Ingabe uyazi ngokuhogela umoya-mpilo?

Ukwahlulela kanye nokuhlukaniswa kwe-Hypoxia

Kungani kukhona i-hypoxia?

Umoya-mpilo uyinto eyinhloko esekela ukuphila. Uma izicubu zingawutholi umoya-mpilo owanele noma zinobunzima bokusebenzisa umoya-mpilo, okubangela izinguquko ezingavamile emisebenzini ye-metabolic yomzimba, lesi simo sibizwa ngokuthi i-hypoxia.

Isisekelo sokwahlulela i-hypoxia

I-Hypoxia degree kanye nezimpawu

Ukuhlukaniswa kwe-hypoxia

Ukuhlushwa komoya-mpilo okuphansi egesini ehogeliwe, ukungasebenzi kokukhipha umoya kwangaphandle, i-venous shunt emithanjeni, njll. Okuvame ukubonakala ku-chronic obstructive pulmonary disease kanye nesifo senhliziyo sokuzalwa njenge-tetralogy ye-Fallot.

Inani elincishisiwe noma izakhiwo ezishintshile ze-hemoglobin, njenge-anemia, ubuthi be-carbon monoxide, ne-methemoglobinemia.

i-circulatory hypoxia

i-hypoxia yenhlangano

Kubangelwa ukusetshenziswa okungavamile komoyampilo ngamaseli ezicubu, njengobuthi be-cyanide.

Ukwelashwa nge-oxygen inhalation kanye nenjongo yakho

Ngaphansi kwezimo ezijwayelekile, abantu abanempilo baphefumula umoya ngokwemvelo futhi basebenzisa umoya-mpilo okuwo ukuze balondoloze izidingo ze-metabolic. Lapho ukugula noma izimo ezithile ezingavamile ziholela ku-hypoxia emzimbeni, imishini ethile kufanele isetshenziselwe ukunikeza umoya-mpilo esigulini, ukwandisa i-arterial oxygen partial pressure (PaO2) kanye ne-oxygen saturation (SaO2), ithuthukise i-hypoxia, ikhuthaze umzimba, futhi igcine ukuphila. Umsebenzi.

Izinzuzo zokuhogela umoya-mpilo

• Yehlisa i-angina pectoris futhi uvikele i-myocardial infarction
• Vimbela ukufa okungazelelwe kwesifo senhliziyo
• Ukwelashwa okuhle kwe-asthma
• Yelapha ngokuphumelelayo i-emphysema, isifo senhliziyo yamaphaphu, kanye ne-bronchitis engapheli
• Ukuhogela umoya-mpilo kunomphumela osizayo wokwelapha isifo sikashukela: ucwaningo lwamanje lubonisa ukuthi isifo sikashukela sihlobene nokuntuleka komoyampilo komzimba. Iziguli ezinesifo sikashukela zinengcindezi ephansi ye-capillary, futhi amangqamuzana ezicubu awakwazi ukuthola umoya-mpilo ngokugcwele, okuholela ekulimazeni ukusebenza kwamangqamuzana kanye ne-glucose metabolism. Ngakho-ke, ukuqaliswa kokwelashwa komoya-mpilo ezigulini ezinesifo sikashukela kuye kwaheha ukunaka komphakathi wezokwelapha.
• Ukuhogela umoya-mpilo kungadlala indima yokunakekelwa kwezempilo kubantu abanempilo: ukungcoliswa komoya, ukusetshenziswa okuvamile kwesimo somoya, ukuhogela umoya-mpilo okuvamile kungahlanza isimiso sokuphefumula, kuthuthukise ukusebenza kwezitho zangaphakathi, kuthuthukise ukuzivikela komzimba okuphelele, futhi kuvimbele izifo ezihlukahlukene.

Yiziphi izigaba ze-oxygen therapy?

