Elisee中文操作培训PPT学习教案

1、会计学1Elisee中文操作培训中文操作培训第1页/共82页第2页/共82页第三代航空智能涡轮供气系统 -超长使用寿命 -超强供气流速，在60厘米水柱时最高供气流速可达300升/分。 -体积小、噪音低、惯性及功耗极低 -能够瞬间准确调节供气流速，与患者自主呼吸匹配，最大程度缩短吸气及呼气的反应时间。成比例三项主动呼气阀技术 第3页/共82页第4页/共82页第5页/共82页第6页/共82页第7页/共82页第8页/共82页肺复张的目标（What is the aim of a maneuver recruitment） ? To avoid atelectasy : sagging of air

2、cells那些病人需要适用该项功能（For which patients ）?For neuromuscular patients which air cells could easily collapseNot for COPD patients or all obstructive patients !同常规的叹息功能比较有什么优势?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页/共82页1.压力波形、流速波形、容量波形，两种向量环等动态波形显示。2.20多项实时呼吸力学监测，并可根据需要随意组合。3.配置先进的参数及波形分析工具，可提供，波形冻结分析，历史波形回顾，波形存储打印等丰富应用工具，为临床诊断及确定治疗方案提供丰富参考依据。 第10页/共82页第11页/共82页实时数据监测区域当前设置状态显示区域实时波形、向量环监测显示区域分析工具区域第12页/共82页不需要拆卸设备 ! 同时按压下按钮 和第13页/共82页Ve

4、ntilation performances are preserved during the whole time of discharge第14页/共82页第15页/共82页第16页/共82页呼吸的介绍呼吸回路的连接启动/关闭呼吸机通气模式通气参数报警管理FiO2通气观测技术维护菜单呼吸力学通气方式的选择雾化吸入第17页/共82页成比例三项主动呼气阀 (双回路)送气端口 触摸屏幕主电源 / 外接电源状态指示灯报警销音按钮蓝牙信号指示灯内置 / 外置电池状态指示灯第18页/共82页氧电池 开 / 关 按钮远程报警控制接口信号输出端口低压氧源空气入口空气入口雾化端口高压氧源12-28V外接直流

5、电源基座第19页/共82页卡扣基准点在进行手动测试时，能自动探测到呼吸回路连接的方式。不需任何工具 !第20页/共82页外接呼气阀控制端口近端压力传感线端口病人呼吸回路(直径 22 mm)第21页/共82页患者呼气口吸气管路 (标准直径 22 mm)呼气管路(标准直径 22 mm)第22页/共82页显示最新的检测结果选择预先设定模式选择设定新模式选择先前使用的模式第23页/共82页正在通气未启动通气第24页/共82页如未通过测试, 请通知技术服务机构第25页/共82页第26页/共82页n 5 个预设通气程序n 存储了通气所需调整所有参数 :- 通气模式- 患者类型- 通气参数- 报警设置区别对

6、待患者 白天/夜间 的通气需求 !减少对医护人员的培训工作 !第27页/共82页第28页/共82页Each element of the configuration is reminded on the screen thanks to an icon 第29页/共82页压力模式容量模式双控制模式通气模式确认后, 随后出现参数设定界面第30页/共82页In P(A)CV mode, the user can set recruitment cyclesMore about recruitment :第31页/共82页可设置使用“肺复张”参数 :Recruitment periodRecruit

7、ment durationRecruitment pressure or第32页/共82页第33页/共82页In (A)CV mode, the user can set recruitment cyclesMore about recruitment :第34页/共82页orRecruitment parameters may be set up :Recruitment periodRecruitment durationRecruitment pressure 第35页/共82页第36页/共82页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页/共82页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页/共82页第39页/共82页When the SIMV mode is selected, an access to “Pressure Support” adjustment is available from the first screen of parameters adjustment第40页/共82页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页/共82页第42页/共82页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页/共82页Apnea ventilation in pressureApnea ventilation in volumeApnea ventilation = Exclusive to Elise 350 !第44页/共82页nMaximum inspiratory timeor第45页/共82页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页/共82页第47页/共82页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页/共82页Apnea ventilation = Exclusive to Elise 350 !Apnea ventilation in pressureApnea ventilation in volume第49页/共82页or第50页/共82页The adjustable parameters of Pressure Support in volume are :Apnea timeTidal VolumeFrequencyInsp

