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1、 ResMed,Elise产品特点,卓越性能源于科技, ResMed,患者适用范围,ICU / CCU 呼吸机 压力 & 容量控制呼吸机 有创 & 无创呼吸机 单 & 双呼吸回路系统 成人 & 儿童呼吸机 （适合体重5 kg以上儿童、呼吸回路直径 15 毫米、最低容量控制通气时潮气量 : 50 ml、最大呼吸频率 : 80 次 / 分）, ResMed,简洁直观操作的界面,无需任何按钮-全触摸式操作 图形文字对照-极易操作使用 通气程序预设-快速启动 具备模式、参数、报警、监测各自独立的设定页面。, ResMed,整体化气路结构,坚固的整体、一体化的气路结构 -坚固耐用，故障率低 -紧凑的气路
2、机械死腔最小，反应最快，呼吸同步性更好 -气路系统的顺应性更小，呼吸机的压力/流量/容量输出更精确 -一体化设计融合了当今工业设计、制造和工艺最新技术, ResMed,超强的供气能力,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, ResMed,“人机协调性”触发技术,具备三种触发判断方式：压力、流速、能量转移，先进的吸气触发技术，保证了优异的人机同步性/协调性，降低了病人的吸气做功 吸气触
3、发调节： 动态压力触发技术 动态流量触发技术 “能量转移触发”技术，呼吸机自动跟踪调节吸气触发水平，即使在大量漏气时也能保证吸气同步性 呼气触发调节： 呼气灵敏度手动调节范围10-90%峰流速，保证呼气同步性，减少提前或延后终止呼吸，避免再次触发呼吸机，或减少肺动态过度充气和AutoPEEP产生。 自动呼气触发功能：具备先进的呼气触发敏感度（ETS）自动调节功能, ResMed,自动能量转移触发原理示意图,优点：自动能量转移技术能有效减少患者的呼吸做功20。, ResMed,对患者波形的控制,方波或递增波：具备气道压力上升斜率调节功能，适应不同病人自主呼吸的吸气用力的需求，保证了病人舒适性和同
4、步性 减速波形：, ResMed,全面、完善、实用的呼吸方式和通气模式,通气模式预先设定功能：Elisee呼吸机提供将临床常用的通气模式、通气参数、报警范围、监测等所有参数预先存储，极大的提高了临床对呼吸机快速简便的使用要求 压力控制呼吸模式：辅助/控制通气（A/C）、同步间歇指令通气（SIMV）、压力支持通气（PSV）、持续气道正压通气（CPAP） 容量控制呼吸模式：辅助/控制通气（A/C）、同步间歇指令通气（SIMV）、窒息后备通气。 压力容量双控制呼吸模式：该模式结合了压力控制通气和容量控制通气的优点，设定最低潮气量目标和最高压力水平，呼吸机根据前次呼吸实际潮气量和设定的潮气量目标的差异
5、，自动调节输出压力水平，尽量达到设定的潮气量目标。Elisee 呼吸机还可以在压力支持条件下在同一次呼吸中保证潮气量，称为压力支持容量保证(Ps-Vt)。 无创呼吸方式：全面兼容各种无创通气模式，具备超强的自动漏气补偿能力，您无需更换设备即可实现有创/无创通气的自由切换, ResMed,窒息后备保障功能,窒息后备通气：可精细预先设定在病人窒息触发后，Elisee呼吸机将采用何种通气方式。具备：容量/压力通气模式、容量水平/压力水平、窒息时间、窒息恢复、窒息报警等内容可选。 阻力、顺应性自动补偿： BTPS 校正 : 气体温度和压力校正 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
6、(Vte) If BTPS = NO ATPD (Ambient Temperature Pressure & Dryness), ResMed,肺部复张工具,什么是肺复张策略（What is a recruitment maneuver）? Periodic increase of insufflation pressure beyond the tele-inspiratory pressure released during the conventional ventilation cycles,肺复张的目标（What is the aim of a maneuver recruitme
7、nt） ? To avoid atelectasy : sagging of air cells,那些病人需要适用该项功能（For which patients ）? For neuromuscular patients which air cells could easily collapse Not 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. Therefo
8、re the pressure is not controlled. In order to avoid barautroma, An HP alarm must be adjusted Long opening of air cells, ResMed,Elisee 呼吸报警设定、呼吸监测界面 病人数据监测、存储、回顾、分析,压力波形、流速波形、容量波形，两种向量环等动态波形显示。 20多项实时呼吸力学监测，并可根据需要随意组合。 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。, ResMed,报警设定
9、,报警设定范围广泛 提供当前患者实际通气数值为临床设定提供依据, ResMed,呼吸力学监测 15英寸彩色触摸屏幕 Its as easy as ,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, ResMed,技术维护菜单,技术维护菜单使得日常维护工作更为简单容易 : 调整呼吸机的传感器 调整供气的传感器,不需要拆卸设备 !,同时按压下按钮 和, ResMed,外观、重量、电源,尺寸 : 290 x 250 x 130 毫米 重量 : 4,5 kg, ventilator only with internal battery 0,4 kg, mains s
10、upply pack 1,1 kg, external battery pack 电源 : 可外接直流电源 内置电池 : 不低于4小时 外置电池 :不低于4小时 (选配件),Ventilation performances are preserved during the whole time of discharge, ResMed,扩展升级功能（Optional）,5个通气预设程序（标准2个） 雾化吸入 2分钟纯氧吸入 P0.I 、阻力及顺应性测量 吸气保持、呼气保持、手动通气, ResMed,Elise操作培训, ResMed,产品介绍目录,呼吸的介绍,呼吸回路的连接,启动/关闭呼吸机,
11、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, ResMed,成比例三项主动呼气阀 (双回路),呼吸机描述, ResMed,呼吸机描述, ResMed,呼吸回路连接,连接单/双肢呼吸回路 只需通过卡扣，即可轻松连接/拆卸,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 !, ResMed,呼吸回路连接,2种呼气阀可供选择 : 单回路 呼气阀上集合了外接呼气阀控制端口及近端压力传感管端口,病人呼吸回路(直径 22 mm), ResMed,呼吸回路连接,2种呼气阀可供选择 : 双回路 成比例三项主动呼气阀上集成了多项传感及控制
12、部分，允许连接双肢呼吸回路.,吸气管路 (标准直径 22 mm),呼气管路 (标准直径 22 mm), ResMed,呼吸机的启动,通过按压按右侧 按钮启动设备 随即出现以下欢迎使用界面 :,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, ResMed,呼吸机的关闭,通过按压按右侧 按钮关闭设备 依据当前所处的不同状态, 会出现以下两种界面中的一个 : 确认想要关闭呼吸机,正在通气,未启动通气, ResMed,手动测试,通过做手动测试可以 : 探测当前患者使用的呼吸回路的类型 探测当前呼吸回路的阻力 / 顺应性数值 何时需要做手动测试 ? 新的患者使用前 通气程序改
