Ngaba uyazi malunga nokuphefumla ioksijini?

Isigwebo kunye noHlelo lweHypoxia

Kutheni kukho i-hypoxia?

Ioksijini yeyona nto iphambili egcina ubomi. Xa iithishu zingafumani ioksijini eyaneleyo okanye zinobunzima bokusebenzisa ioksijini, nto leyo ebangela utshintsho olungaqhelekanga kwimisebenzi yemetabolism yomzimba, le meko ibizwa ngokuba yi-hypoxia.

Isiseko sokugweba i-hypoxia

Iqondo le-Hypoxia kunye neempawu

Ukuhlelwa kwe-hypoxia

Uxinzelelo lwe-oksijini ephantsi kwi-gas inhaled, ukungasebenzi kwe-exhalation yangaphandle, i-venous shunt kwi-arteries, njl. Ngokuqhelekileyo kubonakala kwisifo esingapheliyo se-pulmonary disease kunye nesifo senhliziyo esizalwa njenge-tetralogy ye-Fallot.

Ukunciphisa umthamo okanye iipropathi ezitshintshiweyo ze-hemoglobin, ezifana ne-anemia, i-carbon monoxide poisoning, kunye ne-methemoglobinemia.

i-hypoxia yokujikeleza kwegazi

i-hypoxia yombutho

Ibangelwa kukusetyenziswa okungaqhelekanga kweoksijini ziiseli zethishu, ezifana netyhefu yecyanide.

Unyango lwe-oxygen inhalation kunye nenjongo yalo

Phantsi kweemeko eziqhelekileyo, abantu abasempilweni baphefumla umoya ngokwemvelo kwaye basebenzise ioksijini ekuwo ukugcina iimfuno zemetabolism. Xa ukugula okanye iimeko ezithile ezingaqhelekanga zikhokelela kwi-hypoxia emzimbeni, izixhobo ezithile kufuneka zisetyenziswe ukubonelela nge-oksijeni kwisigulane, ukwandisa i-arterial oxygen partial pressure (PaO2) kunye ne-oxygen saturation (SaO2), ukuphucula i-hypoxia, ukukhuthaza imetabolism, kunye nokugcina ubomi. Umsebenzi.

Iinzuzo zokuphefumla ioksijini

• Ukunciphisa i-angina pectoris kwaye uthintele i-myocardial infarction
• Thintela ukufa ngesiquphe kwisifo sentliziyo
• Unyango olulungileyo lwesifuba
• Inyanga ngokufanelekileyo i-emphysema, isifo sentliziyo ye-pulmonary, kunye ne-bronchitis engapheliyo
• I-oxygen inhalation ine-axiliary therapeutic effect kwi-diabetes: uphando lwangoku lubonisa ukuba isifo seswekile sinxulumene nokungabikho komzimba we-oksijini. Izigulana ezinesifo seswekile zinoxinzelelo oluphantsi kakhulu lwe-capillary, kwaye iiseli zezicubu azikwazi ukufumana ioksijini ngokupheleleyo, nto leyo ekhokelela ekuphazamisekeni kokusebenza kweeseli kunye ne-glucose metabolism. Ngoko ke, ukuphunyezwa kwonyango lwe-oxygen kwizigulane zesifo sikashukela kuye kwatsala ingqalelo kuluntu lwezonyango.
• I-oxygen inhalation inokudlala indima yokunakekelwa kwempilo kubantu abanempilo: ukungcola komoya, ukusetyenziswa ngokuqhelekileyo kwe-air conditioning, i-oxygen inhalation rhoqo kunokucoca inkqubo yokuphefumula, ukuphucula umsebenzi wangaphakathi wezitho zangaphakathi, ukuphucula ukukhuseleka okupheleleyo komzimba, kunye nokukhusela izifo ezahlukahlukeneyo.

Ziziphi iindidi zonyango lwe-oxygen?

