無(wu)(wu)創(chuang)呼(hu)(hu)吸(xi)(xi)(xi)(xi)(xi)(xi)機(ji)（Non-InvasiveVentilator，NIV）是一種通(tong)(tong)過(guo)面罩或(huo)鼻罩等(deng)外部(bu)接口提(ti)供(gong)通(tong)(tong)氣(qi)(qi)(qi)(qi)(qi)支持(chi)(chi)的(de)(de)，無(wu)(wu)需(xu)(xu)侵(qin)入性氣(qi)(qi)(qi)(qi)(qi)管(guan)插管(guan)。根據其工作原(yuan)理(li)、適(shi)(shi)(shi)(shi)用(yong)(yong)場(chang)(chang)景及功(gong)(gong)能特點(dian)，主(zhu)(zhu)要可分為以(yi)下幾類(lei)：###1.**持(chi)(chi)續(xu)氣(qi)(qi)(qi)(qi)(qi)道(dao)正壓(ya)(ya)(ya)(ya)通(tong)(tong)氣(qi)(qi)(qi)(qi)(qi)機(ji)（C）**-**原(yuan)理(li)**：提(ti)供(gong)單(dan)一恒定(ding)正壓(ya)(ya)(ya)(ya)，在患(huan)(huan)者(zhe)(zhe)整個(ge)呼(hu)(hu)吸(xi)(xi)(xi)(xi)(xi)(xi)周(zhou)期(qi)(qi)（吸(xi)(xi)(xi)(xi)(xi)(xi)氣(qi)(qi)(qi)(qi)(qi)和(he)(he)呼(hu)(hu)氣(qi)(qi)(qi)(qi)(qi)）保持(chi)(chi)氣(qi)(qi)(qi)(qi)(qi)道(dao)開(kai)(kai)放。-**適(shi)(shi)(shi)(shi)用(yong)(yong)癥(zheng)**：主(zhu)(zhu)要用(yong)(yong)于(yu)阻塞性睡眠呼(hu)(hu)吸(xi)(xi)(xi)(xi)(xi)(xi)暫停綜合征(zheng)（OSAHS），也適(shi)(shi)(shi)(shi)用(yong)(yong)于(yu)輕(qing)度(du)呼(hu)(hu)吸(xi)(xi)(xi)(xi)(xi)(xi)衰(shuai)(shuai)竭或(huo)心源(yuan)性的(de)(de)輔(fu)助治(zhi)(zhi)(zhi)(zhi)療。-**特點(dian)**：結構簡單(dan)，泉港(gang)區家(jia)用(yong)(yong)呼(hu)(hu)吸(xi)(xi)(xi)(xi)(xi)(xi)監(jian)(jian)測(ce)儀，操作便(bian)(bian)捷，家(jia)用(yong)(yong)呼(hu)(hu)吸(xi)(xi)(xi)(xi)(xi)(xi)監(jian)(jian)測(ce)儀租賃(lin)，適(shi)(shi)(shi)(shi)合家(jia)庭使用(yong)(yong)，但對主(zhu)(zhu)動呼(hu)(hu)吸(xi)(xi)(xi)(xi)(xi)(xi)能力(li)要求較(jiao)高(gao)(gao)。###2.**雙水(shui)(shui)平氣(qi)(qi)(qi)(qi)(qi)道(dao)正壓(ya)(ya)(ya)(ya)通(tong)(tong)氣(qi)(qi)(qi)(qi)(qi)機(ji)（Bi）**-**原(yuan)理(li)**：提(ti)供(gong)兩(liang)個(ge)不同壓(ya)(ya)(ya)(ya)力(li)水(shui)(shui)平——較(jiao)高(gao)(gao)的(de)(de)吸(xi)(xi)(xi)(xi)(xi)(xi)氣(qi)(qi)(qi)(qi)(qi)相正壓(ya)(ya)(ya)(ya)（I）和(he)(he)較(jiao)低的(de)(de)呼(hu)(hu)氣(qi)(qi)(qi)(qi)(qi)相正壓(ya)(ya)(ya)(ya)（E），輔(fu)助患(huan)(huan)者(zhe)(zhe)完成(cheng)呼(hu)(hu)吸(xi)(xi)(xi)(xi)(xi)(xi)周(zhou)期(qi)(qi)。