Oxygen yog ib qho ntawm cov khoom uas txhawb nqa lub neej
Mitochondria yog qhov chaw tseem ceeb tshaj plaws rau lom oxidation hauv lub cev. Yog hais tias cov ntaub so ntswg yog hypoxic, oxidative phosphorylation txheej txheem ntawm mitochondria tsis tuaj yeem ua haujlwm li qub. Yog li ntawd, kev hloov pauv ntawm ADP rau ATP yog qhov tsis zoo thiab lub zog tsis txaus yog muab los tswj kev ua haujlwm ib txwm muaj ntawm ntau yam kev ua haujlwm ntawm lub cev.
Muab cov pa oxygen
Arterial blood oxygen contentCaO2 = 1.39 * Hb * SaO2 + 0.003 * PaO2 (mmHg)
Oxygen transport capacityDO2 = CO*CaO2
Lub sij hawm txwv rau cov tib neeg ib txwm zam kev ua pa nres
Thaum ua pa cua: 3.5 min
Thaum ua pa 40% oxygen: 5.0min
Thaum ua pa 100% oxygen: 11 min
Lub ntsws pauv roj
Oxygen ib nrab siab hauv huab cua (PiO2): 21.2kpa (159mmHg)
Oxygen ib nrab siab hauv ntsws hlwb (PaO2): 13.0kpa (97.5mmHg)
Mixed venous ib nrab siab ntawm oxygen (PvO2): 5.3kpa (39.75mmHg)
Equilibrated pulse oxygen siab (PaO2): 12.7kpa (95.25mmHg)
Ua rau hypoxemia lossis tsis muaj oxygen
- Alveolar hypoventilation (A)
- Ventilation/perfusion(VA/Qc)Disproportionality(a)
- Tsawg dispersion (Aa)
- Nce ntshav ntws los ntawm sab xis mus rau sab laug shunt (Qs / Qt nce)
- Atmospheric hypoxia (I)
- Congestive hypoxia
- Anemic hypoxia
- Cov ntaub so ntswg toxic hypoxia
Physiological txwv
Nws feem ntau ntseeg tias PaO2 yog 4.8KPa (36mmHg) yog tib neeg lub cev muaj sia nyob txwv
Kev phom sij ntawm hypoxia
- Lub paj hlwb: Irreversible puas yuav tshwm sim yog tias cov pa oxygen nres rau 4-5 feeb.
- Lub plawv: Lub plawv siv oxygen ntau dua li lub hlwb thiab yog qhov nkag siab tshaj plaws
- Central paj hlwb: rhiab heev, tsis zoo tolerated
- Ua pa: pulmonary edema, bronchospasm, cor pulmonale
- Lub siab, lub raum, lwm yam: Acid hloov, hyperkalemia, nce ntshav ntim
Cov tsos mob thiab cov tsos mob ntawm tus mob hypoxia
- Ua pa system: ua pa nyuaj, pulmonary edema
- Cov hlab plawv: palpitations, arrhythmia, angina, vasodilation, poob siab
- Central nervous system: Euphoria, mob taub hau, nkees, impaired kev txiav txim, imprecise cwj pwm, sluggishness, nyob tsis tswm, retinal hemorrhage, convulsions, coma.
- Cov leeg nqaij: qaug zog, tshee, hyperreflexia, ataxia
- Metabolism: dej thiab sodium retention, acidosis
Degree ntawm hypoxemia
Mob me: Tsis muaj cyanosis PaO2> 6.67KPa (50mmHg); SaO2 <90%
Nruab nrab: Cyanotic PaO2 4-6.67KPa(30-50mmHg); SaO2 60-80%
Mob hnyav: Cyanosis PaO2<4KPa(30mmHg); SaO2 <60%
PvO2 Mixed venous oxygen ib nrab siab
PvO2 tuaj yeem sawv cev rau qhov nruab nrab PO2 ntawm txhua cov ntaub so ntswg thiab ua qhov taw qhia ntawm cov ntaub so ntswg hypoxia.
Tus nqi ntawm PVO2: 39 ± 3.4mmHg.
<35mmHg cov ntaub so ntswg hypoxia.
Txhawm rau ntsuas PVO2, ntshav yuav tsum tau muab coj los ntawm cov hlab ntsha pulmonary lossis txoj cai atrium.
Cov lus qhia rau kev kho oxygen
Termo Ishihara qhia PaO2 = 8Kp(60mmHg)
PaO2<8Kp, nruab nrab ntawm 6.67-7.32Kp (50-55mmHg) Cov lus qhia rau kev kho cov pa mus ntev.
