ʻO ka oxygen kekahi o nā mea e hoʻomau i ke ola
ʻO ka Mitochondria ka wahi koʻikoʻi no ka hoʻoheheʻe ʻana i ke kino. Inā he hypoxic ka kiko, ʻaʻole hiki ke hele maʻamau ke kaʻina hana phosphorylation oxidative o ka mitochondria. ʻO ka hopena, ua pilikia ka hoʻololiʻana o ka ADP i ka ATP a hāʻawiʻia ka ikaikaʻole e mālama i ka holomua maʻamau o nāʻoihana physiological likeʻole.
Hāʻawi ʻia ka oxygen
Maʻiʻo oxygen koko aʻaʻaCaO2=1.39*Hb*SaO2+0.003*PaO2(mmHg)
Hiki ke lawe oxygen DO2=CO*CaO2
ʻO ka palena manawa no ka poʻe maʻamau e ʻae i ka hopu ʻana i ka hanu
ʻOiai e hanu ana i ka ea: 3.5min
Ke hanu 40% oxygen: 5.0min
Ke hanu 100% oxygen: 11min
Hoʻololi kinoea māmā
Oxygen hapa kaomi i loko o ka ea (PiO2):21.2kpa(159mmHg)
Oxygen hapa kaomi i loko o nā pūmāmā (PaO2):13.0kpa(97.5mmHg)
Huipuia venous hapa kaomi o ka oxygen(PvO2):5.3kpa(39.75mmHg)
Hoʻohālikelike ʻia ke kaomi o ka oxygen pulse (PaO2):12.7kpa(95.25mmHg)
Nā kumu o ka hypoxemia a i ʻole ka nele o ka oxygen
- Alveolar hypoventilation(A)
- Ka hoʻoheheʻe ʻana/perfusion(VA/Qc)Disproportionality(a)
- Hoʻemi ʻia ka hoʻopuehu ʻana (Aa)
- Hoʻonui ʻia ke kahe koko mai ka ʻākau a i ka hema shunt (Qs/Qt Piʻi)
- Hypoxia lewa(I)
- ʻO ka maʻi hypoxia
- ʻAnemic hypoxia
- ʻO ka hypoxia ʻona
Nā palena physiological
Manaʻo maʻamau ʻo PaO2 he 4.8KPa(36mmHg) ka palena ola o ke kino kanaka.
ʻO ka pilikia o ka hypoxia
- ʻO ka lolo: E hiki mai ana ka pōʻino hiki ʻole ke hoʻihoʻi ʻia inā pau ka hāʻawi ʻana o ka oxygen no 4-5 mau minuke.
- Naʻau: ʻOi aku ka nui o ka oxygen i ka naʻau ma mua o ka lolo a ʻoi aku ka maʻalahi
- Pūnaehana nūnū waena: paʻakikī, ʻae ʻole ʻia
- ʻO ka hanu: ʻO ka edema pulmonary, bronchospasm, cor pulmonale
- ʻO ke akepaʻa, ka puʻupaʻa, nā mea ʻē aʻe: Hoʻololi i ka waikawa, hyperkalemia, hoʻonui i ke koko
Nā hōʻailona a me nā hōʻailona o ka hypoxia nui
- Pūnaehana hanu: pilikia ka hanu ʻana, edema pulmonary
- Cardiovascular: Palpitations, arrhythmia, angina, vasodilation, haʻalulu
- Pūnaehana nūnū waena: Euphoria, ʻeha ʻeha, luhi, hoʻopaʻapaʻa ʻole, hana pololei ʻole, palaualelo, hoʻomaha ʻole, retinal hemorrhage, convulsions, coma.
- Nā aʻalolo ʻiʻo: nāwaliwali, haʻalulu, hyperreflexia, ataxia
- Metabolism: ka paʻa ʻana o ka wai a me ka sodium, acidosis
Degere o ka hypoxemia
Māmā: ʻAʻohe cyanosis PaO2>6.67KPa(50mmHg); SaO2<90%
Maikaʻi: Cyanotic PaO2 4-6.67KPa(30-50mmHg); SaO2 60-80%
Koʻikoʻi: Hōʻailona cyanosis PaO2<4KPa(30mmHg); SaO2<60%
PvO2 Huipuia venous oxygen hapa kaomi
Hiki iā PvO2 ke hōʻike i ka PO2 awelika o kēlā me kēia kiko a lilo i hōʻailona o ka hypoxia kiko.
Ka waiwai maʻamau o PVO2: 39±3.4mmHg.
<35mmHg kino hypoxia.
No ke ana ʻana i ka PVO2, pono e lawe ʻia ke koko mai ke aʻaʻa pulmonary a i ʻole atrium ʻākau.
