Ioksijini yenye yezinto ezigcina ubomi
I-Mitochondria yeyona ndawo ibaluleke kakhulu kwi-biological oxidation emzimbeni. Ukuba i-tissue i-hypoxic, inkqubo ye-phosphorylation ye-oxidative ye-mitochondria ayikwazi ukuqhubeka ngokuqhelekileyo. Ngenxa yoko, ukuguqulwa kwe-ADP kwi-ATP kuphazamisekile kwaye amandla anganeleyo anikezelwa ukugcina inkqubela eqhelekileyo yemisebenzi eyahlukeneyo ye-physiological.
Ukubonelela nge-oxygen kwizicubu
Umxholo we-oxygen egazini le-ArterialCaO2=1.39*Hb*SaO2+0.003*PaO2(mmHg)
Umthamo wothutho lweoksijiniDO2=CO*CaO2
Umda wexesha lokuba abantu abaqhelekileyo banyamezele ukubanjwa kokuphefumla
Ngelixa uphefumla umoya:3.5min
Xa uphefumla i-40% i-oxygen: 5.0min
Xa uphefumla 100% ioksijini:11min
Utshintshiselwano lwerhasi yomphunga
Uxinzelelo oluyinxenye yeoksijini emoyeni(PiO2):21.2kpa(159mmHg)
Uxinzelelo oluyinxenye yeoksijini kwiiseli zemiphunga (PaO2):13.0kpa (97.5mmHg)
Uxinzelelo oluyinxenye ye-venous ye-oxygen (PvO2): 5.3kpa (39.75mmHg)
Uxinzelelo lwe-pulse oxygen elinganayo (PaO2):12.7kpa(95.25mmHg)
Iimbangela ze-hypoxemia okanye ukungabikho kwe-oxygen
- I-Alveolar hypoventilation(A)
- Ukungenisa umoya/ukuxuba(VA/Qc)Ukungalingani(a)
- Ukusasazwa okucuthiweyo(Aa)
- Ukonyuka kwegazi ukusuka ekunene ukuya ekhohlo shunt (Qs/Qt Yandiswa)
- I-atmospheric hypoxia(I)
- I-congestive hypoxia
- I-Anemic hypoxia
- I-hypoxia eyityhefu yezicubu
Imida yePhysiology
Kukholelwa ngokubanzi ukuba i-PaO2 yi-4.8KPa(36mmHg) ngumda wokuphila komzimba womntu.
Iingozi ze-hypoxia
- Ubuchopho: Umonakalo ongenakulungiseka uya kwenzeka ukuba ukunikezelwa kwe-oxygen kuyekile imizuzu emi-4-5.
- Intliziyo: Intliziyo itya ioksijini eninzi kunengqondo kwaye yeyona ibuthathaka
- Inkqubo yemithambo-luvo:Inovakalelo, ayinyanyezelwanga kakuhle
- Ukuphefumla: i-edema yemiphunga, i-bronchospasm, i-cor pulmonale
- Isibindi, izintso, nezinye: Acid replacement, hyperkalemia, ukwanda umthamo wegazi
Iimpawu kunye neempawu ze-hypoxia ebukhali
- Inkqubo yokuphefumla: Ubunzima bokuphefumla, i-pulmonary edema
- Intliziyo: ukubetha kwentliziyo, arrhythmia, angina, vasodilation, ukothuka
- Inkqubo yemithambo-luvo ephakathi: Ukonwaba, intloko ebuhlungu, ukudinwa, ukungakwazi ukwenza izigqibo kakuhle, ukuziphatha kakubi, ukonqena, ukungazinzi, ukopha kwiretina, ukuxhuzula, isiqaqa.
- Imithambo-luvo yezihlunu: ubuthathaka, ukungcangcazela, hyperreflexia, ataxia
- I-Metabolism: Ukugcinwa kwamanzi kunye nesodium, i-acidosis
Iqondo le-hypoxemia
Lula:Akukho cyanosis PaO2>6.67KPa(50mmHg); SaO2<90%
Ephakathi:Cyanotic PaO2 4-6.67KPa(30-50mmHg); I-SaO2 60-80%
Kakhulu: Iphawulwe cyanosis PaO2<4KPa(30mmHg); SaO2<60%
PvO2 Uxinzelelo oluyinxenye lwe-venous oxygen
I-PvO2 inokumela i-PO2 ephakathi kwezicubu nganye kwaye isebenze njengesalathisi se-hypoxia yezicubu.
Ixabiso eliqhelekileyo le-PVO2: 39±3.4mmHg.
<35mmHg izicubu ze-hypoxia.
Ukulinganisa i-PVO2, igazi kufuneka lithathwe kumthambo we-pulmonary okanye kwi-atrium yasekunene.