-**適(shi)(shi)(shi)(shi)用(yong)(yong)癥(zheng)**：適(shi)(shi)(shi)(shi)用(yong)(yong)于(yu)慢性阻塞性肺疾病（COPD）、急性呼(hu)(hu)吸(xi)(xi)(xi)(xi)(xi)(xi)衰(shuai)(shuai)竭、神經肌肉疾病等(deng)需(xu)(xu)要較(jiao)高(gao)(gao)通(tong)(tong)氣(qi)(qi)(qi)(qi)(qi)支持(chi)(chi)的(de)(de)患(huan)(huan)者(zhe)(zhe)。-**亞型(xing)**：-**S模(mo)(mo)式(shi)(shi)**：由(you)患(huan)(huan)者(zhe)(zhe)自(zi)(zi)主(zhu)(zhu)觸發(fa)呼(hu)(hu)吸(xi)(xi)(xi)(xi)(xi)(xi)。-**T模(mo)(mo)式(shi)(shi)**：按預設頻率(lv)強制通(tong)(tong)氣(qi)(qi)(qi)(qi)(qi)。-**ST模(mo)(mo)式(shi)(shi)**：結合S和(he)(he)T模(mo)(mo)式(shi)(shi)，確保通(tong)(tong)氣(qi)(qi)(qi)(qi)(qi)保障。###3.**智(zhi)(zhi)能自(zi)(zi)適(shi)(shi)(shi)(shi)應呼(hu)(hu)吸(xi)(xi)(xi)(xi)(xi)(xi)機(ji)（Auto-C/Auto-Bi）**-**原(yuan)理(li)**：通(tong)(tong)過(guo)傳感器實(shi)時監(jian)(jian)測(ce)患(huan)(huan)者(zhe)(zhe)呼(hu)(hu)吸(xi)(xi)(xi)(xi)(xi)(xi)狀態，自(zi)(zi)動調節壓(ya)(ya)(ya)(ya)力(li)水(shui)(shui)平以(yi)匹配需(xu)(xu)求。-**適(shi)(shi)(shi)(shi)用(yong)(yong)癥(zheng)**：適(shi)(shi)(shi)(shi)用(yong)(yong)于(yu)壓(ya)(ya)(ya)(ya)力(li)需(xu)(xu)求波動較(jiao)大的(de)(de)患(huan)(huan)者(zhe)(zhe)（如體(ti)位變化(hua)(hua)導致OSAHS嚴重程度(du)變化(hua)(hua)）。-**特點(dian)**：提(ti)高(gao)(gao)治(zhi)(zhi)(zhi)(zhi)療舒適(shi)(shi)(shi)(shi)度(du)，降低壓(ya)(ya)(ya)(ya)力(li)過(guo)高(gao)(gao)引起的(de)(de)不適(shi)(shi)(shi)(shi)。###4.**便(bian)(bian)攜式(shi)(shi)旅行呼(hu)(hu)吸(xi)(xi)(xi)(xi)(xi)(xi)機(ji)**-**設計**：輕(qing)量(liang)化(hua)(hua)、小型(xing)化(hua)(hua)，內置電(dian)池支持(chi)(chi)移動使用(yong)(yong)。-**適(shi)(shi)(shi)(shi)用(yong)(yong)場(chang)(chang)景**：需(xu)(xu)長期(qi)(qi)通(tong)(tong)氣(qi)(qi)(qi)(qi)(qi)的(de)(de)患(huan)(huan)者(zhe)(zhe)出行或(huo)緊(jin)急轉運。-**功(gong)(gong)能**：通(tong)(tong)常集(ji)成(cheng)基礎C/Bi模(mo)(mo)式(shi)(shi)，兼(jian)顧(gu)續(xu)航與便(bian)(bian)攜性。###5.