Elisee中文操作培訓(xùn)PPT學(xué)習(xí)教案

1、會(huì)計(jì)學(xué)1Elisee中文操作培訓(xùn)中文操作培訓(xùn)第1頁(yè)/共82頁(yè)第2頁(yè)/共82頁(yè)第三代航空智能渦輪供氣系統(tǒng) -超長(zhǎng)使用壽命 -超強(qiáng)供氣流速，在60厘米水柱時(shí)最高供氣流速可達(dá)300升/分。 -體積小、噪音低、慣性及功耗極低 -能夠瞬間準(zhǔn)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(shí)間。成比例三項(xiàng)主動(dòng)呼氣閥技術(shù) 第3頁(yè)/共82頁(yè)第4頁(yè)/共82頁(yè)第5頁(yè)/共82頁(yè)第6頁(yè)/共82頁(yè)第7頁(yè)/共82頁(yè)第8頁(yè)/共82頁(yè)肺復(fù)張的目標(biāo)（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(xiàng)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(shì)?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(yè)/共82頁(yè)1.壓力波形、流速波形、容量波形，兩種向量環(huán)等動(dòng)態(tài)波形顯示。2.20多項(xiàng)實(shí)時(shí)呼吸力學(xué)監(jiān)測(cè)，并可根據(jù)需要隨意組合。3.配置先進(jìn)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(chǔ)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(yè)/共82頁(yè)第11頁(yè)/共82頁(yè)實(shí)時(shí)數(shù)據(jù)監(jiān)測(cè)區(qū)域當(dāng)前設(shè)置狀態(tài)顯示區(qū)域?qū)崟r(shí)波形、向量環(huán)監(jiān)測(cè)顯示區(qū)域分析工具區(qū)域第12頁(yè)/共82頁(yè)不需要拆卸設(shè)備 ! 同時(shí)按壓下按鈕 和第13頁(yè)/共82頁(yè)Ve

4、ntilation performances are preserved during the whole time of discharge第14頁(yè)/共82頁(yè)第15頁(yè)/共82頁(yè)第16頁(yè)/共82頁(yè)呼吸的介紹呼吸回路的連接啟動(dòng)/關(guān)閉呼吸機(jī)通氣模式通氣參數(shù)報(bào)警管理FiO2通氣觀測(cè)技術(shù)維護(hù)菜單呼吸力學(xué)通氣方式的選擇霧化吸入第17頁(yè)/共82頁(yè)成比例三項(xiàng)主動(dòng)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(bào)警銷音按鈕藍(lán)牙信號(hào)指示燈內(nèi)置 / 外置電池狀態(tài)指示燈第18頁(yè)/共82頁(yè)氧電池 開 / 關(guān) 按鈕遠(yuǎn)程報(bào)警控制接口信號(hào)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(yè)/共82頁(yè)卡扣基準(zhǔn)點(diǎn)在進(jìn)行手動(dòng)測(cè)試時(shí)，能自動(dòng)探測(cè)到呼吸回路連接的方式。不需任何工具 !第20頁(yè)/共82頁(yè)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(yè)/共82頁(yè)患者呼氣口吸氣管路 (標(biāo)準(zhǔn)直徑 22 mm)呼氣管路(標(biāo)準(zhǔn)直徑 22 mm)第22頁(yè)/共82頁(yè)顯示最新的檢測(cè)結(jié)果選擇預(yù)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(yè)/共82頁(yè)正在通氣未啟動(dòng)通氣第24頁(yè)/共82頁(yè)如未通過測(cè)試, 請(qǐng)通知技術(shù)服務(wù)機(jī)構(gòu)第25頁(yè)/共82頁(yè)第26頁(yè)/共82頁(yè)n 5 個(gè)預(yù)設(shè)通氣程序n 存儲(chǔ)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(bào)警設(shè)置區(qū)別對(duì)