• Ubonelelo lweoksijini ephezulu (5-8L / min): Isetyenziselwa ukungaphumeleli kokuphefumula okubukhali njengokuphefumla kunye nokubanjwa kwentliziyo, i-acute breathing distress syndrome, i-acute poisoning (efana ne-carbon monoxide poisoning okanye i-gas poisoning) ukudakumba kokuphefumula, njl. i-concentration ephezulu okanye i-oksijeni ecocekileyo kufuneka isetyenziswe nganye yesibini ukuhlangula, kodwa ayifanelekanga ukusetyenziswa kwexesha elide. ukuthintela ityhefu yeoksijini okanye ezinye iingxaki.
• Ukunikezelwa kwe-oksijini yoxinaniso oluphakathi (3-4L / min): Ifanelekile kwizigulane ezine-anemia, ukungabikho kwentliziyo, ukutshatyalaliswa, njl.
• Ukunikezelwa kwe-oksijeni ephantsi (1-2L / min): Ngokuqhelekileyo isetyenziselwa i-bronchitis engapheliyo, i-emphysema, isifo senhliziyo ye-pulmonary, njl., Eyaziwa ngokuba yi-chronic obstructive pulmonary disease. Uxinzelelo lwegazi oluphezulu kakhulu lweoksijini lunokwenza buthathaka uvuselelo lwe-reflex yecarotid sinus kwiziko lokuphefumla, ngaloo ndlela kuncitshiswe umoya wokuphefumla kunye nokugcina icarbon dioxide. kunokwenzeka. Ngoko ke, i-oksijini kufuneka isetyenziswe ngokuqaphela, kwaye i-low-concentration eqhubekayo yokuphefumla i-oxygen isetyenziswa ngokubanzi.

Uxinzelelo lwe-oksijeni kunye nokuhamba kwe-oxygen

I-oxygen concentration: Umlinganiselo weoksijini equlethwe emoyeni. Uxinzelelo lweoksijini kumoya oqhelekileyo we-atmospheric yi-20.93%

• I-oksijini yoxinzelelo oluphantsi <35%
• Ioksijini yoxinaniso oluphakathi 35% -60%
• Uxinzelelo oluphezulu lweoksijini> 60%

Ukuhamba kwe-oksijeni: kubhekisela ekuhambeni kwe-oksijeni ehlengahlengisiweyo kwizigulane, iyunithi L / min.

Ukuguqulwa kwe-oksijeni yoxinaniso lokuhamba kwe-oxygen

• I-cannula yeempumlo, ukuxinana kweempumlo: Uxinzelelo lwe-oxygen (%) = 21 + 4X ukuhamba kwe-oksijini (L / min)
• Ukunikezelwa kwe-oxygen ye-Mask (evulekile kwaye ivaliwe): izinga lokuhamba kufuneka libe likhulu kune-6 L / min
• Ukuphefumula okulula: izinga lokuhamba kwe-oxygen 6 L / min, i-oxygen concentration ye-oxygen iphefumle malunga ne-46% -60%
• I-Ventilator: Ugxininiso lwe-oksijeni = 80X ukuhamba kwe-oxygen (L / min) / umthamo wokungenisa umoya + 20