**高(gao)(gao)流(liu)(liu)(liu)量(liang)氧(yang)(yang)療設備（HFNC）**-**原(yuan)理(li)**：通(tong)(tong)過(guo)高(gao)(gao)流(liu)(liu)(liu)量(liang)加溫濕化(hua)(hua)氧(yang)(yang)氣(qi)(qi)(qi)(qi)(qi)提(ti)供(gong)一定(ding)水(shui)(shui)平的(de)(de)氣(qi)(qi)(qi)(qi)(qi)道(dao)正壓(ya)(ya)(ya)(ya)，兼(jian)具(ju)(ju)氧(yang)(yang)濃(nong)度(du)調節功(gong)(gong)能。-**適(shi)(shi)(shi)(shi)用(yong)(yong)癥(zheng)**：輕(qing)中度(du)呼(hu)(hu)吸(xi)(xi)(xi)(xi)(xi)(xi)衰(shuai)(shuai)竭、拔管(guan)后過(guo)渡支持(chi)(chi)或(huo)拒絕(jue)面罩通(tong)(tong)氣(qi)(qi)(qi)(qi)(qi)的(de)(de)患(huan)(huan)者(zhe)(zhe)。###6.**新生兒(er)/兒(er)童無(wu)(wu)創(chuang)呼(hu)(hu)吸(xi)(xi)(xi)(xi)(xi)(xi)機(ji)**-**特點(dian)**：壓(ya)(ya)(ya)(ya)力(li)范圍、面罩尺寸及算法(fa)針對嬰(ying)幼兒(er)生理(li)特點(dian)優化(hua)(hua)，具(ju)(ju)備更靈敏的(de)(de)觸發(fa)系統和(he)(he)安(an)全保護機(ji)制。###7.**多功(gong)(gong)能無(wu)(wu)創(chuang)呼(hu)(hu)吸(xi)(xi)(xi)(xi)(xi)(xi)機(ji)**-**應用(yong)(yong)場(chang)(chang)景**：醫(yi)院ICU或(huo)急診科，可提(ti)供(gong)通(tong)(tong)氣(qi)(qi)(qi)(qi)(qi)模(mo)(mo)式(shi)(shi)（如AVAPS、iVAPS），集(ji)成(cheng)監(jian)(jian)測(ce)報警(jing)系統，兼(jian)容(rong)有創(chuang)-無(wu)(wu)創(chuang)切換。###總結無(wu)(wu)創(chuang)呼(hu)(hu)吸(xi)(xi)(xi)(xi)(xi)(xi)機(ji)的(de)(de)選擇需(xu)(xu)結合患(huan)(huan)者(zhe)(zhe)疾病類(lei)型(xing)、呼(hu)(hu)吸(xi)(xi)(xi)(xi)(xi)(xi)功(gong)(gong)能狀態及使用(yong)(yong)環境(jing)。C側重維(wei)持(chi)(chi)氣(qi)(qi)(qi)(qi)(qi)道(dao)開(kai)(kai)放，Bi提(ti)供(gong)雙向壓(ya)(ya)(ya)(ya)力(li)支持(chi)(chi)，智(zhi)(zhi)能機(ji)型(xing)提(ti)升個(ge)性化(hua)(hua)治(zhi)(zhi)(zhi)(zhi)療體(ti)驗，而便(bian)(bian)攜式(shi)(shi)和(he)(he)高(gao)(gao)流(liu)(liu)(liu)量(liang)設備則拓(tuo)展(zhan)了臨床應用(yong)(yong)場(chang)(chang)景。隨著技(ji)術進步，遠程監(jian)(jian)測(ce)、云數(shu)據管(guan)理(li)等(deng)功(gong)(gong)能的(de)(de)加入進一步優化(hua)(hua)了長期(qi)(qi)家(jia)庭治(zhi)(zhi)(zhi)(zhi)療的(de)(de)安(an)全性。