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

7、ment durationRecruitment pressure or第32頁(yè)/共82頁(yè)第33頁(yè)/共82頁(yè)In (A)CV mode, the user can set recruitment cyclesMore about recruitment :第34頁(yè)/共82頁(yè)orRecruitment parameters may be set up :Recruitment periodRecruitment durationRecruitment pressure 第35頁(yè)/共82頁(yè)第36頁(yè)/共82頁(yè)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(yè)/共82頁(yè)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(yè)/共82頁(yè)第39頁(yè)/共82頁(yè)When the SIMV mode is selected, an access to “Pressure Support” adjustment is available from the first screen of parameters adjustment第40頁(yè)/共82頁(yè)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(yè)/共82頁(yè)第42頁(yè)/共82頁(yè)P(yáng)rinciple :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(yè)/共82頁(yè)Apnea ventilation in pressureApnea ventilation in volumeApnea ventilation = Exclusive to Elise 350 !第44頁(yè)/共82頁(yè)nMaximum inspiratory timeor第45頁(yè)/共82頁(yè)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(yè)/共82頁(yè)第47頁(yè)/共82頁(yè)P(yáng)rinciple :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(yè)/共82頁(yè)Apnea ventilation = Exclusive to Elise 350 !Apnea ventilation in pressureApnea ventilation in volume第49頁(yè)/共82頁(yè)or第50頁(yè)/共82頁(yè)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(yè)/共82頁(yè)第52頁(yè)/共82頁(yè)在 CPAP 模式, 僅可設(shè)置的參數(shù) :持續(xù)壓力的水平第53頁(yè)/共82頁(yè)第54頁(yè)/共82頁(yè)Maxi flow (l/min) :呼吸機(jī)給患者供氣時(shí)所能提供的最大吸氣流速，在容量控制通氣中會(huì)直接影響到所需吸氣時(shí)間的長(zhǎng)短Flow shape :僅在容量控制模式中有效,可以患者吸氣項(xiàng)進(jìn)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(dá)到設(shè)定的目標(biāo)壓力值而所需要花費(fèi)的時(shí)間第55

16、頁(yè)/共82頁(yè)P(yáng)ositive End Expiratory Pressure (cmH2O) :由呼吸機(jī)維持的，患者在呼氣循環(huán)期間持續(xù)保持的一個(gè)正壓力Inspiratory Pressure (cmH2O) :患者在輔助/控制呼吸循環(huán)中的吸氣項(xiàng)時(shí)，呼吸機(jī)提供的一個(gè)高于PEEP的壓力值I/E ratio (1/x) :在1次呼吸中，吸氣所用時(shí)間和呼氣所用時(shí)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(shí)間區(qū)間之后，如呼吸機(jī)未探測(cè)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(yè)/共82頁(yè)Inspiratory Time (s) :從吸氣流速而時(shí)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(jī)向患者輸入氣體所需最長(zhǎng)時(shí)間區(qū)間，設(shè)定潮氣量達(dá)到與否Expiratory Trigger :達(dá)到一個(gè)規(guī)定的界定值時(shí)，引起的呼氣循環(huán). 定義為最大峰值流速的% 或自動(dòng)觸發(fā)標(biāo)準(zhǔn)Inspiratory Trigger :達(dá)到一個(gè)規(guī)定的界定值時(shí)，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(wú)創(chuàng)通氣中的

18、觸發(fā)（Non invasive trigger）第57頁(yè)/共82頁(yè)Tidal Volume (ml) :吸氣或呼氣時(shí)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(yè)/共82頁(yè)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(rèn)后進(jìn)入報(bào)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(yè)/共82頁(yè)第60頁(yè)/共82頁(yè)BTPS 校正 : 氣體溫度和壓力校

19、正當(dāng)呼吸機(jī)啟用該功能后進(jìn)行自動(dòng)的校正僅限于測(cè)量呼出潮氣量 (Vte)If BTPS = NO ATPD (Ambient Temperature Pressure & Dryness)RC 自動(dòng)測(cè)量患者肺部力學(xué)情況 :每隔 15 分鐘自動(dòng)測(cè)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(yè)/共82頁(yè)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(yè)/共82頁(yè)nThe alarm microprocessornAn hardware independent system suppl

20、ied by an extra battery第63頁(yè)/共82頁(yè)報(bào)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(yè)/共82頁(yè) Elise 350 automatically manages FiO2 value according to FiO2 parameter第65頁(yè)/共82頁(yè) Elise 350 automatically manages FiO2 value according to FiO2 parameter第66頁(yè)/共82頁(yè)2分鐘純氧功能（O2 100 %）- 按壓 圖標(biāo)按鈕后可獲得兩分鐘的純氧通氣 - 在使用高壓供氧方式時(shí)，該功能有效低壓供氧高壓供氧第67頁(yè)/共82頁(yè)O2

21、Flow-by with oxygen+/- Inspiratory flow+/- Flow trigger +/- Flow-by第68頁(yè)/共82頁(yè)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(duì)氧氣的消耗第69頁(yè)/共82頁(yè)Bargraph o

22、f instantaneous pressurePressure curve Flow curve Ventilation measuresTrigger第70頁(yè)/共82頁(yè)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(yè)/共82頁(yè)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(yè)/共82頁(yè)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(yè)/共82頁(yè)通氣時(shí)可選擇使用多種呼吸力學(xué)測(cè)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(cè)屏幕下，通過翻頁(yè)找到相關(guān)需要的測(cè)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(dòng)通氣阻力 / 順應(yīng)性第74頁(yè)/共82頁(yè)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(yè)/共82頁(yè)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(yè)/共82頁(yè)手動(dòng)呼吸- 按壓下該圖標(biāo)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