無創呼(hu)吸(xi)機使用(yong)步(bu)驟（簡明版）一、評(ping)(ping)(ping)估與準備1.評(ping)(ping)(ping)估患(huan)者：確認適應(ying)癥（如慢(man)阻肺(fei)急性(xing)(xing)加重(zhong)(zhong)、心源性(xing)(xing)等(deng)），排(pai)除（嚴(yan)重(zhong)(zhong)意識障礙(ai)、無法自(zi)主排(pai)痰等(deng)）。2.設(she)備檢查(cha)：連接呼(hu)吸(xi)機管路、濕化(hua)罐（建議加滅菌水），檢查(cha)管路密閉性(xing)(xing)，確認空氣/氧(yang)氣源正常。二、患(huan)者連接1.體位選(xuan)擇：取半臥位（床(chuang)頭抬高30°-45°）。2.佩戴面罩：-根(gen)據臉型選(xuan)擇鼻罩/口鼻面罩-先試(shi)戴調整(zheng)頭帶松緊（以1-2指(zhi)可插入為宜(yi)）-開機后固定面罩，避免漏氣三(san)、參數(shu)設(she)置（初始）1.模(mo)式選(xuan)擇：S/T模(mo)式（自(zi)主/時(shi)間控(kong)(kong)制）或C模(mo)式2.初始參數(shu)：-I：8-12cmH?O（逐步(bu)上調至(zhi)目(mu)標值）-E：4-6cmH?O-備用(yong)呼(hu)吸(xi)頻(pin)率：12-16次(ci)/分-FiO?：維(wei)持SpO?≥88%-92%-濕化(hua)溫(wen)度：32-37℃四、監測(ce)與調整(zheng)1.持續監測(ce)：血氧(yang)飽和度、呼(hu)吸(xi)頻(pin)率、潮氣量(liang)（目(mu)標6-8ml/kg）2.間隔30分鐘(zhong)評(ping)(ping)(ping)估耐受性(xing)(xing)：-漏氣量(liang)控(kong)(kong)制在30L/min以內-根(gen)據血氣分析調整(zheng)參數(shu)-處(chu)理胃脹氣（壓力≤20cmH?O）五(wu)、停機標準持續使用(yong)4-6小時(shi)后評(ping)(ping)(ping)估：-呼(hu)吸(xi)頻(pin)率＜25次(ci)/分-pH＞7.35-可逐步(bu)縮短每(mei)日使用(yong)時(shi)間六、注(zhu)意事項(xiang)1.使用(yong)需有醫護(hu)人(ren)員全程監護(hu)2.面罩每(mei)4小時(shi)松解檢查(cha)皮膚3.及時(shi)清理冷(leng)凝水防誤吸(xi)（共398字，符合醫療操作(zuo)規范，覆(fu)蓋關鍵(jian)操作(zuo)節點）

無(wu)創(chuang)(chuang)呼(hu)(hu)吸(xi)(xi)(xi)(xi)機(ji)(ji)（Non-InvasiveVentilation，NIV）是一種無(wu)需氣(qi)(qi)(qi)(qi)管(guan)插管(guan)或(huo)切(qie)開，通過(guo)面罩或(huo)鼻罩等接(jie)口提供(gong)呼(hu)(hu)吸(xi)(xi)(xi)(xi)支持的，廣(guang)泛(fan)應(ying)用于(yu)急慢性(xing)(xing)(xing)(xing)呼(hu)(hu)吸(xi)(xi)(xi)(xi)衰(shuai)竭(jie)(jie)患者(zhe)的治療。###工作原理(li)無(wu)創(chuang)(chuang)呼(hu)(hu)吸(xi)(xi)(xi)(xi)機(ji)(ji)通過(guo)正壓(ya)通氣(qi)(qi)(qi)(qi)改(gai)善患者(zhe)通氣(qi)(qi)(qi)(qi)功能(neng)。常(chang)見模式包括：1.