Okisijeni chimwe chezvinhu zvinotsigira hupenyu
Mitochondria ndiyo inonyanya kukosha nzvimbo yebiological oxidation mumuviri. Kana iyo tishu iri hypoxic, iyo oxidative phosphorylation process ye mitochondria haigone kuenderera zvakajairwa. Nekuda kweizvozvo, kushandurwa kweADP kuenda kuATP kwakaremara uye simba risingakwanisi rinopihwa kuchengetedza kufambira mberi kwemaitiro akasiyana emabasa emuviri.
Tissue oxygen supply
Arterial blood oxygen contentCaO2=1.39*Hb*SaO2+0.003*PaO2(mmHg)
Oxygen transport capacityDO2=CO*CaO2
Iyo nguva yakatarwa yekuti vanhuwo zvavo vabvumire kusungwa kwekufema
Paunenge uchifema mweya:3.5min
Pakufema 40% oksijeni: 5.0min
Pakufema 100% oksijeni: 11min
Lung gasi kuchinjanisa
Oxygen partial pressure in air(PiO2):21.2kpa(159mmHg)
Oxygen chikamu chekumanikidzwa mumasero emapapu (PaO2): 13.0kpa (97.5mmHg)
Yakasanganiswa venous partial pressure yeokisijeni(PvO2):5.3kpa(39.75mmHg)
Yakaenzana pulse oxygen pressure(PaO2):12.7kpa(95.25mmHg)
Zvikonzero zve hypoxemia kana kushaikwa kweokisijeni
- Alveolar hypoventilation (A)
- Ventilation/perfusion(VA/Qc)Disproportionality(a)
- Kudzikira kupararira (Aa)
- Kuwedzera kuyerera kweropa kubva kurudyi kuenda kuruboshwe shunt (Qs/Qt Yakawedzera)
- Atmospheric hypoxia (I)
- Congestive hypoxia
- Anemic hypoxia
- Tissue toxic hypoxia
Physiological limits
Zvinowanzotendwa kuti PaO2 i4.8KPa(36mmHg) ndiyo inogumira kurarama kwemuviri wemunhu.
Ngozi dze hypoxia
- Uropi: Kukuvadzwa kusingadzoreki kuchaitika kana okisijeni yakamira kwemaminetsi 4-5.
- Mwoyo: Mwoyo unodya okisijeni yakawanda kupfuura uropi uye ndiyo inonyanya kunzwa
- Central nerve system:Inonzwa, isingabvumirwe
- Kufema: Pulmonary edema, bronchospasm, cor pulmonale
- Chiropa, itsvo, zvimwe: Acid kutsiva, hyperkalemia, kuwedzera kweropa
Zviratidzo uye zviratidzo zveacute hypoxia
- Respiratory system: Kunetseka kufema, pulmonary edema
- Mwoyo netsinga: palpitations, arrhythmia, angina, vasodilation, kuvhunduka
- Central nervous system: Euphoria, kutemwa nemusoro, kuneta, kusafunga zvakanaka, hunhu husina kujeka, husimbe, kusagadzikana, retinal hemorrhage, kugwinha, pakoma.
- Tsandanyama tsinga: kushaya simba, kudedera, hyperreflexia, ataxia
- Metabolism: Mvura uye sodium retention, acidosis
Dhigirii ye hypoxemia
Nyoro:Hapana cyanosis PaO2>6.67KPa(50mmHg); SaO2<90%
Pakati nepakati:Cyanotic PaO2 4-6.67KPa(30-50mmHg); SaO2 60-80%
Yakanyanya: Yakanyorwa cyanosis PaO2 <4KPa(30mmHg); SaO2<60%
PvO2 Yakasanganiswa venous oxygen partial pressure
PvO2 inogona kumiririra avhareji PO2 yetishu imwe neimwe uye inoshanda sechiratidzo chetishu hypoxia.
Yakajairika kukosha kwePVO2: 39±3.4mmHg.
<35mmHg tishu hypoxia.
Kuyera PVO2, ropa rinofanirwa kutorwa kubva mutsinga yepulmonary kana atrium yekurudyi.
