Kwiminyaka yakutshanje, abantu abaninzi ngakumbi baye banikela ingqalelo ngakumbi kwindima yonyango lwe-oxygen kukhathalelo lwempilo. Unyango lwe-oksijeni aluyona nje indlela ebalulekileyo yonyango kwiyeza, kodwa kunye nenkqubo yezempilo yekhaya.
Yintoni unyango lweOxygen?
Unyango lwe-oksijini ngumlinganiselo wonyango okhululayo okanye olungisa imeko ye-hypoxic yomzimba ngokunyusa i-oxygen concentration kumoya ophefumlelweyo.
Kutheni ufuna ioksijini?
Isetyenziselwa ikakhulu ukukhulula iimeko ezenzeka ngexesha le-hypoxia, ezifana nesiyezi, ukubetha, ukuqina kwesifuba, ukuxinwa, njl njl. Ikwasetyenziselwa ukunyanga izifo ezinkulu. Kwangaxeshanye, ioksijini inokuphucula ukumelana nomzimba kwaye ikhuthaze imetabolism.
Isiphumo seOxygen
Ukuphefumla ioksijini kunokunceda ukuphucula ioksijini yegazi kwaye kuncede inkqubo yokuphefumla yesigulana ibuyele kwimeko yesiqhelo ngokukhawuleza. Ngokuqhelekileyo ziqhubeka kunyango lwe-oksijini, lunokunciphisa ngokufanelekileyo imeko.Ukongezelela, i-oksijini inokuphucula umsebenzi we-neurological wesigulane, umsebenzi wokuzivikela womzimba kunye ne-metabolism yomzimba.
Contraindications kunye nezibonakaliso ze-oxygen
Akukho zichaso zipheleleyo zokuphefumla ioksijini
Ioksijeni ifanelekile kwi-hypoxemia ebukhali okanye engapheliyo, enje: ukutshisa, usulelo lwemiphunga, iCOPD, ukungaphumeleli kwentliziyo, i-pulmonary embolism, ukothuka ngokwenzakala okukhulu kwemiphunga, i-carbon monoxide okanye i-cyanide poisoning, i-gas embolism kunye nezinye iimeko.
Imigaqo yeoksijini
Imigaqo kagqirha: Ioksijini kufuneka isetyenziswe njengechiza elikhethekileyo kunyango lweoksijini, kwaye umyalelo okanye umyalelo kagqirha wonyango lweoksijini kufuneka ukhutshwe.
Umgaqo we-De-scalation: Kwizigulane ezine-hypoxemia enzima yesizathu esingaziwayo, umgaqo wokunciphisa kufuneka uphunyezwe, kunye nonyango lwe-oksijini ukusuka ekugxininiseni okuphezulu ukuya ekugxininiseni okuphantsi kufuneka kukhethwe ngokwemeko.
Umgaqo ojolise kumgomo: Khetha okujoliswe kuko kunyango lwe-oksijini olufanelekileyo ngokwezifo ezahlukeneyo. Kwizigulane ezisengozini yokugcina i-carbon dioxide, i-oxygen saturation target icetyiswayo yi-88% -93%, kunye nezigulane ezingenayo ingozi yokugcinwa kwe-carbon dioxide, i-oxygen saturation target i-94-98%
Izixhobo zokuphefumla ioksijini ezisetyenziswa ngokuqhelekileyo
- ityhubhu yeoksijini
Eyona nto isetyenziswa ngokuqhelekileyo i-oksijini kwiiklinikhi zeklinikhi, Iqhekeza le-oksijini efakwe kwi-tube ye-oksijeni ihambelana nesantya sokuhamba kwe-oksijini, kodwa ityhubhu ye-oksijini ayikwazi ukucwiliswa ngokupheleleyo, kwaye isigulane asikwazi ukunyamezela izinga lokuhamba elidlula i-5L / min.
- Imaski
- Imaski eqhelekileyo: Inokubonelela ngeqhekeza le-oksijini ephefumlelweyo ye-40-60%, kwaye izinga lokuhamba kwe-oksijini akufanele libe ngaphantsi kwe-5L / min. Ifanelekile kwizigulane ezine-hypoxemia kwaye akukho mngcipheko we-hypercapnia.