**C（持續氣(qi)(qi)(qi)(qi)道正壓(ya)通氣(qi)(qi)(qi)(qi)）**：維(wei)持恒定的氣(qi)(qi)(qi)(qi)道壓(ya)力(li)，防止肺泡塌陷，豐澤區呼(hu)(hu)吸(xi)(xi)(xi)(xi)機(ji)(ji)，適用于(yu)阻塞(sai)性(xing)(xing)(xing)(xing)睡眠呼(hu)(hu)吸(xi)(xi)(xi)(xi)暫停或(huo)心(xin)源性(xing)(xing)(xing)(xing)。2.**Bi（雙水平(ping)氣(qi)(qi)(qi)(qi)道正壓(ya)通氣(qi)(qi)(qi)(qi)）**：設置(zhi)吸(xi)(xi)(xi)(xi)氣(qi)(qi)(qi)(qi)壓(ya)（I）和呼(hu)(hu)氣(qi)(qi)(qi)(qi)壓(ya)（E），幫助患者(zhe)完成(cheng)吸(xi)(xi)(xi)(xi)氣(qi)(qi)(qi)(qi)和呼(hu)(hu)氣(qi)(qi)(qi)(qi)，適用于(yu)COPD急性(xing)(xing)(xing)(xing)加(jia)重(zhong)(zhong)或(huo)神經肌肉疾病。###適應(ying)癥-**急性(xing)(xing)(xing)(xing)呼(hu)(hu)吸(xi)(xi)(xi)(xi)衰(shuai)竭(jie)(jie)**：如COPD急性(xing)(xing)(xing)(xing)加(jia)重(zhong)(zhong)、心(xin)源性(xing)(xing)(xing)(xing)、等。-**慢性(xing)(xing)(xing)(xing)呼(hu)(hu)吸(xi)(xi)(xi)(xi)衰(shuai)竭(jie)(jie)**：如肌萎縮側索硬(ying)化(hua)癥（ALS）、重(zhong)(zhong)度脊柱側彎(wan)等。-**術后支持**：預防或(huo)治療術后呼(hu)(hu)吸(xi)(xi)(xi)(xi)功能(neng)不(bu)全。###優(you)勢(shi)-**創(chuang)(chuang)傷(shang)小**：避(bi)免氣(qi)(qi)(qi)(qi)管(guan)插管(guan)相關（如氣(qi)(qi)(qi)(qi)道損(sun)傷(shang)、呼(hu)(hu)吸(xi)(xi)(xi)(xi)機(ji)(ji)相關性(xing)(xing)(xing)(xing)）。-**保留生理(li)功能(neng)**：患者(zhe)可(ke)自(zi)主吞咽、咳嗽和說話。-**縮短(duan)住院時(shi)間**：尤(you)其對COPD患者(zhe)可(ke)顯(xian)著降低插管(guan)率和率。###-嚴重(zhong)(zhong)意(yi)識障礙或(huo)無(wu)法(fa)配合。-氣(qi)(qi)(qi)(qi)道分泌物過(guo)多(duo)且(qie)無(wu)法(fa)清(qing)除。-血(xue)流(liu)動力(li)學不(bu)穩定（如嚴重(zhong)(zhong)低血(xue)壓(ya)）。-面部創(chuang)(chuang)傷(shang)或(huo)畸形(xing)導致(zhi)無(wu)法(fa)佩戴面罩。###使用注意(yi)事項1.**患者(zhe)選擇**：需評估意(yi)識狀態、咳痰(tan)能(neng)力(li)及配合度。2.**參數調(diao)(diao)節**：初始設置(zhi)需個(ge)體(ti)化(hua)，逐步調(diao)(diao)整(zheng)壓(ya)力(li)水平(ping)，避(bi)免氣(qi)(qi)(qi)(qi)壓(ya)傷(shang)。3.**管(guan)理(li)**：常(chang)見問題包括面罩漏(lou)氣(qi)(qi)(qi)(qi)、皮膚壓(ya)傷(shang)或(huo)腹脹，需及時(shi)調(diao)(diao)整(zheng)設備(bei)或(huo)使用促胃腸(chang)動力(li)藥(yao)。