PaO2 = 7.3Kpa(55mmHg) Kev kho oxygen yog tsim nyog
Cov Txheej Txheem Kev Kho Oxygen Therapy
Txais tau cov lus qhia:
- Acute hypoxemia (PaO2<60mmHg; SaO<90%)
- Lub plawv dhia thiab ua tsis taus pa
- Hypotension (Systolic ntshav siab <90mmHg)
- Lub plawv tsis ua haujlwm thiab metabolic acidosis (HCO3 <18mmol / L)
- Ua pa nyuaj siab (R> 24 / min)
- CO Poisoning
Kev ua pa tsis ua haujlwm thiab kho cov pa oxygen
Mob ua pa tsis ua hauj lwm: uncontrolled oxygen inhalation
ARDS: Siv peep, ceev faj txog oxygen lom
CO lom: hyperbaric oxygen
Kev ua pa tsis ua haujlwm ntev: tswj kev kho oxygen
Peb lub hauv paus ntsiab lus tseem ceeb ntawm kev tswj cov pa oxygen:
- Nyob rau theem pib ntawm kev nqus pa oxygen (thawj lub lim tiam), oxygen inhalation concentration <35%
- Nyob rau theem pib ntawm kev kho cov pa oxygen, kev nqus pa tas mus li 24 teev
- Kev kho lub sijhawm:> 3-4 lub lis piam → nqus pa oxygen tsis tu ncua (12-18h / d) * ib nrab xyoo
→ Kev kho pa oxygen hauv tsev
Hloov cov qauv ntawm PaO2 thiab PaCO2 thaum kho cov pa oxygen
Qhov ntau ntawm kev nce hauv PaCO2 hauv thawj 1 mus rau 3 hnub ntawm kev kho cov pa oxygen yog qhov tsis muaj zog ntawm kev sib raug zoo ntawm PaO2 hloov pauv tus nqi * 0.3-0.7.
PaCO2 nyob rau hauv CO2 tshuaj loog yog nyob ib ncig ntawm 9.3KPa (70mmHg).
Nce PaO2 rau 7.33KPa (55mmHg) hauv 2-3 teev ntawm kev nqus pa oxygen.
Lub sij hawm nruab nrab (7-21 hnub); PaCO2 txo qis sai, thiab PaO2↑ qhia tau tias muaj kev sib raug zoo tsis zoo.
Nyob rau lub sijhawm tom qab (hnub 22-28), PaO2↑ tsis tseem ceeb, thiab PaCO2 txo qis ntxiv.
Kev ntsuam xyuas ntawm Oxygen Therapy Effects
PaO2-PaCO2: 5.3-8KPa (40-60mmHg)
Cov nyhuv zoo kawg li: Qhov txawv> 2.67KPa (20mmHg)
Txaus siab curative nyhuv: Qhov txawv yog 2-2.26KPa (15-20mmHg)
Kev ua haujlwm tsis zoo: Qhov txawv <2KPa(16mmHg)
Kev saib xyuas thiab tswj kev kho cov pa oxygen
- Saib xyuas ntshav roj, nco ntsoov, lub zog, cyanosis, ua pa, lub plawv dhia, ntshav siab thiab hnoos.
- Oxygen yuav tsum tau humidified thiab warmed.
- Xyuas catheters thiab qhov ntswg qhov ntswg ua ntej nqus pa.
- Tom qab ob lub nqus pa oxygen, cov cuab yeej nqus pa oxygen yuav tsum tau txhuam thiab tua kab mob.
- Tshawb xyuas lub ntsuas pa oxygen tsis tu ncua, tshuaj tua kab mob hauv lub raj mis thiab hloov dej txhua hnub. Cov dej theem yog li 10 cm.
- Nws yog qhov zoo tshaj kom muaj lub raj mis humidification thiab khaws cov dej kub ntawm 70-80 degrees.
Qhov zoo thiab qhov tsis zoo
Nasal cannula thiab qhov ntswg congestion
- Qhov zoo: yooj yim, yooj yim; tsis cuam tshuam rau cov neeg mob, hnoos, noj mov.
- Qhov tsis zoo: Cov concentration tsis tas mus li, yooj yim cuam tshuam los ntawm kev ua pa; mucous daim nyias nyias irritation.
Daim npog qhov ncauj
- Qhov zoo: Cov concentration yog qhov ruaj khov thiab tsis tshua muaj stimulation.
