Elisee中文操作培訓PPT學習教案

1、會計學1Elisee中文操作培訓中文操作培訓第1頁/共82頁第2頁/共82頁第三代航空智能渦輪供氣系統(tǒng) -超長使用壽命 -超強供氣流速，在60厘米水柱時最高供氣流速可達300升/分。 -體積小、噪音低、慣性及功耗極低 -能夠瞬間準確調(diào)節(jié)供氣流速，與患者自主呼吸匹配，最大程度縮短吸氣及呼氣的反應(yīng)時間。成比例三項主動呼氣閥技術(shù) 第3頁/共82頁第4頁/共82頁第5頁/共82頁第6頁/共82頁第7頁/共82頁第8頁/共82頁肺復張的目標（What is the aim of a maneuver recruitment） ? To avoid atelectasy : sagging of air

2、cells那些病人需要適用該項功能（For which patients ）?For neuromuscular patients which air cells could easily collapseNot for COPD patients or all obstructive patients !同常規(guī)的嘆息功能比較有什么優(yōu)勢?Pressure control. Indeed, in case of a sigh, a volume parameter is set up. Therefore the pressure is not controlled. In order to a

3、void barautroma, An HP alarm must be adjustedLong opening of air cells第9頁/共82頁1.壓力波形、流速波形、容量波形，兩種向量環(huán)等動態(tài)波形顯示。2.20多項實時呼吸力學監(jiān)測，并可根據(jù)需要隨意組合。3.配置先進的參數(shù)及波形分析工具，可提供，波形凍結(jié)分析，歷史波形回顧，波形存儲打印等豐富應(yīng)用工具，為臨床診斷及確定治療方案提供豐富參考依據(jù)。 第10頁/共82頁第11頁/共82頁實時數(shù)據(jù)監(jiān)測區(qū)域當前設(shè)置狀態(tài)顯示區(qū)域?qū)崟r波形、向量環(huán)監(jiān)測顯示區(qū)域分析工具區(qū)域第12頁/共82頁不需要拆卸設(shè)備 ! 同時按壓下按鈕 和第13頁/共82頁Ve

4、ntilation performances are preserved during the whole time of discharge第14頁/共82頁第15頁/共82頁第16頁/共82頁呼吸的介紹呼吸回路的連接啟動/關(guān)閉呼吸機通氣模式通氣參數(shù)報警管理FiO2通氣觀測技術(shù)維護菜單呼吸力學通氣方式的選擇霧化吸入第17頁/共82頁成比例三項主動呼氣閥 (雙回路)送氣端口 觸摸屏幕主電源 / 外接電源狀態(tài)指示燈報警銷音按鈕藍牙信號指示燈內(nèi)置 / 外置電池狀態(tài)指示燈第18頁/共82頁氧電池 開 / 關(guān) 按鈕遠程報警控制接口信號輸出端口低壓氧源空氣入口空氣入口霧化端口高壓氧源12-28V外接直流

5、電源基座第19頁/共82頁卡扣基準點在進行手動測試時，能自動探測到呼吸回路連接的方式。不需任何工具 !第20頁/共82頁外接呼氣閥控制端口近端壓力傳感線端口病人呼吸回路(直徑 22 mm)第21頁/共82頁患者呼氣口吸氣管路 (標準直徑 22 mm)呼氣管路(標準直徑 22 mm)第22頁/共82頁顯示最新的檢測結(jié)果選擇預先設(shè)定模式選擇設(shè)定新模式選擇先前使用的模式第23頁/共82頁正在通氣未啟動通氣第24頁/共82頁如未通過測試, 請通知技術(shù)服務(wù)機構(gòu)第25頁/共82頁第26頁/共82頁n 5 個預設(shè)通氣程序n 存儲了通氣所需調(diào)整所有參數(shù) :- 通氣模式- 患者類型- 通氣參數(shù)- 報警設(shè)置區(qū)別對

6、待患者 白天/夜間 的通氣需求 !減少對醫(yī)護人員的培訓工作 !第27頁/共82頁第28頁/共82頁Each element of the configuration is reminded on the screen thanks to an icon 第29頁/共82頁壓力模式容量模式雙控制模式通氣模式確認后, 隨后出現(xiàn)參數(shù)設(shè)定界面第30頁/共82頁In P(A)CV mode, the user can set recruitment cyclesMore about recruitment :第31頁/共82頁可設(shè)置使用“肺復張”參數(shù) :Recruitment periodRecruit

