Iwe unoziva nezve oxygen inhalation?

Kutonga uye Kurongeka kweHypoxia

Sei pane hypoxia?

Okisijeni ndicho chinhu chikuru chinotsigira hupenyu. Kana matishu akasawana okisijeni yakakwana kana kuomerwa nekushandisa oxygen, zvichikonzera shanduko isina kujairika mumashandiro emuviri wemetabolism, iyi mamiriro anonzi hypoxia.

Nheyo yekutonga hypoxia

Hypoxia dhigirii uye zviratidzo

Kusarudzwa kwe hypoxia

Kuderera kweokisijeni mumhepo inoputika, kusashanda kwekunze kwekunze, venous shunt mutsinga, etc. Inowanzoonekwa muchirwere chisingaperi chechirwere chemapapu uye chirwere chemoyo chekuzvarwa se tetralogy ye Fallot.

Yakaderedzwa huwandu kana kuchinjika zvinhu zve hemoglobin, senge anemia, carbon monoxide poisoning, uye methemoglobinemia.

circulatory hypoxia

organisation hypoxia

Inokonzerwa nekushandiswa kusiri kujairika kweokisijeni nemasero ematishu, akadai sechepfu yecyanide.

Oxygen inhalation therapy uye chinangwa chayo

Mumamiriro ezvinhu akajairwa, vanhu vane hutano vanofema mweya zvakasununguka uye vanoshandisa oxygen iri mairi kuchengetedza zvinodiwa zvemetabolism. Kana kurwara kana mamwe mamiriro asina kujairika achitungamira ku hypoxia mumuviri, zvimwe midziyo inofanira kushandiswa kupa okisijeni kumurwere, kuwedzera arterial oxygen partial pressure (PaO2) uye oxygen saturation (SaO2), kunatsiridza hypoxia, kukurudzira metabolism, uye kuchengetedza hupenyu. Chiitiko.

Benefits of oxygen inhalation

• Bvisa angina pectoris uye kudzivirira myocardial infarction
• Dzivirira kufa kamwe kamwe kubva kuhosha yemwoyo
• Kurapa kwakanaka kweasthma
• Zvinobudirira kurapa emphysema, chirwere chemwoyo chemapapu, uye chisingaperi bronchitis
• Kufemerwa neokisijeni kune rubatsiro rwekurapa chirwere cheshuga: tsvakiridzo yazvino inoratidza kuti chirwere cheshuga chine chekuita nekushaikwa kweokisijeni mumuviri. Varwere vane chirwere cheshuga vane yakaderera zvakanyanya capillary pressure, uye masero ematishu haakwanise kuwana okisijeni zvizere, zvichikonzera kukanganisa kwesero basa uye glucose metabolism. Naizvozvo, kuitwa kweokisijeni kurapwa kwevarwere vane chirwere cheshuga kwakakwezva kutarisisa kwenharaunda yekurapa.
• Oxygen inhalation inogona kuita basa rehutano muvanhu vane hutano: kusvibiswa kwemhepo, kushandiswa kwemhepo, kushandiswa kwemhepo nguva dzose kunogona kuchenesa hurongwa hwekufema, kuvandudza kushanda kwenhengo yemukati, kuwedzera kudzivirirwa kwemuviri, uye kudzivirira zvirwere zvakasiyana-siyana.

Ndezvipi zvikamu zveokisijeni therapy?

• High concentration yeokisijeni inopihwa (5-8L/min):Inoshandiswa kutadza kufema zvakanyanya sekufema uye kusungwa kwemoyo, acute breathing distress syndrome, acute poisoning (senge carbon monoxide poisoning kana gas poisoning) kufema kushushikana, zvichingodaro. kukwirisa kwakanyanya kana okisijeni yakachena inofanira kushandiswa sekondi yega yega yekununura, asi haina kukodzera kushandiswa kwenguva refu. kudzivirira oxygen chepfu kana zvimwe zvinetso.
• Medium concentration oxygen supply (3-4L/min):Ikodzere kuvarwere vane anemia, cardiac insufficiency, shock, etc. vasina zvirambidzo zvakasimba pakusangana kweokisijeni inofemerwa.
• Low concentration yeokisijeni inopa (1-2L/min):Inowanzo shandiswa kusingaperi bronchitis, emphysema, pulmonary heart disease, zvichingodaro, inozivikanwawo sechisingaperi chinotadzisa pulmonary chirwere. Kuwedzera kweokisijeni yeropa chikamu chekumanikidza kunogona kunetesa kurudziro yecarotid sinus kunzvimbo yekufema, nekudaro kuderedza kufefetera uye kuwedzera kuchengetwa kwekabhoni dhaikisaidhi. zvinogoneka. Naizvozvo, okisijeni inofanira kushandiswa nekuchenjerera, uye yakaderera-yakadzika-inoenderera mberi inhalation yeokisijeni inowanzoshandiswa.

