無創呼(hu)(hu)吸(xi)機(ji)（Non-InvasiveVentilation，老(lao)人(ren)呼(hu)(hu)吸(xi)監測(ce)儀(yi)維修，NIV）是一種通(tong)(tong)過面罩(zhao)或(huo)鼻(bi)罩(zhao)等無創接口提供機(ji)械通(tong)(tong)氣(qi)(qi)(qi)(qi)(qi)的(de)，廣泛應用于(yu)急慢性(xing)(xing)呼(hu)(hu)吸(xi)衰竭患者(zhe)(zhe)的(de)輔(fu)助(zhu)治(zhi)療(liao)。其功(gong)(gong)效在(zai)于(yu)通(tong)(tong)過調節(jie)氣(qi)(qi)(qi)(qi)(qi)道壓力，改(gai)(gai)(gai)善患者(zhe)(zhe)通(tong)(tong)氣(qi)(qi)(qi)(qi)(qi)和(he)氧(yang)合功(gong)(gong)能，同時(shi)避免氣(qi)(qi)(qi)(qi)(qi)管(guan)插管(guan)或(huo)氣(qi)(qi)(qi)(qi)(qi)管(guan)切開帶來的(de)創險(xian)。###一、作(zuo)用機(ji)制無創呼(hu)(hu)吸(xi)機(ji)主要(yao)通(tong)(tong)過兩種模式(shi)發揮作(zuo)用：1.**持(chi)(chi)續氣(qi)(qi)(qi)(qi)(qi)道正壓（C）**：維持(chi)(chi)恒定(ding)壓力，老(lao)人(ren)呼(hu)(hu)吸(xi)監測(ce)儀(yi)租(zu)賃，防(fang)止肺泡塌(ta)陷2.**雙水平(ping)氣(qi)(qi)(qi)(qi)(qi)道正壓（Bi）**：設置吸(xi)氣(qi)(qi)(qi)(qi)(qi)壓（I）和(he)呼(hu)(hu)氣(qi)(qi)(qi)(qi)(qi)壓（E），輔(fu)助(zhu)呼(hu)(hu)吸(xi)肌(ji)(ji)做(zuo)功(gong)(gong)###二、主要(yao)臨床(chuang)功(gong)(gong)效1.**改(gai)(gai)(gai)善氣(qi)(qi)(qi)(qi)(qi)體交換**-提升血(xue)氧(yang)飽(bao)和(he)度（SpO?）：通(tong)(tong)過正壓通(tong)(tong)氣(qi)(qi)(qi)(qi)(qi)增(zeng)加肺泡通(tong)(tong)氣(qi)(qi)(qi)(qi)(qi)量-降低(di)(di)二氧(yang)化碳潴留：通(tong)(tong)過壓力支(zhi)持(chi)(chi)促進CO?排出2.**呼(hu)(hu)吸(xi)功(gong)(gong)能支(zhi)持(chi)(chi)**-減少呼(hu)(hu)吸(xi)肌(ji)(ji)負(fu)荷(he)：為(wei)呼(hu)(hu)吸(xi)肌(ji)(ji)提供30-70%的(de)做(zuo)功(gong)(gong)輔(fu)助(zhu)-維持(chi)(chi)氣(qi)(qi)(qi)(qi)(qi)道開放：對抗內(nei)源(yuan)性(xing)(xing)PEEP（auto-PEEP）3.**多系統(tong)保(bao)護作(zuo)用-系統(tong)：降低(di)(di)左(zuo)心(xin)(xin)后負(fu)荷(he)，改(gai)(gai)(gai)善心(xin)(xin)源(yuan)性(xing)(xing)-神經系統(tong)：預防(fang)高碳酸血(xue)癥(zheng)導致的(de)意識障礙###三、適應癥(zheng)與數據|疾(ji)病類型|有效率|插管(guan)率下降||------------------|--------|------------||COPD急性(xing)(xing)加重(zhong)期|85-90%|50-60%||心(xin)(xin)源(yuan)性(xing)(xing)|75-85%|40-50%||神經肌(ji)(ji)肉(rou)疾(ji)病|70-80%|60-70%|###四(si)、特(te)殊優勢(shi)1.