4.**監測指標**：密(mi)切(qie)觀察(cha)血(xue)氧(yang)飽和度、血(xue)氣(qi)(qi)(qi)(qi)分析及患者(zhe)主觀感(gan)受。無(wu)創(chuang)(chuang)呼(hu)(hu)吸(xi)(xi)(xi)(xi)機(ji)(ji)的合理(li)應(ying)用可(ke)顯(xian)著改(gai)善患者(zhe)預后，但需嚴格(ge)把握適應(ying)癥并(bing)規范操作，結合多(duo)學科(ke)團隊協作以(yi)實現。

瑞(rui)思(si)邁(mai)（ResMed）呼(hu)(hu)(hu)(hu)(hu)(hu)(hu)(hu)吸(xi)(xi)(xi)(xi)(xi)(xi)機(ji)(ji)作(zuo)為的睡眠(mian)呼(hu)(hu)(hu)(hu)(hu)(hu)(hu)(hu)吸(xi)(xi)(xi)(xi)(xi)(xi)障礙(ai)治療(liao)設備，提供多(duo)種模(mo)(mo)(mo)(mo)式(shi)以滿足不(bu)同臨床需(xu)求。以下是其主流(liu)機(ji)(ji)型（如(ru)AirSense10/11系列、AirCurve10系列）的治療(liao)模(mo)(mo)(mo)(mo)式(shi)及功(gong)能(neng)(neng)特點(dian)：###一(yi)、單(dan)水平(ping)正壓(ya)(ya)(ya)(ya)(ya)(ya)(ya)通(tong)(tong)氣(qi)(qi)(qi)（C）-**原(yuan)理(li)**：持(chi)續輸(shu)出恒定壓(ya)(ya)(ya)(ya)(ya)(ya)(ya)力(li)(li)(li)(li)(li)，維持(chi)上氣(qi)(qi)(qi)道開放。-**適(shi)用(yong)(yong)(yong)人群**：單(dan)純阻塞性(xing)睡眠(mian)呼(hu)(hu)(hu)(hu)(hu)(hu)(hu)(hu)吸(xi)(xi)(xi)(xi)(xi)(xi)暫(zan)停（OSA）患(huan)(huan)者(zhe)。-**特點(dian)**：基礎模(mo)(mo)(mo)(mo)式(shi)，打(da)鼾呼(hu)(hu)(hu)(hu)(hu)(hu)(hu)(hu)吸(xi)(xi)(xi)(xi)(xi)(xi)機(ji)(ji)維修，操作(zuo)簡單(dan)，噪音低，打(da)鼾呼(hu)(hu)(hu)(hu)(hu)(hu)(hu)(hu)吸(xi)(xi)(xi)(xi)(xi)(xi)機(ji)(ji)出售(shou)，但(dan)壓(ya)(ya)(ya)(ya)(ya)(ya)(ya)力(li)(li)(li)(li)(li)固定可(ke)能(neng)(neng)影響舒適(shi)度(du)。###二、自(zi)動調(diao)壓(ya)(ya)(ya)(ya)(ya)(ya)(ya)模(mo)(mo)(mo)(mo)式(shi)（AutoSet?）-**原(yuan)理(li)**：通(tong)(tong)過實(shi)時(shi)(shi)監測氣(qi)(qi)(qi)流(liu)動態調(diao)整(zheng)壓(ya)(ya)(ya)(ya)(ya)(ya)(ya)力(li)(li)(li)(li)(li)（4-20cmH2O），僅在(zai)呼(hu)(hu)(hu)(hu)(hu)(hu)(hu)(hu)吸(xi)(xi)(xi)(xi)(xi)(xi)事件發生時(shi)(shi)提升壓(ya)(ya)(ya)(ya)(ya)(ya)(ya)力(li)(li)(li)(li)(li)。