Oxygen concentration uye oxygen inoyerera

Oxygen concentration: Chikamu cheokisijeni chiri mumhepo. Iyo oxygen yekusangana mumhepo yakajairika yemuchadenga ndeye 20.93%

• Okisijeni yakaderera <35%
• Pakati pepakati peokisijeni 35% -60%
• High concentration yeokisijeni> 60%

Okisijeni inoyerera: inoreva kuchinjwa kweokisijeni kuyerera kwevarwere, unit L / min.

Oxygen concentration yeokisijeni inoyerera

• Nasal cannula, nasal congestion: Oxygen concentration (%) = 21 + 4X oxygen flow (L/min)
• Mask okisijeni inopa (yakavhurika uye yakavharwa): chiyero chekuyerera chinofanira kunge chakakura kupfuura 6 L / min
• Kufema kuri nyore: mwero wekuyerera kweokisijeni 6 L/min, inhaled oxygen concentration inenge 46% -60%
• Ventilator: Oxygen concentration = 80X kuyerera kweokisijeni (L/min) / vhoriyamu yemhepo + 20

Kurongeka kweokisijeni kurapwa-Maererano neokisijeni nzira yekupa

Zvinhu zvekuona kana uchishandisa oxygen

• Kushandiswa kweokisijeni kwakachengeteka: Shandisa zvinobudirira "zvina kudzivirira": kudzivirira kudengenyeka kwenyika, kudzivirira moto, kudzivirira kupisa, uye kudzivirira mafuta. Inenge mamita mashanu kubva pachitofu uye 1 mita kubva kune hita. Iyo oxygen haigone kushandiswa. Kana iyo pointer pane yekumanikidza geji iri 5kg / cm2, haigone kushandiswa zvakare.
• Nyatsotevedzera maitiro ekushanda kweokisijeni: Paunenge uchishandisa oxygen, unofanirwa kuishandisa kutanga. Kana wamira, buritsa catheter kutanga wozodzima oxygen. Paunenge uchishandura kuyerera kwepakati, iwe unofanirwa kuparadzanisa okisijeni uye catheter yemhino kutanga, gadzirisa chiyero chekuyerera usati wabatanidza.
• Cherekedza mhedzisiro yekushandiswa kweokisijeni: cyanosis inoderedzwa, kurova kwemoyo kunonoka kupfuura kare, dyspnea inorerutswa, mamiriro epfungwa anovandudzwa, uye maitiro muzviratidzo zvakasiyana-siyana zvekuongorora gasi reropa, nezvimwe.
• Shandura nasal cannula uye humidification mhinduro zuva rega rega (1/3-1/2 izere nemvura yakadirwa kana sterilized)
• Iva nechokwadi chekushandiswa kwechimbichimbi: masilinda eokisijeni asina kushandiswa kana asina chinhu anofanirwa kusungirirwa nezviratidzo "zvizere" kana "zvisina chinhu" zvichiteerana.

Chengetedzo huru yekufemerwa neokisijeni

• Nyatsocherechedza kushanda kweokisijeni therapy: Kana zviratidzo zvakadai sedyspnea zvakaderedzwa kana kusunungurwa, uye kurova kwemwoyo kwakajairika kana kuti pedyo nemaitiro, zvinoratidza kuti kurapa kweokisijeni kunoshanda. Kana zvisina kudaro, chikonzero chinofanira kuwanikwa uye kugadziriswa nenguva.
• High-concentration oxygen supply haifaniri kupiwa kwenguva yakareba. Zvinowanzotendwa kuti kana iyo oxygen concentration iri> 60% uye ichienderera kweanopfuura maawa makumi maviri nemana, oxygen poisoning inogona kuitika.
• Kune varwere vane acute exacerbation ye chronic obstructive pulmonary disease, inodzorwa (kureva yakaderera-concentration inoenderera) inhalation yeokisijeni inowanzopiwa.
• Chengetedza kupisa nekunyorovesa: Kuchengeta tembiricha ye37 ° C uye humidity ye95% kusvika 100% mukufema turakiti chinhu chinodiwa kune yakajairika kuchenesa basa remucociliary system.
• Dzivirira kusvibiswa uye kuvharika kwenzira: Zvinhu zvinofanirwa kuchinjwa uye kucheneswa uye kuiswa disinfected nguva nenguva kudzivirira kutapukira. Macatheter uye zvivharo zvemhino zvinofanirwa kuongororwa chero nguva kuti zvione kana zvakavharwa ne secretions uye zvinotsiviwa nenguva kuti ive nechokwadi chekushanda uye yakachengeteka oxygen therapy.

