Umoya-mpilo ungenye yezinto ezisekela ukuphila
I-Mitochondria iyindawo ebaluleke kakhulu ye-oxidation yezinto eziphilayo emzimbeni. Uma izicubu ziyi-hypoxic, inqubo ye-phosphorylation ye-oxidative ye-mitochondria ayikwazi ukuqhubeka ngokujwayelekile. Ngenxa yalokho, ukuguqulwa kwe-ADP ku-ATP konakala futhi kunikezwa amandla anganele ukuze kugcinwe inqubekelaphambili evamile yemisebenzi ehlukahlukene yomzimba.
Ukunikezwa kwe-oxygen kwezicubu
Okuqukethwe komoyampilo we-arterialCaO2=1.39*Hb*SaO2+0.003*PaO2(mmHg)
Umthamo wokuthutha umoya-mpiloDO2=CO*CaO2
Isikhathi esinqunyiwe sokuthi abantu abajwayelekile babekezelele ukuboshwa kokuphefumula
Ngenkathi uphefumula umoya:3.5min
Lapho uphefumula 40% oxygen:5.0min
Lapho uphefumula i-oxygen engu-100%:11min
Ukushintshaniswa kwegesi yamaphaphu
Ukucindezela kwengxenye ye-oksijeni emoyeni(PiO2):21.2kpa(159mmHg)
Ukucindezela kwengxenye ye-oksijeni kumaseli wamaphaphu(PaO2):13.0kpa(97.5mmHg)
Ingcindezi yengxenye ye-venous ehlanganisiwe ye-oxygen(PvO2):5.3kpa(39.75mmHg)
Umfutho we-pulse oxygen olinganisiwe(PaO2):12.7kpa(95.25mmHg)
Izimbangela ze-hypoxemia noma ukuntuleka komoya-mpilo
- I-Alveolar hypoventilation(A)
- Ukungenisa komoya/i-perfusion(VA/Qc)Ukungalingani(a)
- Ukuncipha kokuhlakazeka(Aa)
- Ukwanda kokugeleza kwegazi kusuka kwesokudla kuye kwesokunxele shunt(Qs/Qt Yandiswa)
- I-Atmospheric hypoxia(I)
- I-congestive hypoxia
- I-anemic hypoxia
- I-hypoxia enobuthi yezicubu
Imikhawulo ye-physiological
Kukholelwa ukuthi i-PaO2 ingu-4.8KPa(36mmHg) ingumkhawulo wokuphila komzimba womuntu.
Izingozi ze-hypoxia
- Ubuchopho: Umonakalo ongenakulungiseka uzokwenzeka uma ukunikezwa komoyampilo kuyekwa imizuzu emi-4-5.
- Inhliziyo: Inhliziyo idla umoya-mpilo omningi kunobuchopho futhi iyona ezwela kakhulu
- Isistimu yezinzwa emaphakathi:Izwela, ayibekezeleleki kahle
- Ukuphefumula: I-edema yamaphaphu, i-bronchospasm, i-cor pulmonale
- Isibindi, izinso, nezinye: ukushintshwa kwe-acid, i-hyperkalemia, ukwanda kwevolumu yegazi
Izimpawu nezimpawu ze-hypoxia eyingozi
- Isistimu yokuphefumula: Ukuphefumula kanzima, i-pulmonary edema
- Inhliziyo: i-arrhythmia, i-angina pectoris, i-vasodilation, ukushaqeka
- Isimiso sezinzwa esimaphakathi: ukujabula, ikhanda elibuhlungu, ukukhathala, ukwahlulela okungalungile, ukuziphatha okungalungile, ukuvilapha, ukungahlaliseki, ukopha kweretina, ukudlikiza, ukuquleka.
- Izinzwa zemisipha: ubuthakathaka, ukuthuthumela, i-hyperreflexia, i-ataxia
- I-Metabolism: Ukugcinwa kwamanzi ne-sodium, i-acidosis
Izinga le-hypoxemia
Okumaphakathi:Ayikho i-cyanosis PaO2>6.67KPa(50mmHg); I-SaO2<90%
Okulingene:Cyanotic PaO2 4-6.67KPa(30-50mmHg); I-SaO2 60-80%
Kakhulu: I-cyanosis ephawulwe PaO2<4KPa(30mmHg); I-SaO2<60%
I-PvO2 I-Mixed venous oxygen partial pressure
I-PvO2 ingamela isilinganiso se-PO2 sethishu ngayinye futhi isebenze njengenkomba ye-thishu hypoxia.
Inani elivamile le-PVO2: 39±3.4mmHg.
<35mmHg izicubu hypoxia.
Ukukala i-PVO2, igazi kufanele lithathwe emthanjeni we-pulmonary noma i-atrium yangakwesokudla.
Izinkomba zokwelapha umoya-mpilo
I-Termo Isihara iphakamisa i-PaO2=8Kp(60mmHg)
I-PaO2<8Kp,Phakathi kuka-6.67-7.32Kp(50-55mmHg) Izinkomba zokwelashwa komoya-mpilo wesikhathi eside.