15、iratory time or I/E ratio or Maxi flow第51页/共82页第52页/共82页在 CPAP 模式, 仅可设置的参数 :持续压力的水平第53页/共82页第54页/共82页Maxi flow (l/min) :呼吸机给患者供气时所能提供的最大吸气流速，在容量控制通气中会直接影响到所需吸气时间的长短Flow shape :仅在容量控制模式中有效,可以患者吸气项进行持续递增或递减流速Frequency (cycles/min) :一分钟内所呼吸总的次数Inspiratory slope :仅在压力控制模式中有效, 其意义为要达到设定的目标压力值而所需要花费的时间第55

16、页/共82页Positive End Expiratory Pressure (cmH2O) :由呼吸机维持的，患者在呼气循环期间持续保持的一个正压力Inspiratory Pressure (cmH2O) :患者在辅助/控制呼吸循环中的吸气项时，呼吸机提供的一个高于PEEP的压力值I/E ratio (1/x) :在1次呼吸中，吸气所用时间和呼气所用时间之间的比值Apnea Time (s) :仅在自主呼吸模式下有效, 其表示为一段时间区间之后，如呼吸机未探测到患者的呼吸循环，患者可能出了现窒息的状况。第56页/共82页Inspiratory Time (s) :从吸气流速而时间区间Time

17、 space between the beginning of inspiratory flow and the beginning of expiratory flowMaximum Inspiratory Time (s) :呼吸机向患者输入气体所需最长时间区间，设定潮气量达到与否Expiratory Trigger :达到一个规定的界定值时，引起的呼气循环. 定义为最大峰值流速的% 或自动触发标准Inspiratory Trigger :达到一个规定的界定值时，引起的吸气循环. 触发的方式有 :流速触发（Flow trigger）压力触发（Pressure trigger）在无创通气中的

18、触发（Non invasive trigger）第57页/共82页Tidal Volume (ml) :吸气或呼气时间内患者所吸入或呼出的气体容量FiO2 (%) :患者吸入气体内氧气所占的百分比Plateau time (s) :Time during which insufflation is maintained nil at the patient level第58页/共82页提示但前通气模式提示但前患者状态返回至模式设定界面 确认后进入报警设置界面按压“start ventilation”开始通气其它参数设定界面第59页/共82页第60页/共82页BTPS 校正 : 气体温度和压力校

19、正当呼吸机启用该功能后进行自动的校正仅限于测量呼出潮气量 (Vte)If BTPS = NO ATPD (Ambient Temperature Pressure & Dryness)RC 自动测量患者肺部力学情况 :每隔 15 分钟自动测量阻力和顺应性仅有限于在有创通气的ACV 模式第61页/共82页多种氧源 高压 / 低压氧源更好的适合各种供氧条件可在Ti, maximum flow 或 I/E 中选择使用查看方式:仅限于在 ACV 模式 !第62页/共82页nThe alarm microprocessornAn hardware independent system suppl

20、ied by an extra battery第63页/共82页报警参数的调节方式和通气参数调节方式是一样的！第64页/共82页 Elise 350 automatically manages FiO2 value according to FiO2 parameter第65页/共82页 Elise 350 automatically manages FiO2 value according to FiO2 parameter第66页/共82页2分钟纯氧功能（O2 100 %）- 按压 图标按钮后可获得两分钟的纯氧通气 - 在使用高压供氧方式时，该功能有效低压供氧高压供氧第67页/共82页O2

21、Flow-by with oxygen+/- Inspiratory flow+/- Flow trigger +/- Flow-by第68页/共82页Inspi.Expi.流速曲线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减少对氧气的消耗第69页/共82页Bargraph o

22、f instantaneous pressurePressure curve Flow curve Ventilation measuresTrigger第70页/共82页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页/共82页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页/共82页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页/共82页通气时可选择使用多种呼吸力学测量工具使用的有效性要依据所处在的通气方式或通气模式用户可以通过在曲线监测屏幕下，通过翻页找到相关需要的测量工具P0.1胸腔闭合压力 雾化功能吸气保持呼气保持手动通气阻力 / 顺应性第74页/共82页吸气保持功能- 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页/共82页呼气保持功能- 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页/共82页手动呼吸- 按压下该图标后, 将增加一次呼吸循环- 除了 CPAP 模式外，在所有的通气模式中都有效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