1、氣囊擴張療法MHIApril 26, 2016Bag squeezing擠壓 (Clement & Hubsch 1968)Manual Inflation of the lungs with oxygen (usually 100%)to a tidal volume of 1 liter (Windsor et al 1972)to a tidal volume larger than baseline (McCarren 1996)To a tidal volume 50% greater than that delivered by the ventilator比呼吸機給的潮氣量多50

2、% (Singer et al 1994)定義增加肺容量/防止肺塌陷Increase lung volume/prevention of lung collapse產(chǎn)生快速呼吸流速以刺激/仿效咳嗽Generate a fast expiratory flow rate simulate coughing增加靜態(tài)肺順應性，降低呼吸道阻力Increase static pulmonary compliance and reduced airway resistance改善氧合Enhance ventilation (removal of CO2)目的組成構(gòu)件呼吸球囊進氧貯氧袋單通道閥貯氧袋儲氣閥銜

3、接管氧氣管單通道閥（呼吸活瓣）安全閥MHI / Bagging / bag squeezing鼓肺氣道廓清流程進行吸痰緩慢吸氣、快速呼氣，5-6次患者與球囊相互配合，緩慢呼吸2-3次連接貯氧袋、呼吸球囊、氧氣管吸痰時間15s慢快的放松緩慢吸氣，緩慢呼氣保證貯氧袋充分擴張MHI+胸部振動、扣拍快速呼氣以助分泌物的排除Increase in lung volume/prevention of lung collapseStiller et al 1990, Hodgeson et al 2000, Maa et al 2005Secretion removal (review)Denehy 199

4、9 Increase static pulmonary compliance肺順應性Jones et al 1992Improved static lung compliance and reduced airway resistance Choi and Jones 2005Improved static compliance and oxygenation Blattner et al 2008Effect of Manual Hyperinflation注意事項高吸氣壓會導致肺氣壓傷注意過高吸氣壓不適合急性呼吸窘迫綜合征，急性支氣管痙攣患者未處理的氣胸肺大泡、心血管系統(tǒng)不穩(wěn)定頭部損傷，顱

5、內(nèi)壓18mmHg低心臟輸出量平均動脈壓60mmHg需要高劑量強心藥禁忌癥Pathological conditionsUndrained pneumothorax（張力性氣胸） Bronchopleural fistula（支氣管胸膜瘺） Bronchospasm（支氣管痙攣） Pulmonary bullae（肺大泡）Lung tumours（肺部腫瘤）Central airway obstruction（大氣道阻塞）Lung abscess（肺膿腫）Haemoptysis（咯血）禁忌癥Physiological parameters:Cardiovascular instability MAP 102 mmHgHR 123High dose inotrope requirement高劑量強心藥物Neurological instability ICP 19 mmHgCPP 62 mmHg禁忌癥Pathological conditionsUndrained pneumothorax（張力性氣胸） Bronchopleural fistula（支氣管胸膜瘺） Bronchospasm（支氣管痙攣） Pulmonary bullae（肺大泡）