選(xuan)(xuan)(xuan)擇(ze)(ze)無創(chuang)呼(hu)吸(xi)(xi)(xi)機(ji)(ji)需(xu)根據患(huan)者(zhe)(zhe)病情(qing)、舒(shu)適(shi)度(du)和功能(neng)需(xu)求(qiu)綜合評估(gu)，以下為關鍵考(kao)量要點：**1.明確(que)適(shi)應(ying)癥(zheng)**首先(xian)需(xu)由醫生確(que)診疾病類型(xing)(xing)(xing)（如慢阻肺、睡眠(mian)(mian)呼(hu)吸(xi)(xi)(xi)暫停、心源性(xing)(xing)(xing)等），不同病癥(zheng)對應(ying)不同機(ji)(ji)型(xing)(xing)(xing)。阻塞(sai)性(xing)(xing)(xing)睡眠(mian)(mian)呼(hu)吸(xi)(xi)(xi)暫停（OSA）多選(xuan)(xuan)(xuan)用(yong)(yong)單水(shui)(shui)平自動(dong)調(diao)(diao)(diao)壓呼(hu)吸(xi)(xi)(xi)機(ji)(ji)（A），而慢阻肺或(huo)呼(hu)吸(xi)(xi)(xi)衰竭需(xu)雙水(shui)(shui)平呼(hu)吸(xi)(xi)(xi)機(ji)(ji)（Bi），危重患(huan)者(zhe)(zhe)可(ke)(ke)能(neng)需(xu)帶備(bei)用(yong)(yong)頻(pin)率(lv)的機(ji)(ji)型(xing)(xing)(xing)。**2.模式(shi)與(yu)參(can)數(shu)(shu)調(diao)(diao)(diao)節**?C模式(shi)：持續(xu)正壓通氣，適(shi)用(yong)(yong)于單純(chun)OSA患(huan)者(zhe)(zhe)?AutoC：自動(dong)調(diao)(diao)(diao)壓，適(shi)合壓力需(xu)求(qiu)波動(dong)者(zhe)(zhe)?BiS/T：雙水(shui)(shui)平壓力+時間備(bei)份頻(pin)率(lv)，家(jia)用(yong)(yong)呼(hu)吸(xi)(xi)(xi)監(jian)測儀維修，保障(zhang)慢阻肺患(huan)者(zhe)(zhe)安全(quan)?AVAPS/Auto-Bi：智能(neng)調(diao)(diao)(diao)節潮氣量，適(shi)合神經肌肉疾病患(huan)者(zhe)(zhe)需(xu)選(xuan)(xuan)(xuan)擇(ze)(ze)壓力范圍(wei)（4-25cmH?O為宜）、氧(yang)濃度(du)可(ke)(ke)調(diao)(diao)(diao)機(ji)(ji)型(xing)(xing)(xing)（搭配(pei)制氧(yang)機(ji)(ji)使(shi)用(yong)(yong)）。**3.舒(shu)適(shi)性(xing)(xing)(xing)設(she)(she)計(ji)**?延遲升(sheng)壓功能(neng)（Ramp）：幫助患(huan)者(zhe)(zhe)逐步適(shi)應(ying)壓力?加溫濕化(hua)器：減(jian)少鼻(bi)(bi)(bi)腔干燥，提升(sheng)依從(cong)性(xing)(xing)(xing)?靜音設(she)(she)計(ji)：低于30分(fen)貝(bei)為佳，避免影響(xiang)睡眠(mian)(mian)?面罩適(shi)配(pei)：鼻(bi)(bi)(bi)罩/口鼻(bi)(bi)(bi)罩可(ke)(ke)選(xuan)(xuan)(xuan)，硅膠材質需(xu)柔(rou)軟防過敏。**4.數(shu)(shu)據管理與(yu)售后**選(xuan)(xuan)(xuan)擇(ze)(ze)具(ju)(ju)備(bei)SD卡存儲或(huo)無線傳輸功能(neng)的機(ji)(ji)型(xing)(xing)(xing)（如瑞(rui)思(si)邁(mai)AirSense10、飛利浦DreamStation），家(jia)用(yong)(yong)呼(hu)吸(xi)(xi)(xi)監(jian)測儀租賃，便于。