避免有創通(tong)(tong)氣(qi)(qi)(qi)(qi)(qi)（VAP發生(sheng)率降低(di)(di)80%）2.保(bao)留生(sheng)理性(xing)(xing)氣(qi)(qi)(qi)(qi)(qi)道防(fang)御功(gong)(gong)能3.支(zhi)持(chi)(chi)間歇性(xing)(xing)使(shi)用（每(mei)日4-6小時(shi)即可）###五(wu)、使(shi)用注意事項?：嚴重(zhong)面部創傷、氣(qi)(qi)(qi)(qi)(qi)道分泌(mi)物過多、血(xue)流動(dong)力學不穩定(ding)?需密切監測(ce)：血(xue)氣(qi)(qi)(qi)(qi)(qi)分析(xi)（每(mei)2-4小時(shi)）、人(ren)機(ji)同步性(xing)(xing)、胃(wei)脹(zhang)氣(qi)(qi)(qi)(qi)(qi)風險(xian)?評估窗口期：通(tong)(tong)常1-2小時(shi)內(nei)應有臨床(chuang)改(gai)(gai)(gai)善該設備通(tong)(tong)過智能壓力調節(jie)系統(tong)（Auto-Trak技(ji)術）自動(dong)適應患者(zhe)(zhe)呼(hu)(hu)吸(xi)模式(shi)，在(zai)急性(xing)(xing)呼(hu)(hu)吸(xi)衰竭治(zhi)療(liao)中(zhong)可將(jiang)住院率降低(di)(di)25-30%，已(yi)成為(wei)現(xian)代呼(hu)(hu)吸(xi)支(zhi)持(chi)(chi)治(zhi)療(liao)的(de)重(zhong)要(yao)工具。

飛利浦呼吸(xi)(xi)(xi)機(ji)(ji)選(xuan)(xuan)購(gou)(gou)指南（300字精簡版）一、明確需(xu)(xu)(xu)求類型(xing)(xing)1.睡(shui)眠(mian)呼吸(xi)(xi)(xi)機(ji)(ji)：針鼾(han)/輕度睡(shui)眠(mian)呼吸(xi)(xi)(xi)暫停（OSA）選(xuan)(xuan)C機(ji)(ji)型(xing)(xing)（如(ru)DreamStationGo）2.自動調節機(ji)(ji)型(xing)(xing)：中重度OSA患者建議(yi)AutoC（如(ru)DreamStationAuto）3.雙(shuang)水(shui)平機(ji)(ji)型(xing)(xing)：慢阻肺/復雜呼吸(xi)(xi)(xi)疾病需(xu)(xu)(xu)Bi（如(ru)DreamStationBi）二、參(can)(can)數(shu)考量(liang)1.壓(ya)(ya)力(li)范(fan)圍：C機(ji)(ji)型(xing)(xing)8-20cmH2O為宜，Auto機(ji)(ji)型(xing)(xing)應(ying)支持3-20cmH2O2.噪音值：優選(xuan)(xuan)≤26分貝機(ji)(ji)型(xing)(xing)（如(ru)DreamStation系列）3.智能調節：Auto模(mo)式(shi)需(xu)(xu)(xu)具備壓(ya)(ya)力(li)自動技術4.濕(shi)化(hua)系統(tong)(tong)：建議(yi)選(xuan)(xuan)擇(ze)可調溫濕(shi)化(hua)器(qi)(qi)（如(ru)HeatedTube）三、關(guan)鍵(jian)選(xuan)(xuan)購(gou)(gou)建議(yi)1.醫療認(ren)證(zheng)：認(ren)準FDA/CE/NMPA認(ren)證(zheng)機(ji)(ji)型(xing)(xing)2.