机械通气-峰压和平台压

Peak Pressure

Peak pressure applies when there is airflow in the circuit, i.e. during inspiration. What determines the peak pressure is the airway resistance in the lungs. So it follows that if there is a problem with the airways the peak pressure will rise.

峰值压力

当回路中有气流时，即吸气时，适用峰值压力。决定峰值压力的是肺中的气道阻力。因此，如果呼吸道出现问题，峰值压力将上升。

Plateau Pressure

Plateau pressure applies when there is not airflow in the circuit. That is when inspiration is complete. This pressure is determined by the lung compliance. So it follows that if there is a problem with the compliance the plateau pressure will rise.

平台压

当回路中没有气流时，适用平台压力。这就是吸气完成的时候。该压力由肺顺应性决定。因此，如果顺应性存在问题，平台压将升高。

So lets work through this diagram to help our understanding of the difference, and how it can help us interpret the information.

因此，让我们通过这张图来帮助我们理解差异，以及如何帮助我们解释信息。

If we ventilate the lung then the airway pressure will go up and the flow will increase (1).

如果使肺通气，则气道压力会上升，流量会增加（1）。

When we release the breath, the pressure will go down, and the flow will move in the opposite direction as the air moves out (2). The flow then returns to base line (3).

当释放呼吸时，压力将下降，并且当空气排出时，气流将沿相反的方向移动（2）。流量然后返回到基线（3）。

Let us then say that we inflate the lungs but then hold them at inflation for a period of time. The pressure will reach a peak (4), and then as the breath hold comes in there will be an equilibrium pressure (5), (remember the balloon analogy here: it takes high pressure to inflate the balloon, but once inflated, a lot less effort to keep it inflated) until release of the pressure as exhalation takes place (6).

使肺部膨胀，然后将其保持膨胀状态一段时间。压力将达到峰值（4），然后随着屏住呼吸而出现一个平衡压力（5），（请记住此处的气球类比：要给气球充气需要高压，但是一旦充气，就会产生很多压力。使其保持充气状态的力气较小），直到呼气发生时释放压力为止（6）。

You can see on the flow line the period between (5) and (6) where there is no flow as the breath hold takes place.

So, remember, peak pressure (circled) is a reflection of the airways and plateau pressure is a reflection of lung compliance.

您可以在流量线上看到（5）和（6）之间的时间段，因为屏住呼吸时没有流量。因此，请记住，峰值压力（带圆圈）是气道的反映，而平台压力是肺顺应性的反映。

Remembering that important fact, lets look at a couple of examples that we might encounter.

记住这一重要事实，让我们看一些我们可能遇到的例子。

So firstly we can look at a wave form demonstrating a high peak pressure.
If the difference between the peak pressure and the plateau pressure is greater than 5 mm Hg then that is defined as an elevated peak pressure.

因此，首先，可以观察显示高峰值压力的波形。

如果峰值压力和平台压力之间的差值大于5 mmHg，则将其定义为峰值压力升高。

The other extreme would be where there is not a problem with the peak pressure but instead with a high plateau pressure.

另一个极端是峰值压力没有问题，而是平台压较高。

So if the pressure alarm is going off you need to know whether it is a high peak pressure causing the problem or a high plateau pressure.

因此，如果压力报警响起，您需要知道是高峰值压力引起问题还是高平台压力。

Why is that important?

Because a high peak pressure is an airway issue, for example:

Bronchospasm

Retained secretions

Mucous plug

ETT tip occlusion

为什么这么重要？

由于高峰值压力是呼吸道问题，例如：

支气管痉挛

分泌物滞留

粘液栓

气管插管头端堵塞

...and a high plateau pressure is a compliance issue, for example:

Pneumothorax

Pulmonary oedema

ARDS

Pneumonia.

...以及高平台压是顺应性问题，例如：

气胸

肺水肿

急性呼吸综合征

肺炎

So understanding the difference between peak pressure and plateau pressure will help you diagnose what may be wrong with your patients ventilation

因此，了解峰值压力和平台压力之间的差异将有助于您诊断患者通气可能存在的问题