13、变 呼吸回路改变 在增加 / 减少附件后 (如：湿化器、过滤器 ) 测试前准备 : 连接好通气时所需所有附件 将呼吸机同患者之间断开,如未通过测试, 请通知技术服务机构, ResMed,手动测试,3 个测量阶段 : 传感器便宜校准 (O2, pressure ) 吸气回路阻力校准 呼气回路阻力 (如使用双回路), 顺应性及 O2 传感器校准, ResMed,通气方式选择,5 个预设通气程序 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, ResMed,通气方式选择, ResMed,新模式设定,按压 “New patient”按钮，进入新通气模式设定程序
14、 随即，出现如下患者类型选择界面:,Each element of the configuration is reminded on the screen thanks to an icon, ResMed,新模式设定,一旦，确认了患者通气类型后, 随即会出现通气模式选择确认界面:,压力模式,容量模式,通气模式确认后, 随后出现参数设定界面, ResMed,通气模式 : P(A)CV,P(A)CV = 辅助/控制通气模式（压力控制） The ventilator delivers cycles characterized by a fixed insufflations time and pr
15、essure parameter PCV = cycles are released by the ventilator, insufflation does not depend on patients effort. A frequency should be adjusted. PACV = inspiration can be released by the patient (trigger) The change from PCV to PACV mode depends on inspiratory triggers adjustment,In P(A)CV mode, the u
16、ser can set recruitment cycles More about recruitment :, ResMed,通气模式 : P(A)CV,On P(A)CV mode, the parameters to set are : FiO2 Inspiratory Pressure Positive End Expiratory Pressure (PEEP) Frequency Inspiratory time Flow or Pressure Inspiratory trigger in Invasive ventilation Inspiratory trigger in N
17、IV Inspiratory slope,可设置使用“肺复张”参数 : Recruitment period Recruitment duration Recruitment pressure, ResMed,通气模式 : P(A)CV,临床治疗应用 : As the pressure is controlled, P(A)CV mode is particularly recommended if there is a risk of barautroma or lung infection that could obstruct respiratory tract (inhalation
18、pneumopathy) As the end of inspiratory time is imposed on the patient, the P(A)CV mode could sometimes be uncomfortable because it is not very adapted to the patients needs This mode is recommended at the beginning of weaning to facilitate the adaptation of the patient to the ventilator, ResMed,通气模式
19、 : (A)CV,(A)CV = 辅助/控制通气模式（容量控制） The ventilator delivers cycles characterized by a fixed insufflations time and volume parameter CV = cycles are released by the ventilator, insufflation does not depend on patients effort. A frequency should be adjusted. ACV = inspiration can be released by the patie
20、nt (trigger) The change from CV to ACV mode depends on inspiratory triggers adjustment,In (A)CV mode, the user can set recruitment cycles More about recruitment :, ResMed,通气模式 : (A)CV,On (A)CV mode, the parameters to set are : FiO2 Tidal Volume Positive End Expiratory Pressure (PEEP) Frequency Inspi
21、ratory time or I/E ratio or Maxi flow Flow or Pressure Inspiratory trigger in Invasive ventilation Inspiratory trigger in NIV Flow shape Plateau time,Recruitment parameters may be set up : Recruitment period Recruitment duration Recruitment pressure, ResMed,通气模式 : (A)CV,临床治疗应用 : The CV mode is recom
22、mended when it is better the device totally substitutes itself for the patient ventilation The ACV mode is particularly recommended for patients whose ventilation needs could be changed (volume control). It helps to adapt the patient to the ventilator. The setting of volume and frequency alarms is v
23、ery important in order to avoid hyperventilation risks (exaggerated patients demand), ResMed,通气模式 : PSIMV,PSIMV = 同步间歇指令通气（压力控制） This ventilation mode allows to alternate pressure assisted controlled ventilation and Pressure Support (PS) cycles initiated by the patient,When the PSIMV mode is selecte
24、d, an access to “Pressure Support” adjustment is available from the first screen of parameters adjustment,Suited for weaning and in case of sedation decreasing !, ResMed,通气模式 : PSIMV,On PSIMV mode, the parameters to set are : FiO2 Inspiratory pressure Positive End Expiratory Pressure (PEEP) Frequenc