• Ukunikezwa komoyampilo okugxilile (5-8L/min):Isetshenziselwa ukwehluleka ukuphefumula okunamandla njengokuboshwa kokuphefumula nenhliziyo, i-acute Respiratory Distress Syndrome, ushevu obunzima (njengobuthi be-carbon monoxide noma ubuthi begesi) ukucindezeleka kokuphefumula, njll., lapho ukugcwala okuphezulu noma umoya-mpilo ohlanzekile kufanele kusetshenziswe umzuzwana ngamunye ukuze kutakulwe, kodwa akufanelekile ukusetshenziswa isikhathi eside. ukuvimbela ubuthi be-oxygen noma ezinye izinkinga.
• Ukunikezwa komoya-mpilo okugxilile okumaphakathi (3-4L/min):Kufanele iziguli ezine-anemia, ukwehluleka kwenhliziyo, ukushaqeka, njll. ezingenayo imingcele eqinile ekugxilweni komoyampilo ehogelwe.
• Ukunikezwa komoyampilo okuhlushwa okuphansi (1-2L/min):Imvamisa isetshenziselwa ukucinana kwemigudu yokuphefumula engapheli, i-emphysema, isifo senhliziyo yamaphaphu, njll., ekwaziwa nangokuthi isifo samaphaphu esingamahlalakhona. Umfutho wegazi ophakeme kakhulu wengxenye ungenza buthaka ukugqugquzelwa kwe-reflex ye-carotid sinus endaweni yokuphefumula, ngaleyo ndlela kunciphise ukungena komoya futhi kubhebhethekise ukugcinwa kwe-carbon dioxide. kungenzeka. Ngakho-ke, i-oxygen kufanele isetshenziswe ngokuqapha, futhi ukuhogela umoya-mpilo okungagxili kakhulu okuqhubekayo kusetshenziswa ngokuvamile.

Ukugxila kwe-oksijeni nokugeleza komoya-mpilo

I-oxygen concentration: Ingxenye ye-oxygen equkethwe emoyeni. Ukuhlushwa komoyampilo emoyeni ojwayelekile wasemkhathini kungu-20.93%

• I-oxygen ephansi yokuhlushwa <35%
• I-oxygen ephakathi nendawo 35% -60%
• I-oksijeni ephezulu yokuhlushwa > 60%

Ukugeleza komoya-mpilo: kubhekisela ekugelezeni komoya-mpilo okulungisiwe ezigulini, iyunithi L/min.

Ukuguqulwa kokugeleza kwe-oksijeni okugxilile kwe-oxygen

• I-cannula yamakhala, ukuminyana kwekhala: Ukugcwala komoyampilo (%) = 21+4X ukugeleza komoyampilo (L/min)
• Ukunikezwa kwe-oxygen yemaski (ivuliwe futhi ivaliwe): izinga lokugeleza kufanele libe likhulu kuno-6 L/min
• I-respirator elula: izinga lokugeleza komoyampilo 6 L/min, ukugcwala komoyampilo okuhogelwe cishe ku-46% -60%
• I-Ventilator: I-oxygen concentration = 80X ukugeleza komoyampilo (L/min) / umthamo wokungenisa umoya + 20

