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Kedu ihe ị maara gbasara ọgwụgwọ oxygen?

Oxygen bụ otu n'ime ihe ndị na-akwado ndụ

Mitochondria bụ ebe kachasị mkpa maka oxidation ndu n'ime ahụ. Ọ bụrụ na anụ ahụ bụ hypoxic, usoro phosphorylation oxidative nke mitochondria enweghị ike ịga n'ihu nke ọma. N'ihi ya, ntughari nke ADP na ATP na-adịghị mma ma na-enye ike zuru ezu iji nọgide na-enwe ọganihu nkịtị nke ọrụ dị iche iche nke anụ ahụ.

Ọkpụkpụ oxygen

Ọdịnaya oxygen nke akwara akwaraCaO2=1.39*Hb*SaO2+0.003*PaO2(mmHg)

Ikike ikuku oxygen DO2 = CO * CaO2

Ogologo oge maka ndị nkịtị ga-anabata njide iku ume

Mgbe ikuku na-eku ume: 3.5min

Mgbe iku ume 40% oxygen: 5.0min

Mgbe iku ume 100% oxygen: 11min

Mgbanwe ikuku gas

Nrụgide akụkụ ikuku oxygen na ikuku (PiO2): 21.2kpa (159mmHg)

Nrụgide akụkụ oxygen na mkpụrụ ndụ akpa ume (PaO2): 13.0kpa (97.5mmHg)

Ngwakọta venous akụkụ nrụgide nke oxygen (PvO2):5.3kpa(39.75mmHg)

Nrụgide ikuku oxygen (PaO2): 12.7kpa (95.25mmHg)

Ihe na-akpata hypoxemia ma ọ bụ enweghị oxygen

  • Alveolar hypoventilation (A)
  • Igwe ikuku / perfusion (VA/Qc) adịghị mma (a)
  • Mbelata nkesa (Aa)
  • Mmụba ọbara si n'aka nri gaa n'aka ekpe shunt (Qs/Qt mụbara)
  • Ọnọdụ ikuku hypoxia (I)
  • hypoxia na-egbu mgbu
  • Anemic hypoxia
  • hypoxia na-egbu egbu nke anụ ahụ

Oke gbasara anụ ahụ

A na-ekwenyekarị na PaO2 bụ 4.8KPa(36mmHg) bụ oke ịlanarị ahụ mmadụ.

Ihe ize ndụ nke hypoxia

  • Ụbụrụ: Nbibi na-enweghị ike ịgbanwe ga-eme ma ọ bụrụ na ikuku oxygen kwụsịrị maka nkeji 4-5.
  • Obi: Obi na-eri oxygen karịa ụbụrụ ma bụrụ nke kacha nwee mmetụta
  • Sistemụ ụjọ Central: nke nwere mmetụta, anaghị anabata ya nke ọma
  • iku ume: pulmonary edema, bronchospasm, cor pulmonale
  • Imeju, akụrụ, ndị ọzọ: nnọchi acid, hyperkalemia, mmụba ọbara

Ihe ịrịba ama na mgbaàmà nke nnukwu hypoxia

  • Usoro iku ume: iku ume siri ike, edema pulmonary
  • Obi mgbawa: obi mgbawa, arrhythmia, angina, vasodilation, ujo
  • Sistemụ ụjọ nke etiti: Euphoria, isi ọwụwa, ike ọgwụgwụ, ikpe ziri ezi, omume na-ezighi ezi, ịdị umengwụ, enweghị ike izu ike, ọbara ọgbụgba retina, mgbakasị ahụ, coma.
  • akwara akwara: adịghị ike, ịma jijiji, hyperreflexia, ataxia
  • Metabolism: mmiri na sodium njigide, acidosis

Ọkwa hypoxemia

Dị nwayọọ: Enweghị cyanosis PaO2>6.67KPa(50mmHg); SaO2 <90%

Na-agafeghị oke: Cyanotic PaO2 4-6.67KPa(30-50mmHg); SaO2 60-80%

siri ike: cyanosis akara PaO2 <4KPa(30mmHg); SaO2 <60%

PvO2 agwakọtara akụkụ ikuku oxygen venous

PvO2 nwere ike ịnọchite anya nkezi PO2 nke anụ ahụ ọ bụla ma jee ozi dị ka ihe na-egosi hypoxia anụ ahụ.

Uru nkịtị nke PVO2: 39± 3.4mmHg.

<35mmHg anụ ahụ hypoxia.

Iji tụọ PVO2, a ga-ewepụ ọbara site na akwara pulmonary ma ọ bụ atrium aka nri.