-**適(shi)用(yong)(yong)(yong)人群**：中輕度(du)OSA患(huan)(huan)者(zhe)及體位/睡眠(mian)階段相關呼(hu)(hu)(hu)(hu)(hu)(hu)(hu)(hu)吸(xi)(xi)(xi)(xi)(xi)(xi)波動者(zhe)。-**進階版**：AutoSetforHer?針對女性(xing)呼(hu)(hu)(hu)(hu)(hu)(hu)(hu)(hu)吸(xi)(xi)(xi)(xi)(xi)(xi)特征(zheng)優化(hua)算(suan)(suan)法(fa)，識別更(geng)細(xi)微的氣(qi)(qi)(qi)流(liu)受限。###三、雙水平(ping)模(mo)(mo)(mo)(mo)式(shi)（BiLevel）1.**S模(mo)(mo)(mo)(mo)式(shi)（Spontaneous）**-獨立(li)設置吸(xi)(xi)(xi)(xi)(xi)(xi)氣(qi)(qi)(qi)壓(ya)(ya)(ya)(ya)(ya)(ya)(ya)（I）和呼(hu)(hu)(hu)(hu)(hu)(hu)(hu)(hu)氣(qi)(qi)(qi)壓(ya)(ya)(ya)(ya)(ya)(ya)(ya)（E），壓(ya)(ya)(ya)(ya)(ya)(ya)(ya)力(li)(li)(li)(li)(li)差恒定。-適(shi)用(yong)(yong)(yong)：需(xu)高(gao)壓(ya)(ya)(ya)(ya)(ya)(ya)(ya)力(li)(li)(li)(li)(li)支持(chi)但(dan)自(zi)主呼(hu)(hu)(hu)(hu)(hu)(hu)(hu)(hu)吸(xi)(xi)(xi)(xi)(xi)(xi)穩(wen)定的患(huan)(huan)者(zhe)，如(ru)COPD合并(bing)(bing)OSA。2.**ST模(mo)(mo)(mo)(mo)式(shi)（Spontaneous/Timed）**-在(zai)S模(mo)(mo)(mo)(mo)式(shi)基礎上增加備用(yong)(yong)(yong)呼(hu)(hu)(hu)(hu)(hu)(hu)(hu)(hu)吸(xi)(xi)(xi)(xi)(xi)(xi)頻率，當患(huan)(huan)者(zhe)呼(hu)(hu)(hu)(hu)(hu)(hu)(hu)(hu)吸(xi)(xi)(xi)(xi)(xi)(xi)間隔(ge)超過設定值，自(zi)動觸發吸(xi)(xi)(xi)(xi)(xi)(xi)氣(qi)(qi)(qi)。-適(shi)用(yong)(yong)(yong)：呼(hu)(hu)(hu)(hu)(hu)(hu)(hu)(hu)吸(xi)(xi)(xi)(xi)(xi)(xi)驅動不(bu)足患(huan)(huan)者(zhe)，如(ru)肥胖低通(tong)(tong)氣(qi)(qi)(qi)綜合征(zheng)（OHS）。3.**VAuto模(mo)(mo)(mo)(mo)式(shi)**-自(zi)動調(diao)節I與(yu)E，維持(chi)預設壓(ya)(ya)(ya)(ya)(ya)(ya)(ya)力(li)(li)(li)(li)(li)差（PS，通(tong)(tong)常3-5cmH2O），并(bing)(bing)可(ke)根據需(xu)求臨時(shi)(shi)增壓(ya)(ya)(ya)(ya)(ya)(ya)(ya)。-適(shi)用(yong)(yong)(yong)：復(fu)雜(za)OSA或(huo)需(xu)要更(geng)高(gao)壓(ya)(ya)(ya)(ya)(ya)(ya)(ya)力(li)(li)(li)(li)(li)支持(chi)者(zhe)。###四、通(tong)(tong)氣(qi)(qi)(qi)模(mo)(mo)(mo)(mo)式(shi)-**iVAPS?