- Ukuphefumla ngokuyinxenye kunye neemaski zokugcina ioksijini ezingaphefumliyo: Kwiimaski zokuphefumula ngokuyinxenye ngokutywinwa kakuhle, xa ukuhamba kwe-oksijini kuyi-6-10L / min, iqhekeza levolumu ye-oksijini ephefumlelweyo inokufikelela kwi-35-60%. Umlinganiselo wokuhamba kwe-oksijeni yeemaski ezingaphefumliyo kufuneka zibe ubuncinane ubuncinane be-6L / min. Abafanelekanga abo banomngcipheko wokugcinwa kwe-CO2. yezigulane ezinezifo ezingapheliyo zemiphunga.
- Imaski yeVenturi:Sisixhobo esilungelelaniswayo esine-oksijini ebalekayo ephezulu enokubonelela ngogxininiso lweoksijini ye-24%, 28%, 31%, 35%, 40% kunye 60%. Ifanelekile kwizigulane ze-hypoxic ezine-hypercapnia.
- Isixhobo sonyango lwe-oksijini ephuma ngeempumlo:Izixhobo zonyango lwe-oksijini eziphuma ngeempumlo zibandakanya iinkqubo zempumlo ze-oksijini ye-cannula kunye nemixube yeoksijini yomoya. Isetyenziselwa ikakhulu ekungaphumeleli kokuphefumla okubukhali, unyango olulandelelanayo lwe-oksijini emva kokukhutshwa, i-bronchoscopy kunye neminye imisebenzi ehlaselayo. Kwisicelo seklinikhi, eyona mpembelelo ibonakalayo kwizigulane ezinokukhubazeka kokuphefumula kwe-hypoxic.
Indlela yokusebenza ityhubhu ye-oksijini ngeempumlo
Imiyalelo yokusetyenziswa: Faka iplagi yempumlo kwityhubhu yokuphefumlela ioksijini kwimpumlo, ujike umbhobho ukusuka emva kwendlebe yomguli ukuya ngaphambili entanyeni uze uwubeke endlebeni.
Qaphela: I-oksijeni inikezelwa nge-oxygen inhalation tube kwisantya esiphezulu se-6L / min. Ukunciphisa izinga lokuhamba kwe-oksijini kunokunciphisa ukwenzeka kokoma kweempumlo kunye nokungahambi kakuhle. Ubude betyhubhu ye-oxygen inhalation akufanele ibe yinde kakhulu ukukhusela umngcipheko wokukrwitshwa kunye nokuphefumula.
Izinto eziluncedo kunye nokungalunganga kwe-Cannula ye-Oxygen ye-Nasal
Iinzuzo eziphambili ze-oxygen tube ye-oxygen inhalation kukuba ilula kwaye ilula, kwaye ayichaphazeli i-expectoration kunye nokutya. Ukungalungi kukuba i-oxygen concentration ayitshintshi kwaye ichaphazeleka ngokulula kukuphefumla kwesigulane.
Indlela yokufumana ioksijini ngemaski eqhelekileyo
Iimaski eziqhelekileyo azinazo iingxowa zokugcina umoya. Kukho imingxuma yokukhupha kumacala omabini emaski. Umoya ojikelezileyo unokujikeleza xa uphefumla kwaye igesi inokukhutshwa xa ukhupha.
Qaphela: Imibhobho eqhawukileyo okanye izinga lokuhamba kweoksijini eliphantsi liya kubangela ukuba isigulane sifumane ioksijini eyaneleyo kwaye siphefumle kwakhona ikharbon diokside ephumayo. Ke ngoko, ingqwalasela kufuneka ihlawulwe ekubekweni kweliso ixesha lokwenyani kunye nokusombulula kwangethuba naziphi na iingxaki ezivelayo.
Izinto eziluncedo zeoksijini kunye neemaski eziqhelekileyo
Ukungacaphuki, kwizigulane eziphefumla umlomo
Inokubonelela ngoxinaniso lweoksijini ephefumlelweyo rhoqo
Utshintsho kwindlela yokuphefumla aluyitshintshi i-oxygen ephefumlelweyo
Iyakwazi ukufumisa ioksijini, ibangele ukucaphuka okuncinci kwi-mucosa yeempumlo
Irhasi ephuma phezulu inokukhuthaza ukupheliswa kwekharbon diokside ephumayo kwimaski, kwaye ngokusisiseko akukho ukuphefumla ngokuphindaphindiweyo kwekharbon diokside.
Indlela ye-oxygen ye-Venturi imaski
Imaski yeVenturi isebenzisa umgaqo wokuxuba ijethi ukuxuba umoya ojikeleze neoksijini. Ngokulungelelanisa ubungakanani be-oksijeni okanye umngxuma wokungena emoyeni, igesi edibeneyo ye-Fio2 efunekayo iveliswa. Ngaphantsi kwemaski yeVenturi ineentrainments zemibala eyahlukeneyo, emele iindawo ezahlukeneyo.
