Kev txiav txim thiab kev faib tawm ntawm Hypoxia
Vim li cas thiaj muaj hypoxia?
Oxygen yog cov khoom tseem ceeb uas txhawb nqa lub neej. Thaum cov ntaub so ntswg tsis tau txais cov pa oxygen txaus lossis muaj teeb meem hauv kev siv cov pa, ua rau muaj kev hloov pauv hauv lub cev metabolic, qhov xwm txheej no hu ua hypoxia.
Lub hauv paus rau kev txiav txim siab hypoxia
Hypoxia degree thiab cov tsos mob
Classification ntawm hypoxia
| Classification ntawm hypoxia | arterial ib nrab siab ntawm oxygen | arterial oxygen saturation | Arteriovenous oxygen sib txawv | Tej yam tshwm sim |
| hypotonic hypoxia | ↓ | ↓ | ↓ thiab N | Tsawg oxygen concentration hauv cov pa nqus tau pa, ua haujlwm tsis zoo ntawm exhalation sab nraud, venous shunt rau hauv cov hlab ntsha, thiab lwm yam. Feem ntau pom nyob rau hauv cov kab mob pulmonary ntev thiab kab mob hauv lub plawv xws li tetralogy of Fallot. |
| ntshav hypoxia | N | N | ↓ | Txo cov nqi lossis hloov pauv cov khoom ntawm hemoglobin, xws li ntshav ntshav, carbon monoxide lom, thiab methemoglobinemia. |
circulatory hypoxia | N | N | ↑ Ib | Nws yog tshwm sim los ntawm kev txo cov nqaij mos cov ntshav khiav thiab txo qis cov pa oxygen, uas yog tshwm sim hauv plawv tsis ua haujlwm, shock, lwm. |
koom haum hypoxia | N | N | ↑ los yog ↓ | Ua los ntawm kev siv tsis zoo ntawm cov pa oxygen los ntawm cov ntaub so ntswg, xws li tshuaj lom cyanide. |
Oxygen inhalation therapy thiab nws lub hom phiaj
Raws li ib txwm muaj, cov neeg noj qab haus huv ua pa ib txwm ua pa thiab siv cov pa oxygen hauv nws los tswj cov kev xav tau ntawm metabolic. Thaum muaj mob lossis qee yam kev mob tshwm sim ua rau hypoxia hauv lub cev, qee yam khoom siv yuav tsum tau siv los muab cov pa oxygen rau tus neeg mob, ua kom cov hlab ntsha oxygen ib nrab siab (PaO2) thiab cov pa oxygen saturation (SaO2), txhim kho hypoxia, txhawb cov metabolism, thiab tswj lub neej. Kev ua si.
Cov txiaj ntsig ntawm kev nqus pa oxygen
- Tshem tawm angina pectoris thiab tiv thaiv myocardial infarction
- Tiv thaiv kev tuag tam sim los ntawm kab mob plawv
- Kev kho mob hawb pob zoo
- Zoo kho emphysema, kab mob pulmonary plawv, thiab mob bronchitis
- Kev nqus pa oxygen muaj cov txiaj ntsig kho mob rau ntshav qab zib: kev tshawb fawb tam sim no qhia tias ntshav qab zib muaj feem cuam tshuam rau lub cev tsis muaj oxygen. Cov neeg mob ntshav qab zib muaj qhov txo qis capillary siab, thiab cov ntaub so ntswg tsis tuaj yeem tau txais oxygen tag nrho, ua rau kev ua haujlwm tsis zoo ntawm tes thiab cov piam thaj metabolism. Yog li ntawd, kev siv cov pa oxygen kho rau cov neeg mob ntshav qab zib tau nyiam cov neeg kho mob.
- Kev nqus pa oxygen tuaj yeem ua lub luag haujlwm saib xyuas kev noj qab haus huv hauv cov neeg noj qab haus huv: huab cua paug, kev siv cua txias, kev nqus pa oxygen tsis tu ncua tuaj yeem ntxuav lub cev ua pa, txhim kho lub cev ua haujlwm, txhim kho lub cev tiv thaiv kab mob, thiab tiv thaiv ntau yam kab mob.
Cov kev faib tawm ntawm kev kho cov pa oxygen yog dab tsi?
- High concentration oxygen mov (5-8L / min): Nws yog siv rau mob ua pa tsis ua hauj lwm xws li ua pa thiab mob plawv, mob ua pa nyuaj siab, mob lom (xws li carbon monoxide lom los yog gas lom) ua pa nyuaj siab, thiab lwm yam. siab concentration lossis ntshiab oxygen yuav tsum tau siv txhua thib ob rau kev cawm, tab sis nws tsis haum rau kev siv mus ntev. los tiv thaiv cov pa oxygen los yog lwm yam teeb meem.
- Medium concentration oxygen mov (3-4L / min): Nws yog qhov tsim nyog rau cov neeg mob ntshav qab zib, mob plawv tsis txaus, poob siab, thiab lwm yam uas tsis muaj kev txwv nruj rau kev nqus pa oxygen.