Iimpawu zonyango lwe-oxygen
Termo Isihara isindulule iPaO2=8Kp(60mmHg)
I-PaO2 <8Kp, Phakathi kwe-6.67-7.32Kp (50-55mmHg) Izibonakaliso zonyango lwe-oxygen ixesha elide.
I-PaO2=7.3Kpa(55mmHg) Unyango lwe-oksijeni luyimfuneko
Izikhokelo zoNyango lweOksijini oluqatha
Iimpawu ezamkelekileyo:
- I-Acute hypoxemia(PaO2<60mmHg;SaO<90%)
- Ukubetha kwentliziyo nokuphefumla kuyekile
- Uxinzelelo lwegazi lweSystolic <90mmHg)
- Ukukhutshwa kwentliziyo ephantsi kunye ne-acidosis ye-metabolic (HCO3 <18mmol / L)
- Uxinzelelo lokuphefumla(R>24/min)
- Ityhefu ye-CO
Ukungaphumeleli kokuphefumula kunye nonyango lwe-oxygen
Ukungaphumeleli kokuphefumla: ukuphefumla okungalawulwayo kweoksijini
ARDS:Sebenzisa i-peep, lumka malunga netyhefu ye-oxygen
Ityhefu ye-CO: ioksijini ye-hyperbaric
Ukungaphumeleli kokuphefumla okungapheliyo: unyango lwe-oxygen elawulwayo
Imigaqo emithathu ephambili yonyango lweoksijini elawulwayo:
- Kwinqanaba lokuqala le-oxygen inhalation (iveki yokuqala), i-oxygen inhalation concentration <35%
- Kwinqanaba lokuqala lonyango lwe-oxygen, inhalation eqhubekayo kwiiyure ezingama-24
- Ubude bexesha lonyango: >3-4 iiveki→Ukuphefumlela ioksijini okwethutyana (12-18h/d) * isiqingatha sonyaka
→Unyango lweoksijini yasekhaya
Guqula iipatheni ze-PaO2 kunye ne-PaCO2 ngexesha lonyango lwe-oxygen
Uluhlu lokunyuka kwe-PaCO2 kwi-1 yokuqala kwiintsuku ze-3 zonyango lwe-oxygen lulungelelaniso oluhle olubuthathaka lwe-PaO2 yokutshintsha ixabiso * 0.3-0.7.
I-PaCO2 phantsi kwe-CO2 i-anesthesia ijikeleze i-9.3KPa (70mmHg).
Ukwandisa i-PaO2 ukuya kwi-7.33KPa (55mmHg) kwiiyure ze-2-3 ze-oxygen inhalation.
Phakathi kwexesha (iintsuku ezi-7-21); I-PaCO2 iyancipha ngokukhawuleza, kwaye i-PaO2↑ ibonisa ulungelelwaniso olubi oluluqilima.
Kwixesha elizayo (iintsuku ze-22-28), i-PaO2↑ ayibalulekanga, kwaye i-PaCO2 iyancipha ngakumbi.
Uvavanyo lweeMpembelelo zoNyango lweOxygen
I-PaO2-PaCO2:5.3-8KPa(40-60mmHg)
Isiphumo siyamangalisa: Umahluko>2.67KPa(20mmHg)
Isiphumo esanelisayo sokunyanga: Umahluko yi-2-2.26KPa(15-20mmHg)
Ukusebenza kakubi: Umahluko<2KPa(16mmHg)
Ukubeka iliso kunye nokulawula unyango lwe-oxygen
- Qwalasela igesi yegazi, ingqondo, amandla, i-cyanosis, ukuphefumla, ukubetha kwentliziyo, uxinzelelo lwegazi kunye nokukhohlela.
- Ioksijini kufuneka ifumiswe kwaye ifudumale.
- Qwalasela i-catheters kunye nezithintelo zempumlo phambi kokuba uphefumlele ioksijini.
- Emva kokuphefumla ioksijini ezimbini, izixhobo zokuphefumla ioksijini kufuneka zikhuhlwe kwaye zibulawe iintsholongwane.
- Jonga imitha yokuhamba kweoksijini rhoqo, bulala iintsholongwane kwibhotile yokufuma kwaye utshintshe amanzi yonke imihla. Umgangatho wolwelo umalunga ne-10cm.
- Kungcono ukuba nebhotile ye-humidification kwaye ugcine ubushushu bamanzi kuma-70-80 degrees.
Izinto eziluncedo nezingeloncedo
I-cannula yeempumlo kunye nokuxinana kweempumlo
- Izinto eziluncedo: ilula, iluncedo; ayichaphazeli izigulane, ukukhohlela, ukutya.
- Iingxaki: Ugxininiso alutshintshi, luchatshazelwa lula kukuphefumla; ukucaphuka kwe-mucous membrane.
Imaski
- Iingenelo: Ugxininiso luzinzile kwaye akukho ukuvuselela okuncinci.
- Ukungalungi: Ichaphazela i-expectorration kunye nokutya ukusa kwinqanaba elithile.