QAPHELA: Iimaski ze-Venturi zinemibala enemibala ngumenzi, ngoko ke unonophelo olukhethekileyo lufunekayo ukuseta ngokufanelekileyo izinga lokuhamba kwe-oksijini njengoko kuchaziwe.
Ukuhamba okuphezulu kwe-nasal cannula indlela
Ukubonelela nge-oksijini kwinqanaba lokuhamba elidlula i-40L / min, ukoyisa ukuhamba kwe-oksijini eyaneleyo ebangelwa yi-cannulas ye-nasal eqhelekileyo kunye neemaski ngenxa yokunciphisa izinga lokuhamba. I-oksijini iyafudumala kwaye i-humidified ukuze ithintele ukungahambi kakuhle kwesigulane kunye nokulimala kokuphela konyaka.I-cannula ye-nasal ephumayo ephezulu ivelisa uxinzelelo oluphakathi olulungileyo lokuphelelwa umoya. Ikhulula i-atelectasis kwaye ikhulise amandla okusala okusebenzayo, ukuphucula ukusebenza kakuhle kokuphefumula kunye nokunciphisa imfuno ye-endotracheal intubation kunye ne-mechanical ventilation.
Amanyathelo okusebenza: okokuqala, qhagamshela ityhubhu ye-oksijini kumbhobho we-oksijini yesibhedlele, qhagamshela ityhubhu yomoya kumbhobho womoya wesibhedlele, seta ugxininiso lweoksijini efunekayo kumxube womoya-oksijini, kwaye ulungelelanise isantya sokuhamba kwimitha yokuhamba ukuguqula okuphakamileyo. -ukuhamba kwempumlo I-catheter ixhunywe kwisekethe yokuphefumla ukuqinisekisa ukuhamba komoya okwaneleyo ngokusebenzisa umqobo weempumlo. Vumela irhasi ukuba ifudumale kwaye ifumeze phambi kokuba isigulane singakwazi ukwenza i-cannulating, ubeke iplagi yeempumlo kwimpumlo kwaye ukhusele i-cannula (incam akufuneki itywine ngokupheleleyo impumlo)
Qaphela: Ngaphambi kokusebenzisa i-nasal cannula ephezulu kwisigulane, kufuneka imiselwe ngokwemiyalelo yomenzi okanye phantsi kwesikhokelo sobuchwephesha.
Kutheni usebenzisa i-humidification xa uphefumla ioksijini?
Ioksijini yonyango yioksijini emsulwa. Irhasi yomile kwaye ayinamanzi. I-oksijini eyomileyo iya kucaphukisa i-mucosa yendlela yokuphefumula ephezulu yesigulane, ibangele lula isigulane, kwaye ibangele umonakalo we-mucosal. Ngoko ke, ukwenzela ukuba oku kungenzeki, ibhotile ye-humidification kufuneka isetyenziswe xa unika i-oxygen.
Ngawaphi amanzi ekufuneka afakwe kwibhotile yokufuma?
Ulwelo lwe-humidification kufuneka lube ngamanzi acocekileyo okanye amanzi okutofa, kwaye unokuzaliswa ngamanzi abandayo abilisiwe okanye amanzi adibeneyo.
Zeziphi izigulana ezifuna unyango lwe-oxygen ixesha elide?
Okwangoku, abantu abathatha i-oksijini yexesha elide babandakanya izigulane ezine-hypoxia engapheliyo ebangelwa ukungasebenzi kakuhle kwe-cardiopulmonary, njengezigulane ezine-COPD ephakathi kunye ne-terminal ye-COPD, i-fibrosis ye-interstitial pulmonary fibrosis kunye ne-chronic left ventricular insufficiency. Abantu abadala badla ngokuba ngamaxhoba aphambili ezi zifo.
Ukuhlelwa kokuhamba kweoksijini
Ukuhamba okuphantsi kwe-oxygen inhalation concentration ye-oksijeni 25-29%, 1-2L / min, ifanelekile kwizigulane ezine-hypoxia ezihamba nokugcinwa kwe-carbon dioxide, ezifana nesifo esingapheliyo se-pulmonary obstructive, uhlobo lwe-II yokungaphumeleli kokuphefumla, i-cor pulmonale, i-pulmonary edema, izigulane zasemva kokuhlinzwa, izigulane ezinokuphazamiseka, i-coma okanye isifo sengqondo, njl.