7、ment durationRecruitment pressure or第32頁/共82頁第33頁/共82頁In (A)CV mode, the user can set recruitment cyclesMore about recruitment :第34頁/共82頁orRecruitment parameters may be set up :Recruitment periodRecruitment durationRecruitment pressure 第35頁/共82頁第36頁/共82頁When the PSIMV mode is selected, an access to

8、“Pressure Support” adjustment is available from the first screen of parameters adjustmentSuited for weaning and in case of sedation decreasing !第37頁/共82頁The adjustable parameters of Pressure Support are :Pressure SupportInspiratory slopeFlow or Pressure Inspiratory trigger in Invasive ventilationIns

9、piratory trigger in NIVExpiratory triggerMaximum inspiratory timeor第38頁/共82頁第39頁/共82頁When the SIMV mode is selected, an access to “Pressure Support” adjustment is available from the first screen of parameters adjustment第40頁/共82頁The adjustable parameters of Pressure Support are :Pressure SupportInspi

10、ratory slopeFlow or Pressure Inspiratory trigger in Invasive ventilationInspiratory trigger in NIVExpiratory triggerMaximum inspiratory timeor第41頁/共82頁第42頁/共82頁Principle :The beginning and the end of the inspiratory cycle are initiated by the patient. However, Elise 350 is provided with a minimum fr

11、equency parameter : if the number of patient initiated breaths is lower than Fmini, the ventilator releases support breaths.第43頁/共82頁Apnea ventilation in pressureApnea ventilation in volumeApnea ventilation = Exclusive to Elise 350 !第44頁/共82頁nMaximum inspiratory timeor第45頁/共82頁The adjustable paramet

12、ers of Pressure Support in volume are :Apnea TimeTidal Volume FrequencyInspiratory time or I/E ratio or Maxi flow第46頁/共82頁第47頁/共82頁Principle :The delivered cycle starts in PS ventilation. Every 10 minutes, Elise 350 calculates if the tidal volume parameter can be delivered, according to the already

13、supplied Vt and the remaining inspiratory timeIf the calculation foresees that Vt parameter can be reached, then Elise 350 stands in Pressure Support for the rest of the cycleOtherwise, if the calculation concludes that Vt parameter will not be reached in PS, then Elise 350 insufflates the remaining

14、 volume while maintaining a constant flow until volume parameter is reached第48頁/共82頁Apnea ventilation = Exclusive to Elise 350 !Apnea ventilation in pressureApnea ventilation in volume第49頁/共82頁or第50頁/共82頁The adjustable parameters of Pressure Support in volume are :Apnea timeTidal VolumeFrequencyInsp

15、iratory time or I/E ratio or Maxi flow第51頁/共82頁第52頁/共82頁在 CPAP 模式, 僅可設(shè)置的參數(shù) :持續(xù)壓力的水平第53頁/共82頁第54頁/共82頁Maxi flow (l/min) :呼吸機給患者供氣時所能提供的最大吸氣流速，在容量控制通氣中會直接影響到所需吸氣時間的長短Flow shape :僅在容量控制模式中有效,可以患者吸氣項進行持續(xù)遞增或遞減流速Frequency (cycles/min) :一分鐘內(nèi)所呼吸總的次數(shù)Inspiratory slope :僅在壓力控制模式中有效, 其意義為要達到設(shè)定的目標壓力值而所需要花費的時間第55

16、頁/共82頁Positive End Expiratory Pressure (cmH2O) :由呼吸機維持的，患者在呼氣循環(huán)期間持續(xù)保持的一個正壓力Inspiratory Pressure (cmH2O) :患者在輔助/控制呼吸循環(huán)中的吸氣項時，呼吸機提供的一個高于PEEP的壓力值I/E ratio (1/x) :在1次呼吸中，吸氣所用時間和呼氣所用時間之間的比值A(chǔ)pnea Time (s) :僅在自主呼吸模式下有效, 其表示為一段時間區(qū)間之后，如呼吸機未探測到患者的呼吸循環(huán)，患者可能出了現(xiàn)窒息的狀況。第56頁/共82頁Inspiratory Time (s) :從吸氣流速而時間區(qū)間Time

17、 space between the beginning of inspiratory flow and the beginning of expiratory flowMaximum Inspiratory Time (s) :呼吸機向患者輸入氣體所需最長時間區(qū)間，設(shè)定潮氣量達到與否Expiratory Trigger :達到一個規(guī)定的界定值時，引起的呼氣循環(huán). 定義為最大峰值流速的% 或自動觸發(fā)標準Inspiratory Trigger :達到一個規(guī)定的界定值時，引起的吸氣循環(huán). 觸發(fā)的方式有 :流速觸發(fā)（Flow trigger）壓力觸發(fā)（Pressure trigger）在無創(chuàng)通氣中的