召(zhao)回注(zhu)意：避(bi)開2021年召(zhao)回批次(ci)（具體(ti)型(xing)(xing)號(hao)需(xu)(xu)(xu)查詢）3.配(pei)件(jian)兼(jian)容：優先選(xuan)(xuan)擇(ze)通用(yong)接(jie)口設(she)計（如(ru)DreamWear面罩系統(tong)(tong)）4.數(shu)據管理：選(xuan)(xuan)擇(ze)支持藍牙/WiFi數(shu)據傳輸(shu)機(ji)(ji)型(xing)(xing)四、操作(zuo)注(zhu)意事項1.使(shi)用(yong)前需(xu)(xu)(xu)壓(ya)(ya)力(li)滴定(ding)2.每周清洗(xi)水(shui)箱，每月更換過(guo)濾(lv)棉3.避(bi)免使(shi)用(yong)非原(yuan)裝(zhuang)電源(yuan)適配(pei)器(qi)(qi)4.定(ding)期(qi)回傳數(shu)據給呼吸(xi)(xi)(xi)治(zhi)療師(shi)調整參(can)(can)數(shu)建議(yi)通過(guo)授權渠道購(gou)(gou)買，保(bao)留(liu)完整保(bao)修(xiu)憑證(zheng)。患者建議(yi)在(zai)呼吸(xi)(xi)(xi)科醫師(shi)指導下選(xuan)(xuan)擇(ze)雙(shuang)水(shui)平ST模(mo)式(shi)機(ji)(ji)型(xing)(xing)，切(qie)勿自行選(xuan)(xuan)購(gou)(gou)治(zhi)療級(ji)設(she)備。

老(lao)(lao)年人(ren)(ren)使用(yong)呼(hu)吸(xi)機(ji)時，為(wei)(wei)確(que)保(bao)治果和舒適(shi)(shi)性(xing)(xing)，常(chang)需配(pei)(pei)(pei)備(bei)(bei)以(yi)下關鍵配(pei)(pei)(pei)件(jian)(jian)(jian)(jian)：1.**面罩(zhao)系統(tong)**包括鼻(bi)罩(zhao)、口鼻(bi)罩(zhao)或(huo)全臉面罩(zhao)，需根據呼(hu)吸(xi)習慣選擇。鼻(bi)罩(zhao)適(shi)(shi)合(he)鼻(bi)呼(hu)吸(xi)為(wei)(wei)主(zhu)者(zhe)(zhe)，口鼻(bi)罩(zhao)適(shi)(shi)合(he)口呼(hu)吸(xi)或(huo)夜間張口者(zhe)(zhe)。硅膠襯(chen)墊可(ke)提升(sheng)密(mi)封性(xing)(xing)和舒適(shi)(shi)度(du)，減少(shao)面部(bu)(bu)壓痕，對皮膚(fu)脆弱的老(lao)(lao)人(ren)(ren)尤(you)為(wei)(wei)重要。2.**呼(hu)吸(xi)管(guan)(guan)路(lu)**連接主(zhu)機(ji)與面罩(zhao)的波紋管(guan)(guan)，長(chang)度(du)通(tong)常(chang)1.5-2米，材質需柔韌抗扭結。部(bu)(bu)分(fen)(fen)管(guan)(guan)路(lu)含加熱功能(neng)，可(ke)減少(shao)冷凝水(shui)積聚，老(lao)(lao)人(ren)(ren)呼(hu)吸(xi)監測儀維修，避免冷空(kong)氣刺激(ji)呼(hu)吸(xi)道。3.**空(kong)氣過(guo)濾器**分(fen)(fen)為(wei)(wei)一次性(xing)(xing)靜(jing)電(dian)濾棉與可(ke)清洗(xi)海綿濾網(wang)，能(neng)攔截粉(fen)塵、花粉(fen)等(deng)顆粒物，保(bao)護主(zhu)機(ji)并提升(sheng)空(kong)氣質量。