   
  

  


                .             ,        ,        ""   .

 -, , .





 ,  

   





 

























    .  

       


   -             ().

  III  IV                         ,            -.

        ,         ,          ,    (Vt),      (),  ,  ()     () .

      ,    ,   (NO),     .          .

     , ,               ,              ()       .         (-   Clt;     Raw)    .

 ,   ,          (/  Paw/t,  /  Vt/t,  /  Flow/t),    ( /  Vt/Paw,  /   Flow/Vt)    .                        .

            :       ,               ,   ,    . .

     ,            . ,    ,        ,           .    ,              ,   ,        .

      ,    -, ,            .

           1 . ,         20 . . .  .         .







                        ,   ,    ,     .

   (Villagra A. [et al.], 2002; Jardin F. [et al.], 2003; Piantadosi C. A. [et al.], 2004) ,        ,           (),   Volume control (VC)      ˻ (Slutsky A. S., 1994; 2001),    :

1)        35 . .;

2)     6  8/  ;

3)     ,            (


)   30  40  . .;

4)        30  40  70  80 /;

5)     ();

6)                   ;

7)        л,       ;

8) -     -    50%    ;

9)   ()    30%    ;

10) /     /  1,5: 1;

11)            ,   .

       ,      ,        ,     ,        ,    (PC),         (PRVC). ,  VC,   PC     ,    .  ,   ,                   .





          






  ,                   - ().

      .          ,        -   Vt,  6,2  0,8/ (432 )  11,8  0,8/ (429 ).      ,      ,  6/,    (31,0%),       12/ (39,8%),       (The Acute Respiratory Distress Syndrone Network, 2000; Eisner M. D. [et al.], 2001).

        ,      (6/  )           ,     


 ( 60  70  . .)        -,  30  50%   (Lachmann B., 1992).     .    Vt     PetCO


,     (PaO


, PaCO


)  -   (pH, BE).

  D. A. Kregenow [et al.] (2003) ,         Vt = 12/,        Vt = 6/.                 (Laffey J. G. [et al.], 2004).

          ,               -    (Slutsky A. S., 1994; Petty T. L., 1996; Levy M. M., 2004).                    ,            ,    Vt      (F),     (Thompson B. T. [et al.], 2001; Slutsky A. S., 2001; Brower R. [et al.], 2003).

       : 1)    PaO


 > 60  . .  FiO


 < 0,5     (Venus B. [et al.], 1979; Falke K. J., 1980); 2)   P(a-et)C


 (               ) ( . ., 1989; Murray J. F., 1984); 3)  Open Lung (Lachmann B., 1992); 4)   Vt/Paw (Benito S., Lemaire F., 1990; Lewandowski K., 1995); 5)  CMV     (ARDS Network, 2005).

       (549 )    (8,3  3,2 . c.)   (13,2  3,5 . .)           ,            (10  11% ),   (14,5  13,8 . )    (24,9  27,5% ) (Bhatia P., 2004; The National Heart, Lung, and Blood Institute ARDS Clinical Trials Network, 2004; Perren A. [et al.], 2004).

           .       ,          ,    .   ,      (   ),  (  )               .


    

   ,  ,      (/  Paw/t,  /  Vt/t,  /  Flow/t)     ( /  Vt/Paw,  /   Flow/Vt).    ,      Servo Screen-390 (Siemens Elema, Sweden) (.1  10).

      ,  ,       ,       .






. 1.  Paw/t   CMV (VC, SIMV (VC)):

   ; Y    ; Z   ;    ;      ;        ,    (); D    ()  ;    ; F   






. 2.  Paw/t   PCV (PC, PRVC, SIMV(PC)):

   ; Z   ;    ;      ;        ,    (); D    ()  ;    ; F   






. 3.  Flow/t   CMV (VC, SIMV (VC)):

   ; Y    ; Z   ;    ; G     ; H     ; I     ; J     ; K   ,  






. 4.  Flow/t   PCV (PC, PRVC, SIMV (PC)):

   ; Z   ;    ; G     ; H     ; I     ; J     ; K   ,  






. 5.  Vt/t   CMV (VC, SIMV (VC)):

   ; Y    ; Z   ; L   ; M      ; N   ,   ; O      ; P   ,   






. 6.  Vt/t   PCV (PC, PRVC, SIMV (PC)):

   ; Z   ; L   ; M      ; N   ,   ; O      ; P   ,   



     Paw/t  Flow/t,            ,             (  ,    ) (Rasanen J., 1994).              Paw/t    /  ( . . [ .], 2002).

  Vt/Paw    ;          ;         ,  ;           (\);            -  (lt) ( . ., 1997; nb J., 1994; bin .J., 1994; ett . L., 1996; Lu J. ., 1998).

   F1w/Vt      ,            Clt  Raw,                       (Benito S., 1990; Slutsky A. S., 1994; Brochard L., 1998).          Flow/t         ()      ( . . [ . ], 2002).






. 7.  Vt/Paw   CMV (VC, SIMV (VC)):

A   / ; B    ; C   /  ( PIP  Vt); D    






. 8.  Vt/Paw   PCV (PC, PRVC, SIMV (PC)):




   / ; B    ; C   / ; D    






. 1.9.  Flow/Vt  CMV (VC, SIMV (VC)):

   / ;      ;    / ; D     






. 10.  Flow/Vt   PCV (PC, PRVC, SIMV (PC)):    / ;      ;    / ; D     



     ,       Vt       (PIP).        Vt/t  Paw/t,     ,               .

              .     ,          .    ,       ,   ,         .      ,   ,       .

          (Clt, Raw).      ,  -         ,              ,    ,    ,         .

        ,   :


Raw = PIP  Pplat/Flow

,    .11,    Paw/t    ,      :  ,   .     ( . . [ .], 2000; Mancebo J., Benito S., 1993),     ,   PIP  Pplat        , -     ,       ,    PIP  Pz,     Pz







  .


   .

   ,     (https://www.litres.ru/aleksey-grican/graficheskiy-monitoring-respiratornoy-podderzhki/)  .

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