Ngosipụta maka ọgwụgwọ oxygen

Termo Ishihara tụrụ aro PaO2=8Kp(60mmHg)

PaO2 <8Kp, N'etiti 6.67-7.32Kp (50-55mmHg) Ngosipụta maka ọgwụgwọ oxygen ogologo oge.

PaO2=7.3Kpa(55mmHg) ọgwụgwọ oxygen dị mkpa

Ntuziaka ọgwụgwọ oxygen siri ike

Ngosipụta anabatara:

  1. Nnukwu hypoxemia (PaO2 <60mmHg; SaO <90%)
  2. Nkwụsị obi na iku ume
  3. Hypotension (ọbara mgbali elu systolic <90mmHg)
  4. Mmepụta obi dị ala na metabolic acidosis (HCO3 <18mmol/L)
  5. Nsogbu iku ume(R>24/min)
  6. CO nsi

Mmebi iku ume na ọgwụgwọ oxygen

Nnukwu iku ume iku ume: ikuku oxygen na-achịkwaghị achịkwa

ARDS: Jiri peep, kpachara anya maka nsị oxygen

CO nsi: hyperbaric oxygen

Ọrịa iku ume na-adịghị ala ala: ọgwụgwọ ikuku oxygen na-achịkwa

Ụkpụrụ atọ bụ isi nke ọgwụgwọ oxygen na-achịkwa:

  1. N'oge mmalite nke iku ume ikuku oxygen (izu mbụ), itinye uche ikuku oxygen <35%
  2. Na mmalite usoro ọgwụgwọ oxygen, iku ume na-aga n'ihu maka awa 24
  3. Ogologo oge ọgwụgwọ:> 3-4 izu → ikuku oxygen na-adịte aka (12-18h / d) * ọkara afọ

→ Usoro ọgwụgwọ oxygen n'ụlọ

Gbanwee ụkpụrụ nke PaO2 na PaCO2 n'oge ọgwụgwọ oxygen

Ọnụ ọgụgụ nke mmụba na PaCO2 na mbụ 1 ruo 3 ụbọchị nke ọgwụgwọ oxygen bụ mmekọrịta dị mma na-adịghị ike nke mgbanwe mgbanwe PaO2 * 0.3-0.7.

PaCO2 n'okpuru CO2 anesthesia dị gburugburu 9.3KPa (70mmHg).

Mee PaO2 ruo 7.33KPa (55mmHg) n'ime awa 2-3 nke ikuru ikuku oxygen.

Oge etiti oge (ụbọchị 7-21); PaCO2 na-ebelata ngwa ngwa, na PaO2↑ na-egosi njikọ ọjọọ siri ike.

N'ime oge ikpeazụ (ụbọchị 22-28), PaO2↑ adịghị mkpa, na PaCO2 na-ebelata.

Nlele mmetụta ọgwụgwọ oxygen

PaO2-PaCO2: 5.3-8KPa (40-60mmHg)

Mmetụta dị ịrịba ama: Ọdịiche>2.67KPa(20mmHg)

Mmetụta ọgwụgwọ afọ ojuju: Ọdịiche bụ 2-2.26KPa(15-20mmHg)

Nrụpụta adịghị mma: Ọdịiche <2KPa(16mmHg)

1
Nleba anya na njikwa ọgwụgwọ oxygen

  • Lelee gas ọbara, nsụhọ, ume, cyanosis, iku ume, ọnụọgụ obi, ọbara mgbali elu na ụkwara.
  • Oxygen ga-abụ iru mmiri ma kpoo ọkụ.
  • Lelee catheters na ihe mgbochi imi tupu ikuru ikuku oxygen.
  • Mgbe ikuru ikuku oxygen abụọ gasịrị, a ga-ehichapụ ngwa ọrụ iku ume ikuku oxygen ma kpochapụ ya.
  • Lelee mita ikuku oxygen mgbe niile, kpochapụ karama iru mmiri ma gbanwee mmiri kwa ụbọchị. Ogo mmiri mmiri dị ihe dịka 10 cm.
  • Ọ kacha mma ịnwe karama iru mmiri ma debe okpomọkụ na 70-80 degrees.

Uru na ọghọm

Ọkpụkpọ imi na imi imi

  • Uru: dị mfe, adaba; adịghị emetụta ndị ọrịa, ụkwara, iri nri.
  • Mwepu: Ịta ahụhụ adịghị adịgide adịgide, na-emetụta ngwa ngwa iku ume; akpụkpọ anụ mucous iwe.