- Tsawg concentration oxygen mov (1-2L / min): Feem ntau yog siv rau mob ntsws ntsws, mob ntsws, mob ntsws, mob plawv, thiab lwm yam, tseem hu ua kab mob ntsws ntev. Cov ntshav siab ntau dhau ntawm cov pa oxygen ib nrab tuaj yeem ua rau tsis muaj zog reflex stimulation ntawm carotid sinus mus rau qhov chaw ua pa, yog li txo qhov cua thiab ua rau cov pa roj carbon dioxide ntau dua. ua tau. Yog li ntawd, cov pa oxygen yuav tsum tau siv ceev faj, thiab feem ntau yog siv cov pa nqus pa tsis tu ncua.
Oxygen concentration thiab oxygen txaus
Oxygen concentration: Qhov feem ntawm cov pa oxygen muaj nyob hauv huab cua. Cov pa oxygen concentration nyob rau hauv ib txwm atmospheric huab cua yog 20.93%
- Tsawg concentration oxygen <35%
- Nruab nrab concentration oxygen 35% -60%
- High concentration oxygen> 60%
Oxygen flow: yog hais txog qhov hloov pauv oxygen txaus rau cov neeg mob, chav tsev L / min.
Oxygen concentration oxygen flow conversion
- Nasal cannula, qhov ntswg congestion: Oxygen concentration (%) = 21 + 4X oxygen flow (L / min)
- Mask oxygen mov (qhib thiab kaw): tus nqi ntws yuav tsum siab dua 6 L / min
- Lub tshuab ua pa yooj yim: cov pa oxygen txaus 6 L / min, nqus pa oxygen kwv yees li 46% -60%
- Lub tshuab ua pa: Oxygen concentration = 80X oxygen txaus (L / min) / qhov cua ntim + 20
Kev faib tawm ntawm kev kho cov pa oxygen-Raws li kev siv cov pa oxygen
Tej yam yuav tsum nco ntsoov thaum siv oxygen
- Kev nyab xeeb ntawm cov pa oxygen: Ua kom zoo siv "plaub kev tiv thaiv": kev tiv thaiv av qeeg, tiv thaiv hluav taws, tiv thaiv tshav kub, thiab tiv thaiv roj. Yam tsawg kawg 5 meters deb ntawm lub qhov cub thiab 1 meter deb ntawm lub rhaub. Cov pa oxygen tsis tuaj yeem siv tau. Thaum tus taw tes rau ntawm qhov ntsuas siab yog 5kg / cm2, nws tsis tuaj yeem siv dua.
- Ua raws li cov txheej txheem ua haujlwm oxygen: Thaum siv cov pa oxygen, koj yuav tsum siv nws ua ntej. Thaum nres, rub tawm lub catheter ua ntej thiab tom qab ntawd tua cov pa oxygen. Thaum hloov tus nqi ntws nruab nrab, koj yuav tsum cais cov pa oxygen thiab qhov ntswg catheter ua ntej, kho tus nqi ntws ua ntej txuas.
- Saib xyuas cov txiaj ntsig ntawm kev siv cov pa oxygen: cyanosis yog alleviated, lub plawv dhia qeeb dua li ua ntej, dyspnea zoo li qub, lub siab lub ntsws zoo dua, thiab cov qauv hauv ntau qhov ntsuas ntawm cov ntshav ntsuas roj, thiab lwm yam.
- Hloov cov qhov ntswg cannula thiab cov tshuaj humidification txhua hnub (1/3-1/2 puv ntawm cov dej distilled lossis sterilized)
- Xyuas kom muaj kev siv thaum muaj xwm txheej ceev: lub tog raj kheej tsis siv lossis tsis muaj pa oxygen yuav tsum tau dai nrog cov cim "tag nrho" lossis "dub" raws.
Kev ceev faj tseem ceeb rau kev nqus pa oxygen
- Ua tib zoo saib xyuas cov txiaj ntsig ntawm kev kho cov pa oxygen: Yog tias cov tsos mob xws li dyspnea txo qis lossis txo qis, thiab lub plawv dhia zoo li qub lossis ze li qub, nws qhia tau tias kev kho cov pa oxygen zoo. Txwv tsis pub, qhov laj thawj yuav tsum tau pom thiab kho raws sijhawm.
- High-concentration oxygen mov yuav tsum tsis txhob muab rau ntev heev. Nws feem ntau ntseeg tias yog tias cov pa oxygen concentration yog> 60% thiab txuas ntxiv rau ntau tshaj 24 teev, cov pa oxygen tuaj yeem tshwm sim.
- Rau cov neeg mob uas mob hnyav heev ntawm cov kab mob obstructive pulmonary, tswj tau (piv txwv li qis-concentration nruam) kev nqus pa oxygen feem ntau yuav tsum tau muab.
- Ua tib zoo saib xyuas cov cua sov thiab cov av noo: Kev tswj qhov kub ntawm 37 ° C thiab av noo ntawm 95% mus rau 100% hauv txoj kev ua pa yog qhov tsim nyog rau kev ua haujlwm ntawm lub cev mucociliary.