（智能(neng)(neng)容積保(bao)證(zheng)壓(ya)(ya)(ya)(ya)(ya)(ya)(ya)力(li)(li)(li)(li)(li)支持(chi)）**通(tong)(tong)過測算(suan)(suan)患(huan)(huan)者(zhe)目標潮(chao)氣(qi)(qi)(qi)量，睡眠(mian)呼(hu)(hu)(hu)(hu)(hu)(hu)(hu)(hu)吸(xi)(xi)(xi)(xi)(xi)(xi)機(ji)(ji)出售(shou)，動態調(diao)節壓(ya)(ya)(ya)(ya)(ya)(ya)(ya)力(li)(li)(li)(li)(li)，適(shi)用(yong)(yong)(yong)于神經肌(ji)肉疾病等通(tong)(tong)氣(qi)(qi)(qi)功(gong)能(neng)(neng)不(bu)全(quan)(quan)患(huan)(huan)者(zhe)。-**ASV（適(shi)應(ying)性(xing)伺(si)服通(tong)(tong)氣(qi)(qi)(qi)）**針對性(xing)睡眠(mian)呼(hu)(hu)(hu)(hu)(hu)(hu)(hu)(hu)吸(xi)(xi)(xi)(xi)(xi)(xi)暫(zan)停（CSA）或(huo)混合性(xing)呼(hu)(hu)(hu)(hu)(hu)(hu)(hu)(hu)吸(xi)(xi)(xi)(xi)(xi)(xi)暫(zan)停，通(tong)(tong)過算(suan)(suan)法(fa)穩(wen)定呼(hu)(hu)(hu)(hu)(hu)(hu)(hu)(hu)吸(xi)(xi)(xi)(xi)(xi)(xi)節律。###五、舒適(shi)-**EPR?（呼(hu)(hu)(hu)(hu)(hu)(hu)(hu)(hu)氣(qi)(qi)(qi)壓(ya)(ya)(ya)(ya)(ya)(ya)(ya)力(li)(li)(li)(li)(li)釋放）**：呼(hu)(hu)(hu)(hu)(hu)(hu)(hu)(hu)氣(qi)(qi)(qi)時(shi)(shi)瞬時(shi)(shi)降(jiang)低壓(ya)(ya)(ya)(ya)(ya)(ya)(ya)力(li)(li)(li)(li)(li)（1-3檔），減少呼(hu)(hu)(hu)(hu)(hu)(hu)(hu)(hu)氣(qi)(qi)(qi)阻力(li)(li)(li)(li)(li)。-**ClimateControl**：智能(neng)(neng)加溫加濕，減少鼻腔干(gan)燥(zao)不(bu)適(shi)。###臨床選擇建議-**輕度(du)OSA**：AutoSet系列，兼顧與(yu)舒適(shi)。-**高(gao)碳(tan)酸血癥/呼(hu)(hu)(hu)(hu)(hu)(hu)(hu)(hu)吸(xi)(xi)(xi)(xi)(xi)(xi)衰竭**：需(xu)BiLevelST或(huo)iVAPS模(mo)(mo)(mo)(mo)式(shi)。-**性(xing)呼(hu)(hu)(hu)(hu)(hu)(hu)(hu)(hu)吸(xi)(xi)(xi)(xi)(xi)(xi)障礙(ai)**：ASV模(mo)(mo)(mo)(mo)式(shi)為金標準。瑞(rui)思(si)邁(mai)通(tong)(tong)過算(suan)(suan)法(fa)與(yu)個性(xing)化(hua)設置，覆蓋從單(dan)純OSA到復(fu)雜(za)呼(hu)(hu)(hu)(hu)(hu)(hu)(hu)(hu)吸(xi)(xi)(xi)(xi)(xi)(xi)功(gong)能(neng)(neng)不(bu)全(quan)(quan)的全(quan)(quan)場景治療(liao)需(xu)求，臨床需(xu)結合多(duo)導(dao)睡眠(mian)監測（PSG）結果選擇適(shi)配模(mo)(mo)(mo)(mo)式(shi)。