Me kuka sani game da maganin oxygen?

Oxygen yana daya daga cikin abubuwan da ke raya rayuwa

Mitochondria shine wuri mafi mahimmanci don iskar oxygenation na halitta a cikin jiki. Idan nama ya kasance hypoxic, tsarin phosphorylation oxidative na mitochondria ba zai iya ci gaba ba kullum. A sakamakon haka, jujjuyawar ADP zuwa ATP ya lalace kuma ana ba da isasshen makamashi don kiyaye ci gaba na yau da kullun na ayyuka daban-daban na ilimin lissafi.

Nama oxygen wadata

Abun oxygen na jijiya na jiniCaO2=1.39*Hb*SaO2+0.003*PaO2(mmHg)

Ƙarfin jigilar oxygen DO2 = CO * CaO2

Ƙayyadaddun lokaci ga mutane na yau da kullun don jure wa kama numfashi

Yayin shakar iska:3.5min

Lokacin numfashi 40% oxygen: 5.0min

Lokacin numfashi 100% oxygen: 11min

Canjin iskar gas na huhu

Oxygen partial matsa lamba a cikin iska (PiO2):21.2kpa(159mmHg)

Oxygen partial matsa lamba a cikin huhu Kwayoyin (PaO2):13.0kpa(97.5mmHg)

Mixed venous partial pressure of oxygen(PvO2):5.3kpa(39.75mmHg)

Daidaitaccen bugun oxygen matsa lamba (PaO2): 12.7kpa (95.25mmHg)

Abubuwan da ke haifar da hypoxemia ko rashin iskar oxygen

• Alveolar hypoventilation (A)
• Samun iska/perfusion(VA/Qc) Rashin daidaituwa(a)
• Ragewar watsawa (Aa)
• Ƙara yawan jini daga dama zuwa hagu shunt (Qs/Qt ya karu)
• Hypoxia na yanayi (I)
• Cunkoso hypoxia
• Anemia hypoxia
• Nama mai guba hypoxia

Iyakoki na jiki

An yi imani da cewa PaO2 shine 4.8KPa (36mmHg) shine iyakar rayuwa ta jikin ɗan adam.

Hatsarin hypoxia

• Kwakwalwa: Lalacewar da ba za ta iya jurewa ba za ta faru idan an dakatar da samar da iskar oxygen na mintuna 4-5.
• Zuciya: Zuciya tana cin iskar oxygen fiye da kwakwalwa kuma ita ce mafi mahimmanci
• Tsarin juyayi na tsakiya: M, rashin jurewa
• Numfashi: pulmonary edema, bronchospasm, cor pulmonale
• Hanta, koda, wasu: maye gurbin acid, hyperkalemia, ƙara yawan jini

Alamomi da alamomi na m hypoxia

• Tsarin numfashi: wahalar numfashi, edema na huhu
• Na zuciya da jijiyoyin jini: bugun jini, arrhythmia, angina, vasodilation, girgiza
• Tsarin juyayi na tsakiya: Euphoria, ciwon kai, gajiya, gazawar yanke hukunci, hali mara kyau, sluggishness, rashin natsuwa, zubar da jini na retinal, maƙarƙashiya, coma.
• Jijiyoyin tsoka: rauni, rawar jiki, hyperreflexia, ataxia
• Metabolism: Ruwa da riƙewar sodium, acidosis

Babban darajar hypoxemia

M: Babu cyanosis PaO2> 6.67KPa(50mmHg); SaO2 <90%

Matsakaici: Cyanotic PaO2 4-6.67KPa(30-50mmHg); SaO2 60-80%

Mai tsanani: Alamar cyanosis PaO2 <4KPa(30mmHg); SaO2 <60%

PvO2 Mixed venous oxygen part pressure

PvO2 na iya wakiltar matsakaicin PO2 na kowane nama kuma yayi aiki azaman mai nuna alamar hypoxia nama.

Matsakaicin ƙimar PVO2: 39± 3.4mmHg.

<35mmHg nama hypoxia.

Don auna PVO2, dole ne a ɗauki jini daga jijiya na huhu ko atrium na dama.