I-midium-flow flow oxygen inhalation concentration 40-60%, 3-4L / min, ifanelekile kwizigulane ezine-hypoxia kwaye akukho kugcinwa kwe-carbon dioxide
I-oksijini ephezulu yokuphefumla ine-oxygen concentration ye-oxygen engaphezu kwe-60% kunye nangaphezulu kwe-5L / min.. Ifanelekile kwizigulane ezine-hypoxia ezinzima kodwa kungekhona ukugcinwa kwe-carbon dioxide. Okufana nokuphefumla okukrakra kunye nokubanjwa kwe-circulatory, isifo senhliziyo sokuzalwa kunye ne-shunt ekunene ukuya kwesobunxele, i-carbon monoxide poisoning, njl.
Kutheni ufuna ioksijini emva kotyando?
I-Anesthesia kunye neentlungu zinokwenza lula ukunqanda ukuphefumla kwizigulane kwaye zikhokelela kwi-hypoxia, ngoko ke isigulane kufuneka sinikwe i-oksijini ukunyusa i-oksijini yegazi le-oksijini inxalenye yegazi kunye ne-saturation, ukukhuthaza ukuphulukiswa kwenxeba lesigulana, kunye nokuthintela umonakalo kwingqondo kunye neeseli ze-myocardial. Ukuphelisa iintlungu zesigulana emva koqhaqho
Kutheni ukhetha ukuphefumla okuphantsi kwe-oxygen ngexesha lonyango lwe-oxygen kwizigulana ezingapheliyo zemiphunga?
Ngenxa yokuba isifo esingapheliyo se-pulmonary pulmonary disorder yi-pulmonary ventilation disorder eqhubekayo ebangelwa kukunciphisa ukuhamba komoya, izigulana zinemigangatho eyahlukeneyo ye-hypoxemia kunye nokugcinwa kwe-carbon dioxide. Ngokomgaqo wonikezelo lweoksijini “ikharbon diokside yesigulana Xa inxenye yoxinzelelo lwekharbon diokside inyuka, ukuphefumlelwa kweoksijini enezinga eliphantsi kufanele kunikelwe; xa uxinezeleko lwekharbon diokside luqhelekile okanye luncitshisiwe, kunokuphefumlelwa ioksijini eninzi.”
Kutheni izigulana ezinokwenzakala kwengqondo zikhetha unyango lwe-oxygen?
Unyango lwe-oksijini lunokunceda ekuphuculeni impembelelo yonyango yezigulana ezinomonzakalo wobuchopho, ukukhuthaza ukubuyiswa kwemisebenzi yemithambo-luvo, ukuphucula i-edema ye-nerve cell kunye nokuphendula ukudumba, ukunciphisa umonakalo kwiiseli zemithambo-luvo ngezinto ezinetyhefu ezingapheliyo ezifana ne-oxygen free radicals, kunye nokukhawulezisa ukubuyiswa kwezinto ezonakeleyo. izicubu zengqondo.
Kutheni ityhefu ye-oxygen?
“Ityhefu” ebangelwa kukuphefumla ioksijini engaphaya kwezidingo eziqhelekileyo zomzimba
Iimpawu zetyhefu ye-oxygen
Ubuthi be-oksijeni bubonakaliswa ngokubanzi kwimpembelelo yayo kwimiphunga, kunye neempawu ezifana ne-pulmonary edema, ukukhwehlela, kunye neentlungu zesifuba; okwesibini, inokuphinda ibonakalise njengokungakhululeki kwamehlo, njengokuphazamiseka kokubona okanye iintlungu zamehlo. Kwiimeko ezinzima, iya kuchaphazela inkqubo ye-nervous kwaye ibangele ukuphazamiseka kwe-neurological. Ukongeza, ukuphefumla ioksijini egqithisileyo kunokuthintela ukuphefumla kwakho, kubangele ukubanjwa kokuphefumla, kwaye kube kubeka ubomi esichengeni.
Unyango lwetyhefu ye-oxygen
Uthintelo lungcono kunonyango. Gwema ixesha elide, unyango oluphezulu lwe-oksijeni. Nje ukuba kwenzeke, qala unciphise i-oxygen concentration. Ingqwalasela ekhethekileyo iyadingeka: into ebaluleke kakhulu kukukhetha ngokuchanekileyo kunye nokulawula ukugxilwa kwe-oksijeni.
