"Mukurapa kwevarwere vane chirwere chepfungwa, chirwere chekushaya okisijeni chinoramba chiripo sechirwere chisingazivikanwe chine migumisiro yakaipa. Ichionekwa nekubviswa kweokisijeni pasina dyspnea yakaenzana (inonzi 'hypoxia yakanyarara'), chiratidzo ichi chinoratidza kusakwana kwemweya. Humbowo hwakawanda hunosimbisa basa rayo senzira yekusagona kufema zvakanaka, nekunonoka kuongororwa kuchikonzera kufa kunodzivirirwa pakati pemabayo, COVID-19, uye zvirwere zvemapapu zvisingaperi. New England Journal of Medicine ichangobva kusimbisa iyi 'paradox yechiremba' - uko kuedza kwekufema kwakajairika kunodzivirira kushaikwa kweokisijeni kwakaipisisa, zvichida kutariswa patsva kwekiriniki uye kutarisa shanduko dzeprotocol."
Chii chinonzi hypoxemia?
"Hypoxemia, inotsanangurwa sekushomeka kweoxygen muropa retsinga (PaO2 < 80 mmHg padanho regungwa muvanhu vakuru), inoitika kana chikamu chedzvinyiriro chichiderera pasi pemiganhu yakatarwa nezera (AARC Clinical Practice Guideline 2021). Mapoka ane njodzi huru anoratidza maitiro akasiyana ezvirwere:
- Kusawirirana kwemhepo inofema/kubuda kwemvura: Varwere vane pneumonia yakanyanya vane alveolar vanopinda vachikanganisa kugona kwavo kupararira kwemhepo.
- Maitiro emwoyo: Mapoka ekushaya simba kwemoyo kuruboshwe/kurudyi anoratidza kuzvimba kwemapapu kunokonzerwa nepressure (PCWP >18 mmHg)
- Kukanganiswa kwetsinga dzemutsinga: Vana vane tsandanyama dzisina kukura zvakanaka pakati pechifuva uye vakuru vane dambudziko rekushaya simba kwemuviri
- Kugara uchisangana nechirwere ichi kwenguva refu: Vanhu vanoshandisa fodya vachiratidza kuchinja kwechimiro chemapapu (emphysema, COPD-GOLD stage ≥2)
- Zvikonzero zveIatrogenic: Varwere vanonzwa kushungurudzika kwekufema kunokonzerwa neopioid (RR <12/min) uye atelectasis
Zvinonyanya kukosha kuti, 38% yevarwere vakavhiyiwa chipfuva vanowana hypoxemia mukati memaawa makumi maviri nemana mushure mekubviswa kweropa (ASA Closed Claims Data 2022), zvichisimbisa kukosha kwekutarisa pulse oximetry nguva dzose muvanhu ava.
Ndeipi njodzi yekushaya okisijeni mumuviri?
Zvichienderana nehuwandu hwekiriniki, huwandu hwerufu rwevarwere vane hypoxemia yakanyanya hunogona kusvika 27%, uye muzviitiko zvakakomba, huwandu hwerufu hunogona kusvika kupfuura 50%. Kana kupindira nekukasika kukasaitwa pakutanga kwechirwere, migumisiro yakaipa ingangoitika.
- Kukanganiswa kweuropi: Kana mwero weokisijeni muropa waderera (hypoxemia), uropi hunoshaya okisijeni. Izvi zvinogona kukonzera zviratidzo zvekukurumidza zvakaita semusoro usingaperi, dzungu risingatarisirwi, uye kuyeuka. Kana zvikasarapwa, kushaya okisijeni kwenguva refu kunogona kukuvadza masero europi, zvichikonzera sitiroko inokonzerwa nekuvharika kweropa (cerebral infarction) kana kuputika kwetsinga dzeropa (cerebral hemorrhage). Kuziva zviratidzo izvi nekukurumidza kwakakosha kudzivirira kukuvara kwetsinga zvachose.
- Kukanganiswa kwemoyo: Kana mwoyo usingawani okisijeni yakakwana, unotadza kupomba zvinobudirira. Kumanikidzwa uku kunogona kukonzera zviratidzo zvekunyevera zvakaita sekurova kwemoyo nekukurumidza kana kusina kurongeka, kusimba kwechipfuva (angina), uye kuneta kusingawanzoitiki. Nekufamba kwenguva, kushaikwa kweokisijeni isina kurapwa kunogona kunetesa tsandanyama dzemwoyo, zvichikonzera matambudziko anotyisidzira hupenyu akadai sekushaya simba kwemoyo, uko moyo usingakwanise kuzadzisa zvinodiwa nemuviri.