關注(zhu)保修期（建議3年(nian)以上）及本(ben)地維修網點覆蓋，進口品牌需(xu)確(que)認(ren)授權。**5.特(te)殊需(xu)求(qiu)考(kao)量**?高頻(pin)旅行者(zhe)(zhe)可(ke)(ke)選(xuan)(xuan)(xuan)便攜式(shi)機(ji)(ji)型(xing)(xing)(xing)（如瑞(rui)思(si)邁(mai)AirMini）?合并二(er)氧(yang)化(hua)碳潴留(liu)需(xu)選(xuan)(xuan)(xuan)具(ju)(ju)備(bei)T模式(shi)的雙水(shui)(shui)平機(ji)(ji)型(xing)(xing)(xing)?兒童患(huan)者(zhe)(zhe)需(xu)小兒呼(hu)吸(xi)(xi)(xi)機(ji)(ji)（如費(fei)雪(xue)派克(ke)SleepStyle）。**注(zhu)意事項(xiang)**：呼(hu)吸(xi)(xi)(xi)機(ji)(ji)參(can)數(shu)(shu)必須由呼(hu)吸(xi)(xi)(xi)治療師調(diao)(diao)(diao)試，初始使(shi)用(yong)(yong)需(xu)在醫療機(ji)(ji)構監(jian)測下進行。價格并非標準，5000-15000元區(qu)間機(ji)(ji)型(xing)(xing)(xing)可(ke)(ke)滿足大部(bu)分(fen)需(xu)求(qiu)，但需(xu)警惕二(er)手設(she)(she)備(bei)性(xing)(xing)(xing)能(neng)損耗(hao)風險(xian)。定期清潔管路和濾芯，每2年(nian)進行設(she)(she)備(bei)校(xiao)準。

打(da)(da)鼾呼(hu)(hu)吸(xi)(xi)機（C/Bi設備(bei)(bei)）的常見模(mo)式(shi)(shi)(shi)及功能(neng)(neng)解(jie)析(xi)打(da)(da)鼾呼(hu)(hu)吸(xi)(xi)機主(zhu)要用(yong)(yong)(yong)于治療(liao)阻(zu)(zu)塞(sai)性(xing)(xing)(xing)睡眠呼(hu)(hu)吸(xi)(xi)暫停綜合(he)(he)征（OSA），根據(ju)患者(zhe)(zhe)(zhe)需(xu)求設計(ji)了多(duo)種工(gong)作(zuo)模(mo)式(shi)(shi)(shi)：1.C模(mo)式(shi)(shi)(shi)（持續氣(qi)(qi)(qi)道(dao)正壓(ya)(ya)(ya)(ya)(ya)）基(ji)礎模(mo)式(shi)(shi)(shi)，提供恒(heng)定(ding)(ding)壓(ya)(ya)(ya)(ya)(ya)力(li)(li)(li)維持氣(qi)(qi)(qi)道(dao)開放(fang)。適(shi)(shi)用(yong)(yong)(yong)于壓(ya)(ya)(ya)(ya)(ya)力(li)(li)(li)需(xu)求穩定(ding)(ding)、癥(zheng)狀較(jiao)輕(qing)的患者(zhe)(zhe)(zhe)。優點是(shi)操作(zuo)簡單、價格較(jiao)低，但部分(fen)患者(zhe)(zhe)(zhe)可能(neng)(neng)感到呼(hu)(hu)氣(qi)(qi)(qi)阻(zu)(zu)力(li)(li)(li)較(jiao)大(da)。2.A模(mo)式(shi)(shi)(shi)（自動(dong)調(diao)(diao)壓(ya)(ya)(ya)(ya)(ya)）通(tong)過實(shi)時監測呼(hu)(hu)吸(xi)(xi)氣(qi)(qi)(qi)流自動(dong)調(diao)(diao)節(jie)壓(ya)(ya)(ya)(ya)(ya)力(li)(li)(li)，夜間(jian)壓(ya)(ya)(ya)(ya)(ya)力(li)(li)(li)在(zai)4-20cmH2O范圍內智能(neng)(neng)調(diao)(diao)整。