Ihe mkpuchi

  • Uru: A na-edobe ntinye uche na obere mkpali.
  • Ihe ọghọm: Ọ na-emetụta atụmanya na iri nri ruo n'ókè ụfọdụ.

Ngosipụta maka iwepụ oxygen

  1. Na-eche na ị mara ihe na inwe mmetụta ka mma
  2. Cyanosis na-apụ n'anya
  3. PaO2> 8KPa (60mmHg), PaO2 anaghị ebelata ụbọchị 3 mgbe nkwụsị oxygen gasịrị
  4. Paco2 <6.67kPa (50mmHg)
  5. Iku ume dị nro karị
  6. HR na-ebelata, arrhythmia na-akawanye mma, BP na-aghọkwa nkịtị. Tupu ịwepụ oxygen, a ghaghị ịkwụsị iku ume oxygen (awa 12-18 kwa ụbọchị) maka ụbọchị 7-8 iji hụ mgbanwe na gas ọbara.

Ngosipụta maka ọgwụgwọ oxygen ogologo oge

  1. PaO2<7.32KPa (55mmHg)/PvO2<4.66KPa (55mmHg), ọnọdụ ahụ kwụsiri ike, gas, arọ, na FEV1 agbanwebeghị nke ukwuu n'ime izu atọ.
  2. Bronchitis na-adịghị ala ala na emphysema na FEV2 na-erughị 1.2 lita
  3. Hypoxemia nke abalị ma ọ bụ ọrịa apnea ụra
  4. Ndị nwere mmega ahụ na-akpata hypoxemia ma ọ bụ COPD na mgbaghara ndị chọrọ ịga ebe dị anya

Usoro ọgwụgwọ oxygen na-adịte aka gụnyere iku ume ikuku oxygen na-aga n'ihu ruo ọnwa isii ruo afọ atọ

Mmetụta na mgbochi nke ọgwụgwọ oxygen

  1. Oxygen nsi: Oke kacha mma nchekwa ikuku oxygen bụ 40%. Oxygen nsị nwere ike ime mgbe gafere 50% maka awa 48. Mgbochi: Zere ikuku oxygen na-eku ume maka ogologo oge.
  2. Atelectasis: Mgbochi: Jikwaa mkpokọta oxygen, na-agba ume ịtụgharị ugboro ugboro, gbanwee ọnọdụ ahụ, ma kwalite nsị sputum.
  3. Ihe nzuzo iku ume kpọrọ nkụ: Mgbochi: mee ka iru mmiri dị n'ime ikuku ume ma na-ekuku ikuku mgbe niile.
  4. Lens posterior fibrous anụ ahụ hyperplasia: a na-ahụ naanị na ụmụ amụrụ ọhụrụ, ọkachasị ụmụ ọhụrụ akabeghị aka. Mgbochi: Debe ikuku oxygen n'okpuru 40% ma jikwaa PaO2 na 13.3-16.3KPa.
  5. Ịda mbà n'obi nke iku ume: a na-ahụ na ndị ọrịa nwere hypoxemia na njigide CO2 mgbe ha gbasasịrị nnukwu ikuku oxygen. Mgbochi: oxygenation na-aga n'ihu na obere eruba.

Mmanya Oxygen

Echiche: Mmetụta na-egbu egbu na mkpụrụ ndụ anụ ahụ kpatara site na iku ume oxygen na nrụgide ikuku 0.5 ka a na-akpọ nsị oxygen.

Ihe omume nke nsị oxygen na-adabere na nrụgide akụkụ nke ikuku oxygen kama itinye uche oxygen

Ụdị Mmanya Oxygen

Nsi ikuku oxygen na pulmonary

Ihe kpatara ya: Kunye oxygen na ihe dịka otu ikuku nke nrụgide maka awa 8

Ngosipụta ụlọ ọgwụ: mgbu azụ azụ, ụkwara, dyspnea, ibelata ikike dị mkpa, na mbelata PaO2. Ngụgụ na-egosi ọnya na-egbuke egbuke, na ntinye nke cell na-egbuke egbuke, nkwụsịtụ, edema na atelectasis.

Mgbochi na ọgwụgwọ: ịchịkwa ịta na oge ikuku oxygen

Nsi nke ikuku oxygen

Ihe kpatara ya: Ikuku oxygen n'elu ikuku 2-3

Ngosipụta ụlọ ọgwụ: mmerụ ahụ anya na nke anụ ahụ, ọgbụgbọ, mgbakasị ahụ, ịda mbà n'obi na mgbaàmà akwara ndị ọzọ. N'ọnọdụ ndị siri ike, coma na ọnwụ nwere ike ime.

 

Oge nzipu: Dec-12-2024
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