Zviratidzo zveokisijeni kurapwa
Termo Isihara propose PaO2=8Kp(60mmHg)
PaO2 <8Kp, Pakati pe6.67-7.32Kp (50-55mmHg) Zviratidzo zvekugara kwenguva refu kweokisijeni.
PaO2=7.3Kpa(55mmHg) Oxygen therapy inodiwa
Acute Oxygen Therapy Guidelines
Zvinobvumirwa zviratidzo:
- Acute hypoxemia(PaO2<60mmHg;SaO<90%)
- Kurova kwemoyo nekufema kunomira
- Hypotension (Systolic blood pressure <90mmHg)
- Kubuda kwemoyo wakaderera uye metabolic acidosis (HCO3 <18mmol/L)
- Kushungurudzika kwekufema (R> 24/min)
- CO Poisoning
Kukundikana kwekufema uye kurapwa kweokisijeni
Acute kufema kutadza: isingadzorerwe okisijeni inhalation
ARDS:Shandisa peep, ngwarira nezve oxygen poisoning
CO poisoning: hyperbaric oxygen
Kutadza kufema kwenguva refu: kudzorwa okisijeni kurapwa
Mitemo mitatu mikuru yeanodzorwa okisijeni kurapwa:
- Muchikamu chekutanga chekufema oksijeni (vhiki yekutanga), oksijeni inhalation concentration <35%
- Muchikamu chekutanga cheokisijeni therapy, inhalation inoenderera kwemaawa makumi maviri nemana
- Nguva yekurapa: > 3-4 mavhiki → Kufemerwa neokisijeni mukati (12-18h/d) * hafu yegore
→ Kurapwa kweokisijeni kumba
Shandura maitiro ePaO2 uye PaCO2 panguva yeokisijeni therapy
Mhando yekuwedzera kwePaCO2 mukutanga 1 kusvika ku3 mazuva ekurapa okisijeni isimba risina simba rakanaka rePaO2 shanduko inokosha * 0.3-0.7.
PaCO2 pasi peCO2 anesthesia inenge 9.3KPa (70mmHg).
Wedzera PaO2 kusvika ku7.33KPa (55mmHg) mukati memaawa 2-3 ekufema mweya weokisijeni.
Pakati penguva (mazuva 7-21); PaCO2 inoderera nekukurumidza, uye PaO2↑ inoratidza kusimba kwakashata kwakashata.
Munguva yakazotevera (mazuva 22-28), PaO2↑ haina kukosha, uye PaCO2 inowedzera kuderera.
Kuongororwa kweOxygen Therapy Effects
PaO2-PaCO2:5.3-8KPa(40-60mmHg)
Mhedzisiro yacho inoshamisa: Musiyano> 2.67KPa (20mmHg)
Inogutsa kurapa mhedzisiro: Musiyano uri 2-2.26KPa (15-20mmHg)
Kusashanda zvakanaka:Musiyano<2KPa(16mmHg)
Kuongorora uye manejimendi eokisijeni kurapwa
- Tarisa ropa gasi, kuziva, simba, cyanosis, kufema, kurova kwemwoyo, BP uye kukosora.
- Oxygen inofanira kunyoroveswa uye inodziya.
- Tarisa catheter uye zvivharo zvemhino usati wafema oxygen.
- Mushure mekufema kweokisijeni maviri, maturusi ekufemesa okisijeni anofanirwa kukweshwa uye kuuraya hutachiona.
- Tarisa mita yeokisijeni nguva dzose, disinfecting bhodhoro rehumidification uye shandura mvura mazuva ese. The liquid level inenge 10cm.
- Zvakanakisisa kuva nebhodhoro rehumidification uye chengetedza tembiricha yemvura pa70-80 degrees.
Zvakanakira uye Zvakaipa
Nasal cannula uye nasal congestion
- Zvakanakira: zviri nyore, zviri nyore; haikanganisi varwere, kukosora, kudya.
- Zvakaipa: Kuisa pfungwa hakusi nguva dzose, kukanganiswa nyore nekufema; kushungurudza mucous membrane.
Mask
- Zvakanakira: Kuisa pfungwa kunenge kwakadzikira uye kune kunyandura kushoma.
- Zvakaipa: Zvinokanganisa expectoration uye kudya kune imwe nhanho.