Nā hōʻailona no ka oxygen therapy
Manaʻo ʻo Termo Ishihara PaO2=8Kp(60mmHg)
PaO2<8Kp, Ma waena o 6.67-7.32Kp(50-55mmHg) Nā hōʻailona no ka lāʻau oxygen lōʻihi.
PaO2=7.3Kpa(55mmHg) Pono ka lāʻau oxygen
Acute Oxygen Therapy Guidelines
Nā hōʻailona ʻae ʻia:
- ʻO ka hypoxemia nui (PaO2<60mmHg;SaO<90%)
- Paʻa ka puʻuwai a me ka hanu
- Hypotension (Systolic blood pressure<90mmHg)
- Haʻahaʻa puʻuwai a me ka metabolic acidosis (HCO3<18mmol/L)
- Ka pilikia o ka hanu (R>24/min)
- ʻO ka ʻawaʻawa CO
ʻO ka hāʻule ʻana o ka hanu a me ka hoʻōla oxygen
ʻO ka hāʻule ʻana o ka hanu ʻana: ʻaʻole mālama ʻia ka oxygen inhalation
ARDS: E hoʻohana i ka peep, e makaʻala i ka make ʻana o ka oxygen
Ka make ʻana o CO: hyperbaric oxygen
ʻO ka hāʻule ʻana o ka hanu ʻana: mālama ʻia ka oxygen therapy
ʻEkolu mau kumu nui o ka hoʻokele oxygen therapy:
- I ka hoʻomaka mua o ka oxygen inhalation (mua pule), oxygen inhalation concentration<35%
- I ka wā mua o ka oxygen therapy, hoʻomau i ka inhalation no 24 mau hola
- Ka lōʻihi o ka lāʻau lapaʻau: >3-4 pule→Inhalation oxygen intermittent (12-18h/d) * hapalua makahiki
→Home oxygen therapy
E hoʻololi i nā ʻano o PaO2 a me PaCO2 i ka wā o ka oxygen therapy
ʻO ka laulā o ka hoʻonui ʻana i ka PaCO2 i nā lā mua o 1 a hiki i 3 mau lā o ka oxygen therapy kahi pilina maikaʻi nāwaliwali o ka waiwai hoʻololi PaO2 * 0.3-0.7.
ʻO ka PaCO2 ma lalo o CO2 anesthesia ma kahi o 9.3KPa (70mmHg).
E hoʻonui i ka PaO2 i ka 7.33KPa (55mmHg) i loko o 2-3 mau hola o ka inhalation oxygen.
Kau waena (7-21 mau lā); Hoʻemi wikiwiki ʻo PaCO2, a hōʻike ʻo PaO2↑ i kahi pilina maikaʻi ʻole.
I ka manawa hope (nā lā 22-28), ʻaʻole nui ka PaO2↑, a emi hou ka PaCO2.
Ka Loiloi o ka Oxygen Therapy Effects
PaO2-PaCO2:5.3-8KPa(40-60mmHg)
He mea kupaianaha ka hopena: ʻokoʻa> 2.67KPa (20mmHg)
ʻO ka hopena hoʻōla maikaʻi: ʻO ka ʻokoʻa ka 2-2.26KPa(15-20mmHg)
ʻAʻohe maikaʻi: ʻokoʻa<2KPa(16mmHg)
Ka nānā ʻana a me ka mālama ʻana i ka oxygen therapy
- E nānā i ke kinoea koko, ka noʻonoʻo, ka ikehu, ka cyanosis, ka hanu, ka puʻuwai, ke koko a me ka ʻū.
- Pono e hoʻomāmā a hoʻomaʻamaʻa ʻia ka oxygen.
- E nānā i nā catheters a me nā keakea ihu ma mua o ka hoʻohu ʻana i ka oxygen.
- Ma hope o ʻelua inhalations oxygen, pono e holoi ʻia nā mea hana inhalation oxygen a hoʻomaʻemaʻe ʻia.
- E nānā mau i ka mika kahe o ka oxygen, disinfect i ka ʻōmole humidification a hoʻololi i ka wai i kēlā me kēia lā. ʻO ka pae wai ma kahi o 10cm.
- ʻOi aku ka maikaʻi o ka loaʻa ʻana o kahi hue humidification a mālama i ka mahana o ka wai ma 70-80 degere.
ʻO nā pono a me nā pōʻino
Nasal cannula a me ka nasal congestion
- Pōmaikaʻi: maʻalahi, maʻalahi; ʻaʻole pili i nā mea maʻi, ʻuʻu, ʻai.
- Nā pōʻino: ʻAʻole mau ka noʻonoʻo, pili maʻalahi i ka hanu ʻana; ʻehaʻeha o ka mucous membrane.
Māka
- Pōmaikaʻi: Ua paʻa ka manaʻo a he liʻiliʻi ka hoʻoulu.