Alamu don maganin oxygen

Termo Ishihara ya ba da shawarar PaO2=8Kp(60mmHg)

PaO2 <8Kp, Tsakanin 6.67-7.32Kp (50-55mmHg) Alamomi don maganin oxygen na dogon lokaci.

PaO2=7.3Kpa(55mmHg) Oxygen far ya zama dole

Jagororin Magungunan Oxygen M Cute

Alamomi masu karbuwa:

1. M hypoxemia (PaO2 <60mmHg; SaO <90%)
2. Ajiyar zuciya da tsayawa numfashi
3. Hypotension (Systolic hawan jini <90mmHg)
4. Ƙananan fitarwa na zuciya da kuma metabolism acidosis (HCO3 <18mmol/L)
5. Matsalolin numfashi(R>24/min)
6. CO Guba

Rashin numfashi da kuma maganin oxygen

Mummunan gazawar numfashi: shakar iskar oxygen mara kulawa

ARDS: Yi amfani da peep, yi hankali game da gubar oxygen

CO guba: hyperbaric oxygen

Rashin gazawar numfashi na yau da kullun: maganin iskar oxygen mai sarrafawa

Manyan ka'idoji guda uku na maganin iskar oxygen mai sarrafawa:

1. A farkon mataki na iskar oxygen (makon farko), ƙaddamar da iskar oxygen <35%
2. A farkon matakin iskar oxygen, ci gaba da inhalation na sa'o'i 24
3. Tsawon lokacin jiyya:> 3-4 makonni → Rashin iskar oxygen na ɗan lokaci (12-18h / d) * rabin shekara

→Maganin iskar oxygen na gida

Canza alamu na PaO2 da PaCO2 yayin maganin oxygen

Matsakaicin karuwa a cikin PaCO2 a farkon 1 zuwa 3 kwanaki na maganin oxygen shine rashin daidaituwa mai kyau na PaO2 canjin darajar * 0.3-0.7.

PaCO2 karkashin CO2 maganin sa barci yana kusa da 9.3KPa (70mmHg).

Ƙara PaO2 zuwa 7.33KPa (55mmHg) a cikin sa'o'i 2-3 na iskar oxygen.

Tsakanin lokaci (kwanaki 7-21); PaCO2 yana raguwa da sauri, kuma PaO2↑ yana nuna haɓaka mara kyau.

A cikin lokaci na gaba (kwanakin 22-28), PaO2↑ ba shi da mahimmanci, kuma PaCO2 ya kara raguwa.

Ƙimar Lafiyar Oxygen Therapy Effects

PaO2-PaCO2:5.3-8KPa(40-60mmHg)

Tasirin yana da ban mamaki: Bambanci> 2.67KPa (20mmHg)

Gamsasshiyar magani mai gamsarwa: Bambanci shine 2-2.26KPa(15-20mmHg)

Rashin inganci: Bambanci <2KPa(16mmHg)

Kulawa da kulawa da maganin oxygen

• Kula da iskar jini, sani, kuzari, cyanosis, numfashi, bugun zuciya, hawan jini da tari.
• Oxygen dole ne a humidified da warmed.
• Bincika catheters da toshewar hanci kafin shakar iskar oxygen.
• Bayan shakar iskar oxygen guda biyu, yakamata a goge kayan aikin iskar oxygen kuma a shafe su.
• Bincika mita kwararar iskar oxygen akai-akai, lalata kwalbar humidification kuma canza ruwa kowace rana. Matsayin ruwa yana kusan 10 cm.
• Zai fi kyau a sami kwalban humidification kuma kiyaye zafin ruwa a digiri 70-80.

Abũbuwan amfãni da rashin amfani

Cannula na hanci da cunkoson hanci

• Abũbuwan amfãni: mai sauƙi, dace; baya shafar marasa lafiya, tari, cin abinci.
• Rashin hasara: Ƙaddamarwa ba ta dawwama ba, sauƙi yana shafar numfashi; kumburi da mucous membrane.