Miyero yekudzivirira uye kurapwa kwezvakajairwa matambudziko ekufema okisijeni

Dambudziko 1: Dry breathing secretions

Kudzivirira uye kurapwa: Okisijeni inobuda mumudziyo weokisijeni yaoma. Mushure mekufema, inogona kuomesa mucosa yekufema uye kuita kuti zvivharo zviome uye zvakaoma kubudisa. Mvura yakasvibiswa inofanira kuwedzerwa kubhodhoro rekunyorovesa, uye mvura yakasvibiswa inofanira kuwedzerwa kunyorovesa okisijeni.

Dambudziko 2: Kuora mwoyo kwekufema

Kudzivirira uye kurapwa: Munguva ye hypoxemia, kuderera kwePaO2 kunogona kukurudzira peripheral chemoreceptors, reflexively kufadza nzvimbo yekufema, uye kuwedzera kufema kwemapapu. Kana murwere achivimba neizvi reflex excitation kuti arambe achifema kwenguva yakareba (zvakadai sevarwere vane pulmonary heart disease uye type II kufema kukundikana), kufema kuwedzera kweokisijeni kunogona kubvisa iyi reflex mechanism, kudzivisa kufema kwega, uye kunyange kukonzera Kufema kunomira. . Nokudaro, zvakakosha kupa kuderera-kuyerera, kuderera-kugadziriswa kweokisijeni uye kutarisa kuchinja muPaO2 kuchengetedza murwere wePaO2 pa60mmHg.

Dambudziko rechitatu: Absorptive atelectasis

Kudzivirira uye kurapwa: Mushure mekunge murwere afuridzira huwandu hweokisijeni, huwandu hwakawanda hwenitrogen mualveoli hunotsiviwa. Kana imwe nguva bronchus yakavharwa, okisijeni iri mualveoli inogona kukurumidza kutorwa nekutenderera kweropa kuyerera, zvichiita kuti alveoli iparare uye inokonzera atelectasis. Naizvozvo, kudzivirira kuvharika kwekufema kunokosha. Matanho anosanganisira kukurudzira varwere kutora kufema kwakadzika uye kukosora, kusimbisa kubuda kwesputum, kushandura nzvimbo dzemuviri nguva zhinji, uye kuderedza oxygen concentration (<60%). Varwere vari pamavheiri vanogona kudzivirirwa nekuwedzera yakanaka kupera-expiratory pressure (PEEP).

Dambudziko 4: Retrolental fibrous tissue hyperplasia

Kudzivirira uye kurapwa: Mushure mekushandisa yakakwira-concentration oxygen, yakawandisa arterial okisijeni chikamu chekumanikidza (PaO2 inosvika kupfuura 140mmHg) ndiyo inonyanya kukonzera njodzi yekukonzera retrolental fibrous tishu hyperplasia muvana vachangozvarwa (kunyanya vacheche vasati vasvika). Naizvozvo, huwandu hweokisijeni hwevacheche hunofanirwa kudzorwa zvakanyanya pasi pe40%, uye nguva yekufema okisijeni inofanira kudzorwa.

Dambudziko 5: Oxygen poisoning

Clinical zviratidzo:

• Zviratidzo zve pulmonary oxygen poisoning: marwadzo ekudzokera shure, chikosoro chakaoma uye dyspnea inopfuurira, kuderedzwa kwakakosha simba.
• Zviratidzo zvecerebral oxygen poisoning: kutadza kuona uye kunzwa, kusvotwa, kugwinha, syncope uye zvimwe zviratidzo zvetsinga. Muzviitiko zvakakomba, coma uye rufu zvinogona kuitika.
• Zviratidzo zveocular oxygen poisoning: retinal atrophy. Kana vana vasati vasvika vatora oxygen kwenguva yakareba muincubator, retina inenge iine ropa rakawanda rakavharika, fibroblast infiltration, uye retrolental fiber proliferation, izvo zvinogona kutungamirira kuhupofu.