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96 年理療 12 1 類療療 1 ˍˍˍˍˍˍˍ 不 8 1.25 2 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

12 2 8 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 4 6 8 1 13 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

12 3 16 23 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.5 1 1 2 2 3 3 4 24 復列量量 1. 量 2 量

12 4 25 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- 3 45 38 12 7 mmhg 理量 X neurogenic shock cardiogenic shock septic shock hypovolemic shock 31 21 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

12 5 32 45 38 12 7 mmhg 理量 X 療 pulmonary wedge pressure mmhg 1 15 2 25 33 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.5 1. 1.5 2. 37 臨 CVP 力來 fluid challenge CVP 力 6 cmh 2 O 行 1 ml 量 CVP 3 2 1 5 38 量塞療 cardiac index 2.1 L/min/m 2 cardiac indax L/min/m 2 1.-1.5 2.-2.5 2.5-3. 3.-3.5

12 6 39 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

12 7 45 35 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

12 8 52 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

12 9 6 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 75 5 25-25 -5-75 2 1 Flow Paw 8 Pes 6 cmh2o 4 2

12 1 62 流量 Flow Paw Pes Pga Pdi Time Pdi Pes Pga Paw Flow cmh2o cmh2o L/sec.5 1 15 15 15 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

12 11 66 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 1 15 2 25 69 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 12 24 36 48 72 chronic lung disease 列數 38 療數 55 mmhg cor pulmonale 利尿類狀 73 71 列力 respiratory drive 1-2 復切理療

12 12 74 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 22 2 13.3 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 8 565 mmhg RQ.8 PaCO 2 4 mmhg FiO 2 PaO 2.37.41.46.5 77 3 2 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