Ngaba ukuphefumla rhoqo ioksijini kubangela ukuxhomekeka?
Hayi, ioksijini iyimfuneko ukuze umzimba womntu usebenze ngalo lonke ixesha. Injongo yokuphefumla ioksijini kukuphucula ukuhanjiswa kweoksijini emzimbeni. Ukuba imeko ye-hypoxic iphuculwe, unokuyeka ukuphefumla i-oksijini kwaye akuyi kubakho kuxhomekeka.
Kutheni le nto i-oxygen inhalation ibangela i-atelectasis?
Xa isigulane sikhupha i-oksijeni ephezulu, inani elikhulu le-nitrogen kwi-alveoli litshintshwa. Nje ukuba kukho isithintelo se-bronchial, ioksijini ekwi-alveoli ekuyo iya kufunxwa ngokukhawuleza ligazi lokujikeleza kwemiphunga, okubangela i-atelectasis yokuphefumla. Ibonakaliswa ngokucaphuka, ukuphefumla kunye nokubetha kwentliziyo. Ukukhawulezisa, uxinzelelo lwegazi luyenyuka, kwaye ke unokufumana ubunzima bokuphefumla kunye nekoma.
Amanyathelo othintelo: Thatha umphefumlo onzulu ukukhusela imfihlo ekuvaleni umoya
Ngaba izicubu ze-retrolental fibrous ziya kwanda emva kokuphefumlelwa ioksijini?
Esi siphumo sibonakala kuphela kwiintsana ezisanda kuzalwa, kwaye zixhaphake kakhulu kwiintsana ezizelwe ngaphambi kwexesha. Ikakhulu ngenxa ye-retinal vasoconstriction, i-retinal fibrosis, kwaye ekugqibeleni ikhokelele kubumfama obungenakulungiseka.
Amanyathelo othintelo: Xa iintsana ezisanda kuzalwa zisebenzisa ioksijini, ukuxinana kweoksijini kunye nexesha lokuphefumla ioksijini kufuneka ilawulwe
Yintoni ukudakumba kokuphefumla?
Iqhelekile kwizigulane ezine-type II yokungaphumeleli kokuphefumula. Ekubeni uxinzelelo oluyinxenye lwekharbon diokside sele lukwinqanaba eliphezulu ixesha elide, iziko lokuphefumla liye laphulukana novelwano kwikharbon diokside. Le yimeko apho ukulawulwa kokuphefumla kugcinwa ikakhulu ngokukhuthazwa kwe-peripheral chemoreceptors yi-hypoxia. Ukuba oku kwenzeka Xa izigulane zinikwa i-oksijini ephezulu yokugxila, umphumo ovuselelayo we-hypoxia ekuphefumleni uya kukhululeka, oya kwandisa ukudakumba kweziko lokuphefumula kwaye kubangele ukubanjwa kokuphefumula.
Amanyathelo okuthintela: Nika i-concentration ephantsi, i-oxygen eqhubekayo ephantsi (i-oksijini ehamba nge-oxygen 1-2L / min) kwizigulane ezine-II yokuhluleka kokuphefumula ukugcina ukuphefumla okuqhelekileyo.
Kutheni izigulana ezigula kakhulu kufuneka zithathe ikhefu ngexesha lokuphefumla ioksijini ephezulu?
Kulabo abaneemeko ezinzima kunye ne-hypoxia enzima, i-oksijeni ephezulu inokunikwa kwi-4-6L / min. Le ngqungquthela ye-oksijeni inokufikelela kwi-37-45%, kodwa ixesha akufanele lidlule imizuzu eyi-15-30. Ukuba kuyimfuneko, sebenzisa kwakhona yonke imizuzu eyi-15-30.
Ngenxa yokuba iziko lokuphefumla lolu hlobo lwesigulana alukhathali kangako ekukhuthazeni ukugcinwa kwekhabhoni diokside emzimbeni, ikakhulu luxhomekeke kwioksijini ye-hypoxic ukuvuselela i-chemoreceptors yomzimba we-aortic kunye ne-carotid sinus ukugcina ukuphefumla ngokusebenzisa i-reflexes. Ukuba isigulane sinikwa i-oksijeni ephezulu, i-hypoxic state Xa ikhutshwe, i-reflex stimulation of breathing by the aortic body kunye ne-carotid sinus iyancipha okanye iyanyamalala, enokubangela ukuba i-apnea kwaye ibeka ubomi engozini.
Ixesha lokuposa: Oct-23-2024