- Disadvantages: Nws cuam tshuam rau expectoration thiab noj rau ib qho twg.
Indications rau tshem tawm oxygen
- Nco ntsoov thiab zoo siab
- Cyanosis ploj
- PaO2> 8KPa (60mmHg), PaO2 tsis txo qis 3 hnub tom qab tshem tawm cov pa oxygen
- Paco2 <6.67kPa (50mmHg)
- Ua pa yog smoother
- HR qeeb qeeb, arrhythmia txhim kho, thiab BP ua qhov qub. Ua ntej tshem tawm cov pa oxygen, kev nqus pa oxygen yuav tsum tau txiav tawm (12-18 teev / hnub) rau 7-8 hnub txhawm rau soj ntsuam cov ntshav hloov pauv.
Cov lus qhia rau kev kho oxygen mus sij hawm ntev
- PaO2< 7.32KPa (55mmHg)/PvO2< 4.66KPa (55mmHg), qhov mob yog ruaj khov, thiab cov ntshav roj, qhov hnyav, thiab FEV1 tsis tau hloov ntau hauv peb lub lis piam.
- Cov kab mob bronchitis thiab emphysema nrog FEV2 tsawg dua 1.2 litres
- Nocturnal hypoxemia lossis pw tsaug zog apnea syndrome
- Cov neeg uas muaj kev tawm dag zog vim hypoxemia lossis COPD hauv kev zam txim uas xav mus ncig luv luv
Kev kho cov pa oxygen mus sij hawm ntev yuav tsum tau nqus pa oxygen txuas ntxiv mus rau rau lub hlis txog peb xyoos
Kev mob tshwm sim thiab kev tiv thaiv kev kho mob oxygen
- Oxygen lom: Qhov siab tshaj plaws ntawm kev nqus pa oxygen yog 40%. Oxygen lom yuav tshwm sim tom qab ntau tshaj 50% rau 48 teev.Kev Tiv Thaiv: Tsis txhob muaj cov pa oxygen nqus tau rau lub sijhawm ntev.
- Atelectasis: Kev Tiv Thaiv: Tswj cov pa oxygen concentration, txhawb kom tig ntau zaus, hloov lub cev txoj haujlwm, thiab txhawb cov hnoos qeev tawm.
- Ua pa qhuav: Tiv thaiv: Txhim kho cov av noo ntawm cov pa nqus tau pa thiab ua pa aerosol tsis tu ncua.
- Posterior lens fibrous cov ntaub so ntswg hyperplasia: tsuas yog pom nyob rau hauv cov me nyuam mos, tshwj xeeb tshaj yog cov me nyuam mos ntxov ntxov. Kev Tiv Thaiv: Khaws cov pa oxygen hauv qab 40% thiab tswj PaO2 ntawm 13.3-16.3KPa.
- Kev nyuaj siab ua pa: pom nyob rau hauv cov neeg mob hypoxemia thiab CO2 retention tom qab nqus cov pa oxygen siab. Kev Tiv Thaiv: Nruam oxygenation ntawm qis ntws.
Oxygen Intoxication
Lub tswv yim: Cov tshuaj lom ntawm cov ntaub so ntswg los ntawm kev nqus pa ntawm 0.5 atmospheric siab yog hu ua oxygen lom.
Qhov tshwm sim ntawm oxygen toxicity nyob ntawm qhov siab ntawm cov pa oxygen ntau dua li cov pa oxygen concentration
Hom Oxygen Intoxication
Pulmonary oxygen lom
Yog vim li cas: nqus pa oxygen ntawm ib qho chaw ntawm lub siab rau 8 teev
Kev kho mob tshwm sim: mob retrosternal, hnoos, dyspnea, txo lub peev xwm tseem ceeb, thiab txo PaO2. Lub ntsws qhia cov kab mob inflammatory, nrog rau cov cell infiltration, congestion, edema thiab atelectasis.
Kev tiv thaiv thiab kev kho mob: tswj cov concentration thiab lub sijhawm ntawm kev nqus pa oxygen
Cerebral oxygen lom
Yog vim li cas: nqus pa oxygen saum 2-3 cua
Clinical manifestations: pom thiab hnov tsis zoo, xeev siab, convulsions, fainting thiab lwm yam neurological tsos mob. Hauv cov xwm txheej hnyav, coma thiab tuag yuav tshwm sim.
Post lub sij hawm: Dec-12-2024