Ulwahlulo lonyango lwe-oxygen-Ngokutsho kwindlela yokubonelela nge-oxygen

Izinto ekufuneka uziqwalasele xa usebenzisa ioksijini

• Ukusetyenziswa ngokukhuselekileyo kweoksijini: Sebenzisa ngokufanelekileyo "uthintelo olune": ukuthintela inyikima, ukuthintela umlilo, ukuthintela ubushushu, kunye nokuthintela ioyile. Ubuncinci ziimitha ezi-5 ukusuka kwisitovu kunye nemitha e-1 ukusuka kwisifudumezi. Ioksijini ayinakusetyenziswa. Xa isalathisi kwi-gauge yoxinzelelo yi-5kg / cm2, ayikwazi ukusetyenziswa kwakhona.
• Ukuthobela ngokuthe ngqo iinkqubo zokusebenza kweoksijini: Xa usebenzisa ioksijini, kufuneka uyisebenzise kuqala. Xa umisa, khupha i-catheter kuqala uze ucime ioksijini. Xa utshintsha isantya sokuhamba phakathi, kufuneka uhlukanise i-oxygen kunye ne-catheter ye-nasal kuqala, ulungise izinga lokuhamba ngaphambi kokudibanisa.
• Qwalasela umphumo wokusetyenziswa kwe-oksijeni: i-cyanosis iyancitshiswa, izinga lokubetha kwentliziyo licotha kunangaphambili, i-dyspnea iyakhululeka, imeko yengqondo iphuculwe, kunye neendlela ezahlukeneyo zohlalutyo lwegesi yegazi, njl.
• Guqula incannula yeempumlo kunye nesisombululo sokufuma yonke imihla (i-1/3-1/2 izele ngamanzi anedistilled okanye inzala)
• Qinisekisa ukusetyenziswa ngexesha likaxakeka: iisilinda zeoksijini ezingasetyenziswanga okanye ezingenanto kufuneka zixhonywe ngeempawu “ezizeleyo” okanye “ezingenanto” ngokulandelelanayo.

Izilumkiso eziphambili zokuphefumla ioksijini

• Qaphela ngokusondeleyo umphumo we-oxygen therapy: Ukuba iimpawu ezifana ne-dyspnea ziyancipha okanye ziyancipha, kwaye ukubetha kwentliziyo kuqhelekileyo okanye kusondele kwisiqhelo, kubonisa ukuba unyango lwe-oksijini lusebenza kakuhle. Ngaphandle koko, unobangela kufuneka ufunyanwe kwaye ujongwe kwangethuba.
• Ukunikezelwa kwe-oksijeni ephezulu ekugxilwe kuyo akufanele kubonelelwe ixesha elide. Ngokuqhelekileyo kukholelwa ukuba ukuba i-oxygen concentration i> 60% kwaye iqhubeka ngaphezu kweeyure ze-24, i-oxygen poisoning ingenzeka.
• Kwizigulana ezinokwanda kakhulu kwesifo semiphunga esingapheliyo, ukulawulwa (okt ukuxinana okuphantsi okuqhubekayo) ukuphefumlelwa kweoksijini kufuneka kunikwe ngokubanzi.
• Naka ingqalelo ekufudumeni kunye nomswakama: Ukugcina ukushisa kwe-37 ° C kunye nomswakama we-95% ukuya kwi-100% kwindlela yokuphefumula yimeko efunekayo kumsebenzi oqhelekileyo wokucoca we-mucociliary system.
• Thintela ukungcoliseka kunye nokuvaleka kwemibhobho: Izinto kufuneka zitshintshwe kwaye zicocwe kwaye zibulawe iintsholongwane rhoqo ukunqanda ukosuleleka. I-Catheters kunye nezithintelo zeempumlo kufuneka zihlolwe nangaliphi na ixesha ukujonga ukuba zivaliwe ngeemfihlo kwaye zitshintshwe ngexesha ukuqinisekisa unyango olusebenzayo nolukhuselekileyo lwe-oksijini.

Imigangatho yokuthintela kunye nokunyangwa kweengxaki eziqhelekileyo ze-oxygen inhalation

Ingxaki yoku-1: Iimfihlo zokuphefumula ezomileyo

Uthintelo kunye nonyango: Ioksijini ephuma kwisixhobo sokubonelela ngeoksijini yomile. Emva kokuphefumla, inokomisa i-mucosa yokuphefumula kwaye yenza iimfihlo zome kwaye kunzima ukukhupha. Amanzi adityanisiweyo kufuneka afakwe kwibhotile yokufuma, kwaye amanzi ahlambulukileyo kufuneka afakwe kwi-oxygen.