- Kukanganiswa kwemapapu: Okisijeni shoma inomanikidza mapapu kushanda nesimba kuti arambe achishanda. Nekufamba kwenguva, kumanikidzwa uku kunogona kukanganisa nzira dzekufema nemapfupa, zvichiwedzera njodzi yekurwara nekufema senge COPD (chirwere chemapapu chisingaperi). Muzviitiko zvakakomba, kushaikwa kweokisijeni kwenguva refu kunogona kutoderedza simba remoyo sezvo uchitadza kupomba ropa mumapapu akaomarara, chirwere chinozivikanwa se cor pulmonale.
- Migumisiro yemuviri wese: Kushaikwa kweokisijeni kwenguva refu kunodzvinyirira nhengo dzese dzemuviri semota inomhanya nemafuta mashoma. Itsvo nechiropa zvinova zvishoma nezvishoma zvisingashande zvakanaka pakusefa chepfu, ukuwo masoja emuviri achidzikira, zvichiita kuti hutachiona hunowanzoonekwa huve hwakaoma kurwisa. Nekufamba kwenguva, chikwereti ichi cheokisijeni chinowedzera njodzi yekukuvara kwenhengo dzemuviri uye chinoita kuti muviri uve panjodzi yematambudziko ehutano - kubva kuzvirwere zvinowanzoitika kusvika kumavanga enhengo anogara kwenguva refu. Izvi zvinoita kuti kuongororwa kwemazinga eokisijeni nekukurumidza kuve kwakakosha kudzivirira matambudziko enhengo dzakawanda.
Ungaziva sei kana uine hypoxemia?
Mwero weokisijeni muropa chinhu chakakosha pakuona kushomeka kweokisijeni muropa. Muvanhu vane hutano hwakanaka, kuverenga kwakajairika kunobva pa95% kusvika 100%. Kuyera kuri pakati pe90-94% kunoratidza kushomeka kweokisijeni zvishoma, izvo zvingasaratidza zviratidzo zviri pachena. Kudzikira kusvika pa80-89% kunoratidza kushomeka kweokisijeni zviri pakati nepakati, kazhinji zvichikonzera kufema zvakaoma kana kuvhiringidzika. Kuyera kuri pasi pe80% kunomiririra emergency yakakura, uko nhengo dzinokosha dziri panjodzi yekukuvara nekuda kwekushaya okisijeni zvakanyanya uye zvinoda kurapwa nekukurumidza.
Maitiro ekuchengetedza kuzara kweokisijeni muropa kwakajairika？
- Vhura mahwindo kuti mhepo ipinde
Zorodza mweya wemukati mako nekuvhura mahwindo zuva nezuva kuti mweya mutsva utenderere. Kuti uwane mhedzisiro iri nani, shanyira mapaki kana nzvimbo dzine zvisikwa zvakawanda kunze kwemaguta kuti ufeme mweya wakadzika uye wakachena unobatsira kuwedzera mweya wemuviri wako.
- Maekisesaizi eAerobics
Zviitwa zvekurovedza muviri nguva dzose zvakaita sekufamba nekukurumidza, kushambira, kana kutasva bhasikoro zvinogona kuwedzera kuyerera kweropa uye kutenderera kwemhepo. Sarudza nzira dzisinganyanyi kusimba dzakadai sekurovedza muviri mumvura kana kumhanya zvishoma nezvishoma kana uchangotanga kurovedza muviri - maekisesaizi aya anovandudza kuendeswa kwemhepo nekuchengetedza uku uchivaka simba nekufamba kwenguva.
- Kurapa okisijeni kumba
Kune vanhu vane matambudziko ekufema kwenguva refu uye vane dambudziko rekushaya okisijeni yakakwana, kushandisa mudziyo weokisijeni kumba kunogona kubatsira kuchengetedza oxygen yakakwana. Vanachiremba vanowanzo kurudzira kutanga nekushandisa oxygen concentrators dzinotakurika panguva yekurara kana mabasa ezuva nezuva - kana ikashandiswa sezvakarairwa, kurapa uku kunogona kuvandudza simba, kuderedza kufema, uye kutsigira kunaka kwekurara.
Nguva yekutumira: Kubvumbi-25-2025