Zviratidzo zvekubviswa kweokisijeni
- Kunzwa uchiziva uye kunzwa zviri nani
- Cyanosis inonyangarika
- PaO2> 8KPa (60mmHg), PaO2 haideredzi mazuva matatu mushure mekubviswa kweokisijeni
- Paco2<6.67kPa (50mmHg)
- Kufema kuri nyore
- HR inononoka, arrhythmia inovandudza, uye BP inova yakajairika. Usati wabvisa okisijeni, kufema kweokisijeni kunofanirwa kuregedzwa (12-18 maawa / zuva) kwemazuva 7-8 kuona shanduko mumagasi eropa.
Zviratidzo zvenguva refu yeokisijeni therapy
- PaO2< 7.32KPa (55mmHg)/PvO2< 4.66KPa (55mmHg), mamiriro acho akagadzikana, uye gasi reropa, uremu, uye FEV1 hazvina kuchinja zvakanyanya mukati memavhiki matatu.
- Chronic bronchitis uye emphysema ine FEV2 isingasviki 1.2 litita
- Nocturnal hypoxemia kana sleep apnea syndrome
- Vanhu vane kurovedza muviri-induced hypoxemia kana COPD mukuregererwa vanoda kufamba madaro mapfupi
Kurapa kweokisijeni kwenguva refu kunosanganisira kuenderera mberi kwekufema kweokisijeni kwemwedzi mitanhatu kusvika kumakore matatu
Migumisiro uye kudzivirira kweokisijeni therapy
- Oxygen poisoning: Iyo yakanyanya kuchengetedzeka kusungirirwa kweokisijeni inhalation ndeye 40%. Oxygen poisoning inogona kuitika mushure mekupfuura 50% kwemaawa 48. Kudzivirira: Dzivisa kukwirira-kunyanya kupinza oksijeni kwenguva yakareba.
- Atelectasis: Kudzivirira: Kudzora oksijeni kuisa, kukurudzira kutendeuka kakawanda, shandura nzvimbo dzemuviri, uye kukurudzira kubuda kwesputum.
- Dry breathing secretions: Dziviriro: Simbisa humidification yegasi rinofemerwa uye ita aerosol inhalation nguva dzose.
- Posterior lens fibrous tissue hyperplasia: inongoonekwa muvana vachangoberekwa, kunyanya vacheche vasati vasvika. Kudzivirirwa: Chengetedza huwandu hweokisijeni pasi pe40% uye kutonga PaO2 pa13.3-16.3KPa.
- Kuora mwoyo kwekufema: kunoonekwa kune varwere vane hypoxemia uye CO2 kuchengetedza mushure mekufema yakawandisa yeokisijeni. Kudzivirira: Kuenderera mberi kweokisijeni pakuyerera kwakaderera.
Oxygen Intoxication
Chirevo: Muchetura pamasero ematishu unokonzerwa nekufema mweya weokisijeni pa0.5 atmospheric pressure inonzi oxygen poisoning.
Kuitika kweokisijeni toxicity kunoenderana nechikamu chekumanikidzwa kweokisijeni pane kuzara kweokisijeni
Rudzi rweOkisijeni Kudhakwa
Pulmonary oxygen poisoning
Chikonzero: Inhale okisijeni pane imwe mhepo yekumanikidza kwemaawa masere
Kuratidzwa kwekiriniki: marwadzo ekudzokera shure, kukosora, dyspnea, kuderedzwa kwakakosha simba, uye kuderera kwePaO2. Mapapu anoratidza zvipembenene zvinoputika, nekuputika kwesero infiltration, congestion, edema uye atelectasis.
Kudzivirirwa uye kurapwa: kudzora kusungirirwa uye nguva yeokisijeni inhalation
Cerebral oxygen poisoning
Chikonzero: Kufemera okisijeni pamusoro pe2-3 atmospheres
Kuratidzwa kwekiriniki: kutadza kuona uye kunzwa, kusvotwa, kugwinha, kupera simba uye zvimwe zviratidzo zvetsinga. Muzviitiko zvakakomba, coma uye rufu zvinogona kuitika.
Nguva yekutumira: Zvita-12-2024