Ingxaki yesi-2: Uxinzelelo lokuphefumla

Uthintelo kunye nonyango: Ngexesha le-hypoxemia, ukuhla kwe-PaO2 kunokuvuselela i-peripheral chemoreceptors, i-reflexively ivuse iziko lokuphefumula, kunye nokwandisa umoya we-lung. Ukuba isigulane sithembele kule excitation ye-reflex ukugcina ukuphefumla ixesha elide (njengezigulane ezinesifo senhliziyo ye-pulmonary kunye nohlobo lwe-II yokungaphumeleli kokuphefumla), ukuphefumla i-oksijeni ephezulu kunokuphelisa le ndlela ye-reflex, inqanda ukuphefumla ngokuzenzekelayo, kwaye kubangele ukuyeka ukuphefumla. . Ngoko ke, kuyimfuneko ukubonelela nge-low-flow flow, i-oxygen ephantsi-concentration elawulwa yi-oxygen kunye nokubeka iliso utshintsho kwi-PaO2 ukugcina i-PaO2 yesigulane kwi-60mmHg.

Ingxaki yesi-3: I-atelectasis efunxayo

Uthintelo kunye nonyango: Emva kokuba isigulane siphefumle i-oksijeni ephezulu, isixa esikhulu se-nitrogen kwi-alveoli sitshintshwa. Emva kokuba i-bronchus ivaliwe, i-oksijini kwi-alveoli inokuthatyathwa ngokukhawuleza ngokujikeleza kwegazi, okubangela ukuba i-alveoli iwele kwaye ibangele i-atelectasis. Ngoko ke, ukuthintela ukuphazamiseka kokuphefumla kubalulekile. Amanyathelo abandakanya ukukhuthaza izigulane ukuba ziphefumle kakhulu kunye nokukhwehlela, ukomeleza ukukhutshwa kwesikhwehlela, ukutshintsha izikhundla zomzimba rhoqo, kunye nokunciphisa i-oxygen concentration (<60%). Izigulana kwii-ventilators zinokuthintelwa ngokongeza uxinzelelo oluqinisekileyo lokuphelelwa umoya (PEEP).

Ingxaki yesi-4: I-Retrolental fibrous tissue hyperplasia

Uthintelo kunye nonyango: Emva kokusebenzisa i-oksijeni ephezulu yoxinaniso, i-oxygen eninzi ye-arterial i-partial pressure (i-PaO2 ifikelela ngaphezu kwe-140mmHg) iyona nto ibangela ingozi yokubangela i-retrolental fibrous tissue hyperplasia kwiintsana ezisanda kuzalwa (ingakumbi iintsana ezingaphambi kwexesha). Ngoko ke, i-oxygen concentration yeentsana ezisanda kuzalwa kufuneka ilawulwe ngokungqongqo ngaphantsi kwe-40%, kwaye ixesha lokuphefumla i-oksijini kufuneka lilawulwe.

Ingxaki yesi-5: Ityhefu yeoksijini

Iimpawu zeklinikhi:

• Iimpawu zetyhefu ye-oksijeni yomphunga: iintlungu zangasemva, ukukhohlela okomileyo kunye ne-dyspnea eqhubekayo, ukunciphisa umthamo obalulekileyo.
• Iimpawu ze-cerebral oxygen poisoning: ukukhubazeka okubonakalayo kunye nokuva, isicaphucaphu, ukuxubha, i-syncope kunye nezinye iimpawu ze-neurological. Kwiimeko ezinzima, i-coma kunye nokufa kungenzeka.
• Ukubonakaliswa kwetyhefu yeoksijini yamehlo: i-retinal atrophy. Ukuba iintsana ezizelwe ngaphambi kwexesha zithatha i-oksijini ixesha elide kwi-incubator, i-retina iya kuba ne-occlusion ye-blood occlusion, i-fibroblast infiltration, kunye ne-retrolental fiber proliferation, enokubangela ukungaboni.