適(shi)(shi)合(he)(he)體位變(bian)化(hua)大(da)、體重波動(dong)或飲(yin)酒等導(dao)致壓(ya)(ya)(ya)(ya)(ya)力(li)(li)(li)需(xu)求變(bian)化(hua)的患者(zhe)(zhe)(zhe)。舒適(shi)(shi)度較(jiao)高，但價格高于普通(tong)C。3.Bi模(mo)式(shi)(shi)(shi)（雙水平正壓(ya)(ya)(ya)(ya)(ya)）提供吸(xi)(xi)氣(qi)(qi)(qi)壓(ya)(ya)(ya)(ya)(ya)（I）和呼(hu)(hu)氣(qi)(qi)(qi)壓(ya)(ya)(ya)(ya)(ya)（E）兩個(ge)(ge)獨立壓(ya)(ya)(ya)(ya)(ya)力(li)(li)(li)，壓(ya)(ya)(ya)(ya)(ya)力(li)(li)(li)差通(tong)常為4-10cmH2O。適(shi)(shi)用(yong)(yong)(yong)于：-需(xu)要較(jiao)高治療(liao)壓(ya)(ya)(ya)(ya)(ya)力(li)(li)(li)（>15cmH2O）者(zhe)(zhe)(zhe)-慢性(xing)(xing)(xing)阻(zu)(zu)塞(sai)性(xing)(xing)(xing)肺疾(ji)病（COPD）合(he)(he)并(bing)OSA患者(zhe)(zhe)(zhe)-出(chu)現(xian)二氧化(hua)碳潴留的復(fu)雜(za)病癥(zheng)4.進階模(mo)式(shi)(shi)(shi)-AutoBi：自動(dong)調(diao)(diao)節(jie)雙壓(ya)(ya)(ya)(ya)(ya)力(li)(li)(li)水平-AVAPS（平均容積(ji)保(bao)證壓(ya)(ya)(ya)(ya)(ya)力(li)(li)(li)支持）：確保(bao)恒(heng)定(ding)(ding)潮氣(qi)(qi)(qi)量-ASV（適(shi)(shi)應性(xing)(xing)(xing)伺(si)服通(tong)氣(qi)(qi)(qi)）：針對性(xing)(xing)(xing)呼(hu)(hu)吸(xi)(xi)暫停-Timed模(mo)式(shi)(shi)(shi)：為呼(hu)(hu)吸(xi)(xi)衰竭(jie)患者(zhe)(zhe)(zhe)提供后備(bei)(bei)呼(hu)(hu)吸(xi)(xi)頻率輔助功能(neng)(neng)：?加溫濕化(hua)：減少鼻腔(qiang)干燥?延遲(chi)升(sheng)壓(ya)(ya)(ya)(ya)(ya)（Ramp）：起始(shi)低壓(ya)(ya)(ya)(ya)(ya)逐步(bu)遞(di)增?漏氣(qi)(qi)(qi)補償：自動(dong)調(diao)(diao)整維持有效(xiao)壓(ya)(ya)(ya)(ya)(ya)力(li)(li)(li)?呼(hu)(hu)吸(xi)(xi)波形監測：SD卡記錄治療(liao)數(shu)據(ju)選(xuan)擇建議：初診患者(zhe)(zhe)(zhe)建議選(xuan)用(yong)(yong)(yong)A模(mo)式(shi)(shi)(shi)進行壓(ya)(ya)(ya)(ya)(ya)力(li)(li)(li)滴定(ding)(ding)，嚴重呼(hu)(hu)吸(xi)(xi)功能(neng)(neng)不全需(xu)Bi，性(xing)(xing)(xing)呼(hu)(hu)吸(xi)(xi)暫停優先考慮ASV設備(bei)(bei)。實(shi)際選(xuan)擇應結合(he)(he)睡眠監測報告、醫生建議及個(ge)(ge)體舒適(shi)(shi)度，新型設備(bei)(bei)多(duo)采用(yong)(yong)(yong)混合(he)(he)模(mo)式(shi)(shi)(shi)（如C+A），兼顧治果和使用(yong)(yong)(yong)體驗。