心肺功能不全的物理治疗诊断与治疗：气囊扩张疗法

1、气囊扩张疗法MHIApril 26, 2016Bag squeezing挤压 (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比呼吸机给的潮气量多50

2、% (Singer et al 1994)定义增加肺容量/防止肺塌陷Increase lung volume/prevention of lung collapse产生快速呼吸流速以刺激/仿效咳嗽Generate a fast expiratory flow rate simulate coughing增加静态肺顺应性，降低呼吸道阻力Increase static pulmonary compliance and reduced airway resistance改善氧合Enhance ventilation (removal of CO2)目的组成构件呼吸球囊进氧贮氧袋单通道阀贮氧袋储气阀衔

3、接管氧气管单通道阀（呼吸活瓣）安全阀MHI / Bagging / bag squeezing鼓肺气道廓清流程进行吸痰缓慢吸气、快速呼气，5-6次患者与球囊相互配合，缓慢呼吸2-3次连接贮氧袋、呼吸球囊、氧气管吸痰时间15s慢快的放松缓慢吸气，缓慢呼气保证贮氧袋充分扩张MHI+胸部振动、扣拍快速呼气以助分泌物的排除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肺顺应性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注意事项高吸气压会导致肺气压伤注意过高吸气压不适合急性呼吸窘迫综合征，急性支气管痉挛患者未处理的气胸肺大泡、心血管系统不稳定头部损伤，颅

5、内压18mmHg低心脏输出量平均动脉压60mmHg需要高剂量强心药禁忌症Pathological conditionsUndrained pneumothorax（张力性气胸） Bronchopleural fistula（支气管胸膜瘘） Bronchospasm（支气管痉挛） Pulmonary bullae（肺大泡）Lung tumours（肺部肿瘤）Central airway obstruction（大气道阻塞）Lung abscess（肺脓肿）Haemoptysis（咯血）禁忌症Physiological parameters:Cardiovascular instability MAP 102 mmHgHR 123High dose inotrope requirement高剂量强心药物Neurological instability ICP 19 mmHgCPP 62 mmHg禁忌症Pathological conditionsUndrained pneumothorax（张力性气胸） Bronchopleural fistula（支气管胸膜瘘） Bronchospasm（支气管痉挛） Pulmonary bullae（肺大泡）