Ukuhlukaniswa kwe-oxygen therapy-Ngokwendlela yokunikezwa komoya-mpilo

Izinto okufanele uziqaphele lapho usebenzisa i-oxygen

• Ukusetshenziswa okuphephile komoyampilo:Sebenzisa ngokuphumelelayo "izivimbelo ezine": ukuvimbela ukuzamazama komhlaba, ukuvimbela umlilo, ukuvimbela ukushisa, nokuvimbela uwoyela. Okungenani kuqhele ngamamitha angu-5 ukusuka esitofini kanye nemitha elilodwa kude ne-heater. I-oxygen ayikwazi ukusetshenziswa. Lapho i-pointer ku-gauge yokucindezela ingu-5kg/cm2, ayikwazi ukusetshenziswa futhi.
• Landela ngokuqinile izinqubo zokusebenza komoya-mpilo: Lapho usebenzisa umoya-mpilo, kufanele uwusebenzise kuqala. Lapho umisa, khipha i-catheter kuqala bese uvala umoya-mpilo. Uma ushintsha izinga lokugeleza phakathi nendawo, kufanele uhlukanise i-oxygen ne-catheter yamakhala kuqala, ulungise izinga lokugeleza ngaphambi kokuxhuma.
• Qaphela umphumela wokusetshenziswa komoya-mpilo: i-cyanosis iyancishiswa, izinga lokushaya kwenhliziyo lihamba kancane kunangaphambili, i-dyspnea iyakhululeka, isimo sengqondo siyathuthukiswa, kanye nezitayela zezinkomba ezihlukahlukene zokuhlaziywa kwegesi yegazi, njll.
• Shintsha i-cannula yamakhala kanye nesisombululo somswakama nsuku zonke (i-1/3-1/2 egcwele amanzi acwengekile noma ahlutshiwe)
• Qinisekisa ukusetshenziswa okuphuthumayo: amasilinda komoyampilo angasetshenzisiwe noma angenalutho kufanele alengiswe ngezimpawu "ezigcwele" noma "ezingenalutho" ngokulandelanayo.

Izinyathelo eziyinhloko zokuhogela umoya-mpilo

• Qaphela ngokucophelela umphumela wokwelapha umoya-mpilo: Uma izimpawu ezifana ne-dyspnea zincishiswa noma zikhululeka, futhi ukushaya kwenhliziyo kuyinto evamile noma eduze nokujwayelekile, kubonisa ukuthi ukwelapha komoya-mpilo kuyasebenza. Uma kungenjalo, imbangela kufanele itholwe futhi kubhekwane nayo kusenesikhathi.
• Ukunikezwa komoya-mpilo okugxilwe kakhulu akufanele kuhlinzekwe isikhathi eside kakhulu. Ngokuvamile kukholakala ukuthi uma ukuhlushwa komoyampilo ku> 60% futhi kuqhubeka amahora angaphezu kwama-24, ubuthi be-oxygen bungenzeka.
• Ezigulini ezinomfutho wegazi ophakeme kakhulu wesifo samaphaphu esingamahlalakhona, ukuhogela umoya komoya-mpilo okulawulwayo (okungukuthi, okuqhubekayo) kufanele kunikezwe ngokujwayelekile.
• Naka ukufudumeza nokuswakama: Ukugcina izinga lokushisa elingu-37°C kanye nomswakama ongu-95% kuya ku-100% emgudwini wokuphefumula kuyisimo esidingekayo somsebenzi ojwayelekile wokusula wesistimu ye-mucociliary.
• Vimbela ukungcola kanye nokuvaleka kwemigudu: Izinto kufanele zishintshwe futhi zihlanzwe futhi zibulawe amagciwane njalo ukuze kuvinjelwe ukuthelelana ngezifo. Ama-catheter kanye nokuvinjwa kwamakhala kufanele kubhekwe nganoma yisiphi isikhathi ukuze kubonakale ukuthi avinjwe yini uketshezi futhi kushintshwe kusenesikhathi ukuze kuqinisekiswe ukwelashwa komoya-mpilo okuphumelelayo nokuphephile.

Amazinga okuvimbela nokwelashwa kwezinkinga ezivamile zokuhogela umoya-mpilo

Inkinga 1: Ukukhishwa kokuphefumula okomile

Ukuvimbela nokwelashwa: Umoya-mpilo ophuma emshinini wokuphakela komoya womile. Ngemuva kokuhogela, kungomisa i-mucosa yokuphefumula futhi yenze izimfihlo zome futhi kube nzima ukuyikhipha. Amanzi acwengekile kufanele engezwe ebhodleleni lomswakama, futhi amanzi ahlanzekile kufanele engezwe ukuze kuthobe umoya-mpilo.

