecessarilyharmful(有害的)itcanhaveamajoreffectonthequalityoflife,andthisdiscoverycouldbeahugestepforwardintreatingthisproblem,”saidProfessorPeterBarnes.Tenhealthyvolunteers(志愿者)weregiventheobromine,codeineorplacebo,apillthatcontainsnomedicine,duringtheexperiment.Neitherthevolunteersnortheresearchersknewwhoreceivedwhichpill.Theresearchersthenmeasuredlevelsofcapsaicin,whichisusedinresearchtocausecoughingandasasignofhowwellthemedicinearestoppingcoughs.Theteamfoundthat,whenthevolunteersweregiventheobromine,thecapsaicinneedtoproduceacoughwasaroundathirdhigherthanintheplacebogroup.Whentheyweregivencodeinetheyneedonlyslightlyhigherleversofcapsaicintocauseacoughcomparedwiththeplacebo.Theresearcherssaidthattheobromineworkedbykeepingdownaverveactivity(神经活动),whichcausecoughing.Theyalsofoundthatunlikesomestandardcoughtreatments,theobrominecausednosideeffectssuchassleepiness.（2008年全国卷阅读理解D篇）56.Whichofthefollowingwouldbethebesttitleforthetext?A.Codeine:ANewMedicine B.ChocolateMayCureCoughsC.CoughTreatment:AHardCase D.TheobromineCanCauseCoughs(08浙江D)Tellastoryandtellitwell,andyoumayopenwidetheeyesofachild,openuplinesofcommunicationinabusiness,orevenopenpeople’smindtoanothercultureorrace.…Peopleregardstorytellingnotonlyasausefultoolinchildeducation,butalsoasameaningfulactivitythathelpsadultsunderstandthemselvesaswellasthosewhoseculturemaybeverydifferentfromtheirown.…Weareallstorytellers.Weallhaveastorytotell.Wetelleverybody’sstory.Question:What’sthemainideaofthetext?Storytellingcaninfluencethewaypeoplethink.B.Storytellingisvitaltothegrowthofbusiness.C.Storytellingisthebestwaytoeducatechildreninschool.D.Storytellinghelpspeopleunderstandthemselvesandothers.
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