25、y Inspiratory time Inspiratory slope,The adjustable parameters of Pressure Support are : Pressure Support Inspiratory slope Flow or Pressure Inspiratory trigger in Invasive ventilation Inspiratory trigger in NIV Expiratory trigger Maximum inspiratory time, ResMed,通气模式 : PSIMV,临床治疗应用 : The PSIMV mode
26、 allows a good distribution of work between the device and the patient It is ideal for weaning and in case of sedation decreasing (gradual return of patients ventilation autonomy) It is particularly recommended for treatment of chronic respiratory insufficiencies, ResMed,通气模式 : SIMV,SIMV =同步间歇指令通气（容
27、量控制） This ventilation mode allows to alternate flow assisted controlled ventilation and Pressure Support (PS) cycles initiated by the patient,When the SIMV mode is selected, an access to “Pressure Support” adjustment is available from the first screen of parameters adjustment, ResMed,通气模式 : SIMV,On
28、SIMV mode, the parameters to set are : FiO2 Tidal Volume Positive End Expiratory Pressure (PEEP) Frequency Inspiratory time or I/E ratio or Maxi flow Flow shape Plateau Time,The adjustable parameters of Pressure Support are : Pressure Support Inspiratory slope Flow or Pressure Inspiratory trigger in
29、 Invasive ventilation Inspiratory trigger in NIV Expiratory trigger Maximum inspiratory time, ResMed,通气模式 : SIMV,临床治疗应用 : The SIMV mode allows a good distribution of work between the device and the patient It is ideal for weaning and in case of sedation decreasing (gradual return of patients ventila
30、tion autonomy) It is particularly recommended for treatment of chronic respiratory insufficiencies, ResMed,通气模式 : PS,PS = 压力支持通气（压力控制） This mode is a pressure mode assisting the patients spontaneous breathing,Principle : The beginning and the end of the inspiratory cycle are initiated by the patient
31、. However, Elise 350 is provided with a minimum frequency parameter : if the number of patient initiated breaths is lower than Fmini, the ventilator releases support breaths., ResMed,通气模式 : PS,PS mode also allows to set an apnea time at the end of which the ventilator switches to backup apnea ventil
32、ation if the patient does not initiate a breath Apnea ventilation setting is only available when “Fmini = NO” If the patient initiates a breath afterwards, ventilation switches back to Pressure Support,Apnea ventilation = Exclusive to Elise 350 !, ResMed,通气模式 : PS,On PS mode, the parameters to set a
33、re : FiO2 Pressure Support Positive End Expiratory Pressure (PEEP) Inspiratory slope Leak Alarm threshold Flow or Pressure Inspiratory trigger in Invasive ventilation Inspiratory trigger in NIV Expiratory trigger Maximum inspiratory time, ResMed,通气模式 : PS,The adjustable parameters of Pressure Suppor
34、t in pressure are : Apnea Time Inspiratory Pressure Frequency Inspiratory time,The adjustable parameters of Pressure Support in volume are : Apnea Time Tidal Volume Frequency Inspiratory time or I/E ratio or Maxi flow, ResMed,通气模式 : PS,临床治疗应用 : Because of its functioning, the PS mode allows to help
35、and reduce the work of respiratory muscles Therefore, it is recommended for postoperative ventilation rehabilitation and in physiotherapy It is also recommended for weaning, ResMed,通气模式 : PS.VT,PS-VT = 压力支持潮气量保证双模式通气（Pressure Support with guaranteed tidal volume） This ventilation mode is described a