Abin rufe fuska

• Abũbuwan amfãni: Ƙididdiga yana da ƙayyadaddun ƙayyadaddun ƙayyadaddun kuma akwai ƙananan ƙarfafawa.
• Hasara: Yana rinjayar tsammanin da cin abinci zuwa wani yanki.

Alamu don cire iskar oxygen

1. Jin hankali da jin daɗi
2. Cyanosis bace
3. PaO2> 8KPa (60mmHg), PaO2 baya rage kwanaki 3 bayan cire iskar oxygen
4. Paco2 <6.67kPa (50mmHg)
5. Numfashi ya fi santsi
6. HR yana raguwa, arrhythmia yana inganta, kuma BP ya zama al'ada. Kafin cire iskar oxygen, dole ne a daina shakar iskar oxygen (awanni 12-18 / rana) na kwanaki 7-8 don ganin canje-canjen iskar gas.

Alamu don dogon lokaci oxygen far

1. PaO2<7.32KPa (55mmHg)/PvO2<4.66KPa (55mmHg), yanayin ya tsaya tsayin daka, kuma iskar jini, nauyi, da FEV1 ba su canza da yawa cikin makonni uku ba.
2. Na kullum mashako da emphysema tare da FEV2 kasa da 1.2 lita
3. Hypoxemia na dare ko ciwon barci na barci
4. Mutanen da ke da hypoxemia mai haifar da motsa jiki ko COPD a cikin gafara waɗanda suke so suyi tafiya mai nisa

Maganin iskar oxygen na dogon lokaci ya ƙunshi ci gaba da shakar iskar oxygen na watanni shida zuwa shekaru uku

Sakamakon sakamako da rigakafin iskar oxygen

1. Guba Oxygen: Matsakaicin amintaccen taro na iskar oxygen shine 40%. Guba na iskar oxygen na iya faruwa bayan wuce 50% na sa'o'i 48. Rigakafin: Ka guje wa iskar iskar oxygen mai girma na dogon lokaci.
2. Atelectasis: Rigakafin: Sarrafa iskar oxygen, ƙarfafa jujjuyawa akai-akai, canza matsayi na jiki, da haɓaka haɓakar sputum.
3. Busassun ɓoye na numfashi: Rigakafi: Ƙarfafa humidification na iskar gas ɗin da ake shaka da kuma yin shakar iska akai-akai.
4. Lens na baya fibrous nama hyperplasia: ana gani kawai a cikin jarirai, musamman jariran da ba su kai ba. Rigakafin: Ci gaba da ƙaddamar da iskar oxygen a ƙasa 40% kuma sarrafa PaO2 a 13.3-16.3KPa.
5. Bacin rai na numfashi: ana gani a cikin marasa lafiya tare da hypoxemia da riƙewar CO2 bayan shakar iskar oxygen mai yawa. Rigakafin: Ci gaba da oxygenation a ƙananan kwarara.

Maganin Oxygen

Ra'ayi: Sakamakon mai guba akan ƙwayoyin nama wanda ya haifar da iskar oxygen a matsa lamba na yanayi 0.5 ana kiransa gubar oxygen.

Abin da ya faru na gubar iskar oxygen ya dogara ne akan matsa lamba na sashin oxygen maimakon yawan iskar oxygen

Nau'in Ciwon Oxygen

Guba oxygen na huhu

Dalili: Shakar iskar oxygen a kusan yanayi guda na matsa lamba na awanni 8

Bayyanar cututtuka: ciwon baya, tari, dyspnea, rage ƙarfin mahimmanci, da rage PaO2. Huhu yana nuna raunuka masu kumburi, tare da ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar cuta ce ta ƙumburi , kumburi , edema da atelectasis .

Rigakafin da magani: sarrafa taro da lokacin iskar oxygen

Guba oxygen na cerebral

Dalili: Shakar iskar oxygen sama da yanayi 2-3

Bayyanar cututtuka: nakasar gani da na ji, tashin zuciya, jujjuyawa, suma da sauran alamun jijiya. A lokuta masu tsanani, coma da mutuwa na iya faruwa.