Iimpawu zokurhoxiswa kweoksijini
- Ukuziva unolwazi kwaye uziva ngcono
- I-Cyanosis iyanyamalala
- I-PaO2> 8KPa (60mmHg), i-PaO2 ayinciphisi iintsuku ze-3 emva kokuhoxiswa kwe-oxygen
- I-Paco2<6.67kPa (50mmHg)
- Ukuphefumla kulula
- I-HR iyancipha, i-arrhythmia iphucula, kwaye i-BP iba yinto eqhelekileyo. Ngaphambi kokuhoxiswa kweoksijini, i-oxygen inhalation kufuneka iyekwe (iiyure eziyi-12-18 / imini) kwiintsuku ezingama-7-8 ukujonga utshintsho kwiigesi zegazi.
Izibonakaliso zonyango lwe-oxygen ixesha elide
- PaO2< 7.32KPa (55mmHg)/PvO2< 4.66KPa (55mmHg), imeko izinzile, kwaye igesi yegazi, ubunzima, kunye ne-FEV1 ayikatshintshi kakhulu kwiiveki ezintathu.
- Ibronchitis engapheliyo kunye ne-emphysema ene-FEV2 ngaphantsi kwe-1.2 ilitha
- I-Nocturnal hypoxemia okanye i-sleep apnea syndrome
- Abantu abane-hypoxemia eyenziwa ngumthambo okanye iCOPD ekuxolelweni abafuna ukuhamba imigama emifutshane
Unyango lwexesha elide lwe-oksijini lubandakanya ukuphefumlelwa kweoksijini rhoqo kwiinyanga ezintandathu ukuya kwiminyaka emithathu
Imiphumo emibi kunye nokuthintela unyango lwe-oxygen
- Ityhefu yeoksijini: Olona xinzelelo luphezulu lukhuselekile lokuphefumlela ioksijini ngama-40%. Ityhefu ye-oksijeni inokuthi yenzeke emva kokudlula i-50% kwiiyure ze-48. Ukuthintela: Gwema i-high-concentration oxygen inhalation ixesha elide.
- I-Atelectasis: Ukuthintela: Lawula ukugxilwa kwe-oksijini, ukhuthaze ukuguquka ngokuphindaphindiweyo, utshintshe izikhundla zomzimba, kwaye ukhuthaze ukukhupha isikhohlela.
- Iimfihlo zokuphefumla ezomileyo: Uthintelo: Yomeleza i-humidification yerhasi erholeyo kwaye wenze i-aerosol inhalation rhoqo.
- I-posterior lens fibrous tissue hyperplasia: ibonwa kuphela kwiintsana ezisanda kuzalwa, ingakumbi iintsana ezizelwe ngaphambi kwexesha. Ukuthintela: Gcina i-oxygen concentration phantsi kwe-40% kwaye ulawule i-PaO2 kwi-13.3-16.3KPa.
- Ukudakumba kokuphefumla: kubonwa kwizigulane ezine-hypoxemia kunye nokugcinwa kwe-CO2 emva kokuphefumla i-oxygen ephezulu. Uthintelo: I-oksijini eqhubekayo kwi-low flow.
Ukuxiliswa kweoksijini
Ingqikelelo: Isiphumo esiyityhefu kwiiseli zethishu ebangelwa kukuphefumla ioksijini kwi-0.5 yoxinzelelo lwe-atmospheric ibizwa ngokuba yityhefu ye-oxygen.
Ukwenzeka kwetyhefu yeoksijini kuxhomekeke kuxinzelelo oluyinxenye lweoksijini kunoxinzelelo lweoksijini
Uhlobo lwe-Oxygen Ukuxiliswa
Ityhefu yeoksijini yemiphunga
Isizathu: Ukuphefumlela ioksijini malunga ne-atmosfera enye yoxinzelelo kwiiyure ze-8
Ukubonakaliswa kweklinikhi: intlungu ye-retrosternal, ukukhwehlela, i-dyspnea, ukunciphisa amandla abalulekileyo, kunye nokunciphisa i-PaO2. Imiphunga ibonisa izilonda ezivuthayo, kunye ne-infiltration cell cell, congestion, edema kunye ne-atelectasis.
Uthintelo kunye nonyango: lawula ukugxila kunye nexesha lokuphefumla i-oxygen
Ityhefu ye-cerebral oxygen
Isizathu: Ukuphefumlela ioksijini ngaphezu kwe-2-3 ye-atmosphere
Ukubonakaliswa kweklinikhi: ukukhubazeka okubonakalayo kunye nokuva, isicaphucaphu, ukuxhuzula, ukuphelelwa amandla kunye nezinye iimpawu ze-neurological. Kwiimeko ezinzima, i-coma kunye nokufa kungenzeka.
Ixesha lokuposa: Dec-12-2024