- Tiv thaiv kom tsis txhob kis kab mob thiab cov kab thaiv kab mob: Tej yam yuav tsum tau hloov thiab ntxuav thiab tua kab mob tsis tu ncua kom tsis txhob kis kab mob. Cov catheters thiab qhov ntswg qhov ntswg yuav tsum tau kuaj xyuas txhua lub sijhawm kom pom tias lawv raug thaiv los ntawm kev zais cia thiab hloov lub sijhawm kom ntseeg tau tias kev kho cov pa oxygen zoo thiab nyab xeeb.
Cov qauv kev tiv thaiv thiab kev kho mob ntawm cov teeb meem tshwm sim ntawm oxygen inhalation
Teebmeem 1: Cov pa ua pa qhuav
Kev Tiv Thaiv thiab Kev Kho Mob: Cov pa oxygen tawm ntawm cov khoom siv oxygen yog qhuav. Tom qab nqus pa, nws tuaj yeem qhuav cov pa mucosa thiab ua rau cov kua qaub qhuav thiab nyuaj rau kev tawm. Cov dej distilled yuav tsum tau ntxiv rau hauv lub raj mis humidification, thiab cov dej sterilized yuav tsum tau ntxiv rau cov pa oxygen.
Teeb meem 2: Ua pa nyuaj siab
Kev tiv thaiv thiab kev kho mob: Thaum lub sij hawm hypoxemia, qhov txo qis hauv PaO2 tuaj yeem ua rau cov tshuaj tua kab mob peripheral, ua kom lub ntsws ua pa, thiab ua kom lub ntsws ua pa. Yog tias tus neeg mob tso siab rau qhov kev ua kom rov qab los ua kom ua pa ntev ntev (xws li cov neeg mob uas muaj kab mob ntsws pulmonary thiab hom II ua pa tsis ua haujlwm), kev nqus cov pa oxygen siab tuaj yeem tshem tawm qhov kev xav no, inhibit qhov ua tsis taus pa, thiab txawm tias ua pa tsis ua pa. . Yog li ntawd, nws yog ib qho tsim nyog yuav tsum tau muab cov pa qis qis, qis qis tswj cov pa oxygen thiab saib xyuas cov kev hloov pauv hauv PaO2 kom tswj tus neeg mob PaO2 ntawm 60mmHg.
Teeb meem 3: Absorptive atelectasis
Kev Tiv Thaiv thiab Kev Kho Mob: Tom qab tus neeg mob nqus cov pa oxygen ntau, cov nitrogen ntau hauv cov alveoli hloov. Thaum lub bronchus raug thaiv, cov pa oxygen hauv alveoli tuaj yeem nqus sai sai los ntawm cov ntshav ntws, ua rau lub alveoli vau thiab ua rau atelectasis. Yog li ntawd, kev tiv thaiv ua pa tsis ua pa yog qhov tseem ceeb. Kev ntsuas suav nrog txhawb cov neeg mob kom ua pa tob thiab hnoos, ntxiv dag zog rau cov hnoos qeev, hloov lub cev tsis tu ncua, thiab txo qis oxygen concentration (<60%). Cov neeg mob ntawm lub tshuab ua pa tuaj yeem tiv thaiv tau los ntawm kev ntxiv qhov zoo kawg nkaus-kawg siab (PEEP).
Teeb meem 4: Retrolental fibrous cov ntaub so ntswg hyperplasia
Kev Tiv Thaiv thiab Kev Kho Mob: Tom qab siv cov pa oxygen ntau dhau, cov pa oxygen ntau dhau ntawm cov hlab ntsha (PaO2 nce mus txog ntau dua 140mmHg) yog qhov tseem ceeb ntawm kev ua rau cov nqaij ntshiv retrolental fibrous hyperplasia hauv cov menyuam mos (tshwj xeeb yog cov menyuam mos ntxov ntxov). Yog li ntawd, cov pa oxygen concentration ntawm cov me nyuam mos yuav tsum nruj me ntsis tswj hauv qab 40%, thiab lub sij hawm nqus pa oxygen yuav tsum tau tswj.
Teeb meem 5: Oxygen lom
Clinical manifestations:
- Cov tsos mob ntawm pulmonary oxygen lom: mob retrosternal, hnoos qhuav thiab ua tsis taus pa, txo lub peev xwm tseem ceeb
- Cov tsos mob ntawm cerebral oxygen lom: tsis pom kev thiab hnov lus tsis zoo, xeev siab, convulsions, syncope thiab lwm yam paj hlwb. Hauv cov xwm txheej hnyav, coma thiab tuag yuav tshwm sim.
- Cov tsos mob ntawm cov pa oxygen lom ntawm lub qhov muag: retinal atrophy. Yog tias cov me nyuam mos ntxov ntxov noj cov pa ntev ntev hauv qhov chaw tsim khoom, lub retina yuav muaj cov hlab ntsha loj occlusion, fibroblast infiltration, thiab retrolental fiber ntau, uas tuaj yeem ua rau dig muag.
Post lub sij hawm: Nov-21-2024