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1 96 年 理 療 12 1 類 療 療 1 ˍˍˍˍˍˍˍ 不 不 1 列 PaO 2 度 FiO 2 mean Paw 降 I/E ratio PEEP 2 列 ARDS 4/min 率 量 PIP PIP 1 cmh 2 O 3 PIP 1 cmh 2 O 2 PIP 5 cmh 2 O 1 PIP 1 cmh 2 O 15 PIP 5 cmh 2 O 15 PIP 1 cmh 2 O 5 PIP 5 cmh 2 O 25 3 列 tracheal gas insufflation TGI 連 流 continuous flow TGI volume ventilation Ppeak 塞 air emboli 降 PaCO 2 4 兩 CPAP 1 cmh 2 O FiO 2.5 率 4/min ph 7.2 PaCO 2 65 mmhg PaO 2 55 mmhg 列 理 CPAP 2 cmh 2 O FiO 2 sedation ACMV 5 列 不 ARDS recruitment maneuver CPAP 3-6 mmhg 2-4 利 sigh 利 PCV PIP PEEP manual resuscitator 6 ARDS 療 不易 肋 7 列 ARDS 理 proliferative phase proliferative phase fibrosis 塞 functional lung unit exudative phase 見 alveolar type cell proliferation

2 ARDS 流 列 力降 易 量降 9 ARDS 力 列 力 泌 力 力降 不 易 力 1 列 ECMO 療 ARDS VA venoarterial bypass 易 8-1% 量 bypass 見 ARDS ECMO 療 11 ARDS IRV inverse ratio ventilation 列 volume-controlled IRV minute ventilation pressure-controlled IRV peak airway pressure Peak flow rate volume-controlled IRV pressure-controlled IRV 度 12 ARDS NETWORK ARDS tidal volume ml/kg 塞 extrathoracic upper airway obstruction 流量 不 14 列 non-invasive positive pressure ventilation 不 paradoxical abdominal motion 不 15 COPD 列 狀 行 PaCO 2 4 mmhg 識不 數 25

3 年 女 列 hydrocortisone 2 mg aminophylline 5 mg 5 ml 5% glucose 24 nebulizer Atrovent 量 metered-dose inhaler Ventolin 17 塞 pulmonary infarction 18 識不 ph 7.3 PaCO 2 49 mmhg 理 療 2 - agonist 類 19 COPD 列 降 auto-peep 流量 tidal volume 度 2 NIV 列 NIV 度 COPD 惡 PaCO 2 連 CPAP 力 PSV 不 識不 21 hypercapnic hypoxemia 降 力 decreased ventilatory drive increased work of breathing respiratory muscle fatigue 22 列 respiratory muscle fatigue MIP 力 量 FVC 量 MVV 了 力 力 tension-time index.15 易 量 量 MVV 6% 易 respiratory alternans 23 g/kg body weight/day 復 列 量 量 1. 量 2 量

4 療 transtracheal oxygen therapy 列 療 LTOT 量 療 降 力 26 列 kyphoscoliosis 塞 acute exacerbation of COPD acute attack of asthma quadriplegia 27 American Respiratory Care Foundation 列 來 不 不 28 列 臨 increase pumping load dead space 力 力 drive 29 pro-inflammatory cytokines anti-inflammatory cytokines tumor necrosis factor, TNF -1 interleukin-1, IL-1 - interferon- - transforming growth factor mmhg 理 量 X neurogenic shock cardiogenic shock septic shock hypovolemic shock 年 理 Food and Drug Administration, FDA 臨 療 率 Tumor necrosis factor TNF inhibitor Recombinant human activated protein C Anti-endotoxin Ab 2 Thromboxane antagonists

5 mmhg 理 量 X 療 pulmonary wedge pressure mmhg systemic inflammatory response syndrome, SIRS 離 Critical illness polyneuropathy Acute inflammatory demyelinating polyneuropathy AIDP Acute motor sensory axonal neuropathy AMSAN Acute motor axonal neuropathy AMAN 34 離 勞 respiratory muscle fatigue 度 列 力 contractility 不 力 endurance capacity 不 力 contractility 不 力 endurance capacity 降 力 contractility 力 endurance capacity 不 力 contractility 力 endurance capacity 降 35 sepsis syndrome acute lung injury 來 力 列 不 力 alveolar macrophages 不 neutrophils 不 mast cells 不 療 aspirin aminophylline 36 復 尿量 ml/kg body weight/hr 臨 CVP 力來 fluid challenge CVP 力 6 cmh 2 O 行 1 ml 量 CVP 量 塞 療 cardiac index 2.1 L/min/m 2 cardiac indax L/min/m