Inkinga 2: Ukucindezeleka kokuphefumula

Ukuvimbela kanye nokwelashwa: Ngesikhathi se-hypoxemia, ukwehla kwe-PaO2 kungashukumisa ama-chemoreceptors e-peripheral, kujabulise ngokuphindaphindiwe isikhungo sokuphefumula, nokwandisa umoya wamaphaphu. Uma isiguli sithembele kulokhu kuthakazelisa kwe-reflex ukuze sigcine ukuphefumula isikhathi eside (njengeziguli ezinesifo senhliziyo yamaphaphu kanye nohlobo lwe-II yokuhluleka ukuphefumula), ukuhogela umoya-mpilo ophezulu kungaqeda le nqubo ye-reflex, kuvimbele ukuphefumula okuzenzakalelayo, futhi kubangele nokuyeka Ukuphefumula. . Ngakho-ke, kuyadingeka ukuhlinzeka ngokugeleza okuphansi, oksijini olawulwayo ophansi futhi uqaphe izinguquko ku-PaO2 ukuze kugcinwe i-PaO2 yesiguli ku-60mmHg.

Inkinga 3: I-atelectasis ebambayo

Ukuvimbela nokwelashwa: Ngemva kokuba isiguli sihogele umoya-mpilo omningi, inani elikhulu le-nitrogen ku-alveoli liyashintshwa. Uma i-bronchus ivinjiwe, umoya-mpilo ose-alveoli ungamuncwa ngokushesha ukugeleza kwegazi okujikelezayo, okubangela ukuba i-alveoli igoqe futhi ibangele i-atelectasis. Ngakho-ke, ukuvimbela ukuvinjelwa kokuphefumula kubalulekile. Izinyathelo zihlanganisa ukukhuthaza iziguli ukuthi ziphefumule kakhulu futhi zikhwehlele, ukuqinisa ukuphuma kwesikhwehlela, ukushintsha izikhundla zomzimba njalo, nokunciphisa ukugcwala komoyampilo (<60%). Iziguli kuma-ventilators zingavinjelwa ngokungeza i-positive end-expiratory pressure (PEEP).

Inkinga 4: I-Retrolental fibrous tissue hyperplasia

Ukuvimbela nokwelashwa: Ngemva kokusebenzisa i-oksijini ene-concentrate ephezulu, ukucindezela kwengxenye ye-oxygen okweqile kwe-arterial (i-PaO2 ifinyelela ngaphezu kuka-140mmHg) iyisici esiyinhloko sengozi yokubangela i-retrolental fibrous tissue hyperplasia ezinganeni ezisanda kuzalwa (ikakhulukazi izinsana ezizalwa ngaphambi kwesikhathi). Ngakho-ke, ukugcwala komoyampilo kwezingane ezisanda kuzalwa kufanele kulawulwe ngokuqinile ngaphansi kwama-40%, futhi isikhathi sokuhogela komoyampilo kufanele silawulwe.

Inkinga 5: Ubuthi be-oksijini

Ukubonakaliswa komtholampilo:

• Izimpawu ze-pulmonary oxygen poisoning: ubuhlungu be-retrosternal, ukukhwehlela okomile kanye ne-dyspnea eqhubekayo, ukuncipha kwamandla abalulekile.
• Izimpawu ze-cerebral oxygen poisoning: ukukhubazeka kokubona nokuzwa, isicanucanu, ukudlikizela, i-syncope nezinye izimpawu zemizwa. Ezimweni ezimbi kakhulu, i-coma nokufa kungase kwenzeke.
• Ukubonakaliswa kobuthi be-ocular oxygen: i-retinal atrophy. Uma izinsana ezizalwa ngaphambi kwesikhathi zithatha umoya-mpilo isikhathi eside ku-incubator, i-retina izoba nokuvaleka okukhulu kwemithambo yegazi, ukungena kwe-fibroblast, kanye nokwanda kwe-fiber retrolental, okungaholela ebumpumputhe.