- Nā pōʻino: Hoʻopilikia ia i ka expectoration a me ka ʻai ʻana i kekahi ʻano.
Nā hōʻailona no ka wehe ʻana o ka oxygen
- Manaʻo noʻonoʻo a maikaʻi hoʻi
- Nalo ka cyanosis
- PaO2>8KPa (60mmHg), ʻaʻole emi ʻo PaO2 i nā lā 3 ma hope o ka wehe ʻana o ka oxygen.
- Paco2<6.67kPa (50mmHg)
- Ua maʻalahi ka hanu
- Hoʻolohi ka HR, hoʻomaikaʻi ka arrhythmia, a lilo ka BP i mea maʻamau. Ma mua o ka wehe ʻana i ka oxygen, pono e hoʻopau ʻia ka inhalation o ka oxygen (12-18 mau hola / lā) no 7-8 mau lā e nānā i nā loli o ke kinoea koko.
Nā hōʻailona no ka lōʻihi o ka oxygen therapy
- PaO2< 7.32KPa (55mmHg)/PvO2< 4.66KPa (55mmHg), paʻa ke kūlana, a ʻaʻole i loli nui ke kinoea koko, kaumaha, a me FEV1 i loko o ʻekolu pule.
- ʻO ka maʻi bronchitis a me ka emphysema me ka FEV2 ma lalo o 1.2 lita
- Nocturnal hypoxemia a i ʻole sleep apnea syndrome
- ʻO ka poʻe me ka hypoxemia hoʻoikaika kino a i ʻole COPD i kala ʻia e makemake e hele i kahi mamao
ʻO ka lāʻau oxygen lōʻihi e pili ana i ka inhalation oxygen mau no ʻeono mahina a ʻekolu mau makahiki
Nā hopena ʻaoʻao a me ka pale ʻana i ka oxygen therapy
- Oxygen poisoning: ʻO ka nui o ka palekana palekana o ka inhalation oxygen he 40%. Hiki ke make ka ʻona o ka oxygen ma hope o ka ʻoi aku o ka 50% no nā hola 48. Kāohi: E pale i ka inhalation oxygen kiʻekiʻe no ka manawa lōʻihi.
- Atelectasis: Kāohi: E hoʻomalu i ka ʻike o ka oxygen, paipai i ka huli pinepine ʻana, hoʻololi i nā kūlana o ke kino, a hoʻoikaika i ka hoʻokuʻu ʻana i ka sputum.
- ʻO nā mea huna hanu maloʻo: Kāohi: E hoʻoikaika i ka humidification o ke kinoea inhaled a hana mau aerosol inhalation.
- ʻO ka hyperplasia fibrous tissue hope o ka lens: ʻike wale ʻia i nā keiki hānau hou, ʻoi aku ka nui o nā pēpē ʻōpiopio. Kāohi: E mālama i ka ʻike o ka oxygen ma lalo o 40% a mālama iā PaO2 ma 13.3-16.3KPa.
- ʻO ke kaumaha o ka hanu: ʻike ʻia i nā poʻe maʻi me ka hypoxemia a me ka paʻa ʻana o CO2 ma hope o ka hoʻoulu ʻana i nā kiʻekiʻe o ka oxygen. Kāohi: Hoʻomau i ka oxygenation ma ke kahe haʻahaʻa.
ʻona ʻona
Manaʻo: ʻO ka hopena ʻawaʻawa ma nā pūnaewele kino i hoʻoiho ʻia e ka inha ʻana i ka oxygen ma 0.5 kaomi lewa i kapa ʻia ʻo oxygen poisoning.
ʻO ka loaʻa ʻana o ka ʻawaʻawa o ka oxygen e pili ana i ke kaomi hapa o ka oxygen ma mua o ka ʻike oxygen
Ke ʻano o ka ʻona o ka Oxygen
ʻO ka ʻawaʻawa o ka pulmonary oxygen
Ke kumu: Inhale oxygen ma kahi o hoʻokahi lewa o ke kaomi no 8 mau hola
Nā hōʻike maʻi: ka ʻeha hope, ka ʻū, ka dyspnea, ka emi ʻana o ka hiki, a me ka emi ʻana o ka PaO2. Hōʻike nā māmā i nā maʻi ʻeha, me ka infiltration cell inflammatory, congestion, edema a me atelectasis.
Ka pale ʻana a me ka mālama ʻana: mālama i ka ʻike a me ka manawa o ka inhalation oxygen
ʻO ka make ʻana o ka oxygen cerebral
Ke kumu: Inhaing oxygen ma luna o 2-3 lewa
Nā hōʻike maʻi: ʻikeʻole a me ka auditory impairment, nausea, convulsions, maule a me nā hōʻailona neurological ʻē aʻe. I nā hihia koʻikoʻi, hiki ke coma a me ka make.
Ka manawa hoʻouna: Dec-12-2024