建議每(mei)月(yue)更(geng)(geng)換，霧霾高發期(qi)(qi)需縮短周期(qi)(qi)。4.**濕(shi)化(hua)器組件(jian)(jian)(jian)(jian)**集成式或(huo)外置濕(shi)化(hua)罐通(tong)過(guo)加熱蒸餾(liu)水(shui)產生濕(shi)潤氣流，防止(zhi)鼻(bi)腔干燥出(chu)血(xue)或(huo)痰液黏稠。恒溫控(kong)制(zhi)可(ke)調(diao)節濕(shi)度(du)等(deng)級，冬季(ji)使用(yong)率更(geng)(geng)高。5.**固定頭帶**多段式魔術貼設計(ji)，可(ke)調(diao)節松緊(jin)避免漏氣。部(bu)(bu)分(fen)(fen)型號采用(yong)記憶(yi)棉內襯(chen)，分(fen)(fen)散(san)壓力，適(shi)(shi)合(he)長(chang)期(qi)(qi)佩戴。夜間翻身時需確(que)保(bao)穩定性(xing)(xing)。6.**電(dian)源配(pei)(pei)(pei)件(jian)(jian)(jian)(jian)**備(bei)(bei)用(yong)電(dian)池（12V直流）應(ying)對停電(dian)突發，車載適(shi)(shi)配(pei)(pei)(pei)器便(bian)于出(chu)行(xing)。電(dian)源線(xian)(xian)防拉(la)扯設計(ji)可(ke)延長(chang)使用(yong)壽命。7.**清潔消毒(du)工(gong)具**中性(xing)(xing)清洗(xi)劑(ji)、管(guan)(guan)路(lu)刷(shua)、紫外線(xian)(xian)消毒(du)盒(he)等(deng)，每(mei)周深度(du)清潔可(ke)防止(zhi)細菌滋生。消毒(du)濕(shi)巾(jin)適(shi)(shi)合(he)日常(chang)擦拭(shi)面罩(zhao)。8.**智能(neng)管(guan)(guan)理配(pei)(pei)(pei)件(jian)(jian)(jian)(jian)**SD卡或(huo)無線(xian)(xian)模塊記錄血(xue)氧、呼(hu)吸(xi)頻(pin)率等(deng)數據，龍巖老(lao)(lao)人(ren)(ren)呼(hu)吸(xi)監測儀，通(tong)過(guo)APP生成報告(gao)，方便(bian)醫生遠程(cheng)調(diao)整參數。報警器可(ke)監測管(guan)(guan)路(lu)脫(tuo)落等(deng)異常(chang)。9.**舒適(shi)(shi)性(xing)(xing)配(pei)(pei)(pei)件(jian)(jian)(jian)(jian)**防褥(ru)瘡鼻(bi)梁墊、管(guan)(guan)路(lu)支架、降噪耳塞等(deng)提升(sheng)使用(yong)體驗。便(bian)攜包兼顧主(zhu)機(ji)與配(pei)(pei)(pei)件(jian)(jian)(jian)(jian)收納，適(shi)(shi)合(he)旅(lv)居(ju)使用(yong)。**提示**：老(lao)(lao)年人(ren)(ren)應(ying)定期(qi)(qi)檢查配(pei)(pei)(pei)件(jian)(jian)(jian)(jian)老(lao)(lao)化(hua)情況，面罩(zhao)每(mei)6-12個(ge)月(yue)更(geng)(geng)換，過(guo)濾器依(yi)使用(yong)環境(jing)調(diao)整頻(pin)率。正確(que)搭配(pei)(pei)(pei)配(pei)(pei)(pei)件(jian)(jian)(jian)(jian)能(neng)顯著提高治療依(yi)從(cong)性(xing)(xing)，降低等(deng)風險。