18、觸發(fā)（Non invasive trigger）第57頁/共82頁Tidal Volume (ml) :吸氣或呼氣時間內(nèi)患者所吸入或呼出的氣體容量FiO2 (%) :患者吸入氣體內(nèi)氧氣所占的百分比Plateau time (s) :Time during which insufflation is maintained nil at the patient level第58頁/共82頁提示但前通氣模式提示但前患者狀態(tài)返回至模式設(shè)定界面 確認后進入報警設(shè)置界面按壓“start ventilation”開始通氣其它參數(shù)設(shè)定界面第59頁/共82頁第60頁/共82頁BTPS 校正 : 氣體溫度和壓力校

19、正當呼吸機啟用該功能后進行自動的校正僅限于測量呼出潮氣量 (Vte)If BTPS = NO ATPD (Ambient Temperature Pressure & Dryness)RC 自動測量患者肺部力學情況 :每隔 15 分鐘自動測量阻力和順應(yīng)性僅有限于在有創(chuàng)通氣的ACV 模式第61頁/共82頁多種氧源 高壓 / 低壓氧源更好的適合各種供氧條件可在Ti, maximum flow 或 I/E 中選擇使用查看方式:僅限于在 ACV 模式 !第62頁/共82頁nThe alarm microprocessornAn hardware independent system suppl

20、ied by an extra battery第63頁/共82頁報警參數(shù)的調(diào)節(jié)方式和通氣參數(shù)調(diào)節(jié)方式是一樣的！第64頁/共82頁 Elise 350 automatically manages FiO2 value according to FiO2 parameter第65頁/共82頁 Elise 350 automatically manages FiO2 value according to FiO2 parameter第66頁/共82頁2分鐘純氧功能（O2 100 %）- 按壓 圖標按鈕后可獲得兩分鐘的純氧通氣 - 在使用高壓供氧方式時，該功能有效低壓供氧高壓供氧第67頁/共82頁O2

21、Flow-by with oxygen+/- Inspiratory flow+/- Flow trigger +/- Flow-by第68頁/共82頁Inspi.Expi.流速曲線O2 concentration at level patientSAIME systemOther systemAn important oxygen peak can be delivered at the very beginning of the inspiration phase where the flow is the most important減少對氧氣的消耗第69頁/共82頁Bargraph o

22、f instantaneous pressurePressure curve Flow curve Ventilation measuresTrigger第70頁/共82頁By pressing on one of the 4 displayed measures at the bottom of the screen, you have direct access to the measures screen Choice between 11 measuresReal time display of the values 第71頁/共82頁From curves screen, the e

23、volution of measures can be frozen by pressing one of the curvesPress on any point of the curves to display the corresponding valuePossibility to determine value between two points第72頁/共82頁The journal of events registers :The whole of alarms release / stopEvery act made on the ventilator :Start / St

24、op of the ventilationStart / Stop of the ventilatorChange of the ventilation parameters valueStart / Stop of the alarmsChange of the alarms threshold第73頁/共82頁通氣時可選擇使用多種呼吸力學測量工具使用的有效性要依據(jù)所處在的通氣方式或通氣模式用戶可以通過在曲線監(jiān)測屏幕下，通過翻頁找到相關(guān)需要的測量工具P0.1胸腔閉合壓力 霧化功能吸氣保持呼氣保持手動通氣阻力 / 順應(yīng)性第74頁/共82頁吸氣保持功能- It is carried out at

25、 the end of the inspiratory cycle when the tidal volume is delivered.- A nil flow is manually maintained.- The pause cannot exceed 5 seconds. After this time, an exhalation cycle is automatically released.- This option is available only in invasive ACV modeMaximum pressure valuePlateau pressure valu

26、e Resistance value第75頁/共82頁呼氣保持功能- It is carried out at the end of the exhalation cycle.- During the pause, the circuit is obstructed.- The pause cannot exceed 12 seconds. After this time, an inspiratory cycle is automatically released.- This option is available only in invasive ACV modePositive End Expiratory PressureIntrinsic Positive End expiratory Pressure 第76頁/共82頁手動呼吸- 按壓下該圖標后, 將增加一次呼吸循環(huán)- 除了 CPAP 模式外，在所有的通氣模式中都有效P0.1- Measurement are carried out when the patient initiates a breath. The depression generated by the patients inspiratory effort is measured 0.1 second