36、s a dual mode : it requires setting a pressure support and a target tidal volume that must be reached for each cycle,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 supplied Vt a
37、nd the remaining inspiratory time If the calculation foresees that Vt parameter can be reached, then Elise 350 stands in Pressure Support for the rest of the cycle Otherwise, if the calculation concludes that Vt parameter will not be reached in PS, then Elise 350 insufflates the remaining volume whi
38、le maintaining a constant flow until volume parameter is reached, ResMed,通气模式 : PS.VT,PS.VT mode also allows to set an apnea time at the end of which the ventilator switches to apnea ventilation if the patient has not breathed Apnea ventilation setting is only available when Fmini = NO If the patien
39、t initiates a breath afterwards, ventilation switches back to pressure support,Apnea ventilation = Exclusive to Elise 350 !, ResMed,通气模式 : PS.VT,On PS.VT mode, the parameters to set are : Pressure Support Positive End Expiratory Pressure (PEEP) Tidal Volume Leak Alarm threshold Flow or Pressure Insp
40、iratory trigger in Invasive ventilation Inspiratory trigger in NIV Expiratory trigger Maximum inspiratory time, ResMed,通气模式 : PS.VT,The adjustable parameters of Pressure Support in pressure are : Apnea time Inspiratory pressure Frequency Inspiratory time,The adjustable parameters of Pressure Support
41、 in volume are : Apnea time Tidal Volume Frequency Inspiratory time or I/E ratio or Maxi flow, ResMed,通气模式 : PS.VT,临床治疗应用 : PS.VT 模式 : 安全的容量控制模式 舒适的压力控制模式 The PS.VT mode is particularly recommended for patients whose physiological characteristics (resistance ) are likely to change It is recommended
42、for patients who are in weaning test of a respiratory insufficiency, ResMed,通气模式 : CPAP,CPAP = 持续气道正压通气 The patient can breathe spontaneously thanks to a PEEP level The device counters the depression caused by the inspiration with a flow increase. During expiration, a back pressure on the exhalation
43、 valve maintains the expiratory pressure at the pressure level set by the user,在 CPAP 模式, 仅可设置的参数 : 持续压力的水平, ResMed,通气模式 : CPAP,临床治疗 应用: 阻塞性睡眠呼吸暂停（Obstructive Apnea Sleep syndrome） 肺动脉瓣狭窄（Pulmonary oedema）, ResMed,通气参数定义,Pressure Support (cmH2O) : 在患者吸气循环中呼吸机在PEEP压力之上，额外给予的一个压力水平,Maxi flow (l/min) :
44、 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, ResMed,通气参数定义,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)
45、: 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。, ResMed,通气参数定义,Inspiratory Time (s) : 从吸气流速而时间区间Time space between the beginning of inspiratory flow and the beginning of expiratory flow,Maxim
46、um 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） 在无创通气中的触发（Non invasive trigger）, ResMed,通气参数定义,Tidal Volume (ml) : 吸气或呼气时间内患者所吸入或呼出的气体容量,
47、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, ResMed,参数设置,要设置某项参数时, 只需按压下相对应的图标 随即弹出增减调节按钮 和 调整至需要使用的数值后, 按压 按钮进行确认修改,提示但前通气模式,提示但前患者状态, ResMed,扩展特点,进入扩展特点设置界面 :, ResMed,扩展特点,BTPS 校正 : 气体温度和压力校正 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)
48、 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, ResMed,扩展特点,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 !, ResMed,报警管理,Two independent systems to trigger audible alarms 1 voice synthesis Adjustable volu
49、me Controlled by the main microprocessor 1 buzzer controlled by : The main microprocessor The alarm microprocessor An hardware independent system supplied by an extra battery, ResMed,通气报警,需要设置报警参数时，可通过按压 按钮直接进入呼吸机报警设置界面 随即出现如图参数 :,报警参数的调节方式和通气参数调节方式是一样的！, ResMed,FiO2,低压供氧 供气口压力不超过 400 kPa 氧气供给方式 : - An oxygen bottle equipped with a rotameter and pressure reducer - An