6 不 率 Pre-renal intra-renal post-renal Pre-renal post-renal intra-renal Intra-renal pre-renal post-renal Post-renal intra-renal pre-renal 4 multiple trauma 列 6% 量 療 療 來 41 MODS 列 circulatory hypoperfusion 力 降 oxygen extraction tissue hypoxia inhibition of immunoinflammatory response systemic inflammatory response syndrome, SIRS ischemia-reperfusion injury 理論 42 列 療不 來 MODS oxygen delivery packed red blood cells transfusion 療 volume expansion by fluid infusion 療 positive end-expiratory pressure, PEEP 43 cardiovascular dysfunction 列 力 降 狀 hyperdynamic circulation peripheral edema microvasculature 塞 microthrombi 更惡 了 流 circulatory shunt nitric oxide, NO nitroprusside nitroglycerin 流 療 率 異度 variability 44 MODS 列 不 MODS 率 度 狀 systemic inflammatory response syndrome-sirs 不

7 ARDS 1 療 離 度 降 惡 數 列 降 來 central venous line 46 不 例 立 列 理 狀 立 paralytic agents 47 MODS liver injury 列 ongoing hepatic ischemia alkaline phosphatase 來 數 TPN total parenteral nutrition cholestasis 48 helium-oxygen gas mixture, heliox 塞 列 Heliox nitrogen 更 度 Heliox 降 Reynold s number 更 laminar flow Heliox Reynold s number 更 laminar flow Heliox functional residual capacity 49 療 5-6 肋 6-7 肋 7-8 肋 8-9 肋 5 列 不 NO 理 camp 度 oxygen free radical 降 oxygen toxicity 51 列 NO 聯 methemoglobinemia production of peroxynitrite paradoxical response rebound hypoxemia

8 列 立 ILV 見 度 53 high frequency oscillation 54 列 不 略 low volume strategy 漏 air leak syndrome pulmonary interstitial emphysema 55 列 HBO 療 量 不 糖尿 爛 56 降 列 不 流量不 率 量 57 力 airway pressure release ventilation, APRV 列 bilevel or biphasic positive airway pressure ventilation, BIPAP APRV 1.5 APRV spontaneous breathing APRV 力 pressure-controlled, time cycled mechanical ventilation 58 若 1% resuscitator 行 manual ventilation 惡 列 不 塞 滑 59 pulse oximetry 列 來 度 量 度 7% 量 不 度來 度

9 了 tidal volume dual control within a breath, DCWB dual-control breath to breath, DCBB Pressure Target volume Volume time DCWB DCBB DCWB DCBB DCWB DCBB 61 流量 flow Paw Pes 力 pressure support inspiratory trigger sensitivity -2 cmh 2 O ineffective triggering effort cmh2o Liters/min Flow Paw 8 Pes 6 cmh2o 4 2

10 流量 Flow Paw Pes Pga Pdi Time Pdi Pes Pga Paw Flow cmh2o cmh2o L/sec Time sec 力 ineffective triggering effort 63 車 度 SpO 2 讀 列 流狀 64 positive pressure ventilation 列 降 流 cerebral perfusion pressure 降 流 Hyperventilation CSF ph 力 cerebral vascular resistance 65 positive pressure ventilation 泌 列 renin 泌 antidiuretic hormon ADH 泌 atrial natriuretic factor 泌 aldosterone 泌

11 列 不 permissive hypercapnia 67 不 biotrauma 不 列 Tumor necrosis factor- TNF- Thromboxane-B 2 Interleukin-1 Leukotrienes 68 力 cmh 2 O 易 略 protective ventilatory strategy 列 度 shear stretch injury 不 PaO 2 降 不 PaCO 2 7 列 PEEP 行 力參數 Lung compliance chest wall compliance 降 Lung compliance chest wall compliance Lung compliance 降 chest wall compliance Lung compliance 降 chest wall compliance 降 71 Ventilator-associated pneumonia chronic lung disease 列 數 38 療 數 55 mmhg cor pulmonale 利尿 類 狀 列 力 respiratory drive 1-2 復 切 理 療

12 量數 SIMV rate 2/min PCV mode, PIP 36 cmh 2 O, PEEP 12 cmh 2 O, Ti 1.5 sec, FiO 2.55 inhaled tidal volume 528 ml, exhaled tidal volume 48 ml auto-peep 16 cmh 2 O static compliance ml/cmh 2 O 料 75 溺 fresh water near-drowning 見 laryngospasm hyponatremia noncardiogenic pulmonary edema metabolic alkalosis 76 FiO 2 3% 療 PaO 2 1 mmhg 8 度 mmhg RQ.8 PaCO 2 4 mmhg FiO 2 PaO 列 rapid sequence intubation Pre-oxygenation with 1% FiO 2 atropine.2 mg 狀 cricoid Sellick s maneuver 78 列 apnea periodic breathing 度 Idiopathic apnea of prematurity 見 mixed apnea Apnea 狀 79 respiratory distress syndrome 列 力 力不 糖尿 不易 RDS B 率略 8 coagulation 力 fibrinolysis 參 列 plasminogen activator inhibitor-1 PAI-1 降 thrombin-activatable fibrinolysis inhibitor TAFI 降 protein C 降 tissue factor 降