I-PaO2=7.3Kpa(55mmHg) Ukwelashwa komoyampilo kuyadingeka
Izinkombandlela Zokwelapha Nge-Oxygen Acute
Izinkomba ezamukelekayo:
- I-Acute hypoxemia(PaO2<60mmHg;SaO<90%)
- Ukushaya kwenhliziyo nokuphefumula kuyema
- I-Hypotension(Systolic blood pressure<90mmHg)
- Umphumela ophansi wenhliziyo kanye ne-metabolic acidosis(HCO3<18mmol/L)
- Ukucindezeleka kokuphefumula(R>24/min)
- I-CO Poisoning
Ukwehluleka ukuphefumula kanye nokwelashwa kwe-oxygen
Ukwehluleka ukuphefumula okunamandla: ukuhogela umoya-mpilo okungalawuleki
ARDS:Sebenzisa i-peep, qaphela ngobuthi komoyampilo
Ubuthi be-CO: i-hyperbaric oxygen
Ukwehluleka ukuphefumula okungapheli: ukwelashwa komoya-mpilo okulawulwayo
Izimiso ezintathu eziyinhloko zokwelashwa komoya-mpilo okulawulwayo:
- Esigabeni sokuqala sokuphefumula komoyampilo (isonto lokuqala), ukugcwala kwe-oxygen inhalation <35%
- Esigabeni sokuqala sokwelashwa komoya-mpilo, phefumula ngokuqhubekayo amahora angama-24
- Ubude besikhathi sokwelashwa: >3-4 amaviki→Ukuhogela umoya komoyampilo ngezikhathi ezithile (12-18h/d) * uhhafu wonyaka
→Ukwelashwa komoyampilo wasekhaya
Shintsha amaphethini we-PaO2 ne-PaCO2 ngesikhathi sokwelashwa kwe-oxygen
Ububanzi bokwanda kwe-PaCO2 ku-1 yokuqala ezinsukwini ze-3 zokwelashwa kwe-oxygen kuwukuhlobana okubuthakathaka okuhle kwe-PaO2 inani lokushintsha * 0.3-0.7.
I-PaCO2 ngaphansi kwezinzwa ze-CO2 icishe ibe ngu-9.3KPa (70mmHg).
Nyusa i-PaO2 iye ku-7.33KPa (55mmHg) phakathi namahora angu-2-3 okuphefumula komoyampilo.
Phakathi nesikhathi (izinsuku ezingu-7-21); I-PaCO2 yehla ngokushesha, futhi i-PaO2↑ ikhombisa ukuhlobana okunamandla okungalungile.
Esikhathini sakamuva (izinsuku ze-22-28), i-PaO2↑ ayibalulekile, futhi i-PaCO2 iyancipha futhi.
Ukuhlolwa Kwemiphumela Yokwelapha Nge-Oxygen
I-PaO2-PaCO2:5.3-8KPa(40-60mmHg)
Umphumela uyamangalisa: Umehluko>2.67KPa(20mmHg)
Umphumela owanelisayo wokwelapha:Umehluko ngu-2-2.26KPa(15-20mmHg)
Ukusebenza kabi: Umehluko<2KPa(16mmHg)
Ukuqapha nokuphathwa kwe-oxygen therapy
- Qaphela igesi yegazi, ukwazi, amandla, i-cyanosis, ukuphefumula, ukushaya kwenhliziyo, umfutho wegazi kanye nokukhwehlela.
- I-oksijeni kufanele ifakwe emanzini futhi ifudumale.
- Hlola ama-catheter kanye nokuvinjwa kwamakhala ngaphambi kokuhogela umoya-mpilo.
- Ngemuva kokuhogela umoya-mpilo kabili, amathuluzi okuphefumula komoyampilo kufanele akhuhlwe futhi abulawe amagciwane.
- Hlola imitha yokugeleza komoyampilo njalo, bulala amagciwane ebhodleleni lokuswakama futhi ushintshe amanzi nsuku zonke. Izinga le-liquid lingaba ngu-10cm.
- Kungcono ukuba nebhodlela lomswakama futhi ugcine izinga lokushisa lamanzi ku-70-80 degrees.
Izinzuzo kanye Nemibi
I-cannula yamakhala kanye nokucinana kwamakhala
- Izinzuzo: elula, elula; akuthinti iziguli, ukukhwehlela, ukudla.
- Ukungalungi: Ukugxila akuhlali njalo, kuthinteka kalula ukuphefumula; ukucasuka kolwelwesi lwamafinyila.
Imaski
- Izinzuzo: Ukugxilisa ingqondo kulinganiselwe futhi kukhona ukukhuthazwa okuncane.
- Ukubi: Kuthinta i-expectoration nokudla ngezinga elithile.
Izinkomba zokuhoxiswa komoyampilo
- Ukuzizwa unolwazi futhi uzizwa ungcono
- I-Cyanosis iyanyamalala
- I-PaO2>8KPa (60mmHg), i-PaO2 ayehli izinsuku ezi-3 ngemva kokuhoxiswa komoyampilo
- I-Paco2<6.67kPa (50mmHg)
- Ukuphefumula kulula
- I-HR iyancipha, i-arrhythmia iyathuthuka, futhi i-BP iba evamile. Ngaphambi kokuhoxisa umoya-mpilo, ukuhogela umoya-mpilo kufanele kuyekwe (amahora ayi-12-18/ngosuku) izinsuku ezingama-7-8 ukuze kubonwe izinguquko kumagesi egazi.
Izinkomba zokwelashwa komoya-mpilo isikhathi eside
- I-PaO2< 7.32KPa (55mmHg)/PvO2< 4.66KPa (55mmHg), isimo sizinzile, futhi igesi yegazi, isisindo, kanye ne-FEV1 akukashintshi kakhulu phakathi namaviki amathathu.
- I-bronchitis engapheli kanye ne-emphysema ene-FEV2 ngaphansi kwamalitha angu-1.2
- I-Nocturnal hypoxemia noma i-apnea syndrome yokulala
- Abantu abane-hypoxemia ebangelwa ukuzivocavoca noma i-COPD ekuxolelweni abafuna ukuhamba amabanga amafushane
Ukwelashwa komoya-mpilo isikhathi eside kuhilela ukuhogela umoya-mpilo okuqhubekayo izinyanga eziyisithupha kuya eminyakeni emithathu
Imiphumela emibi kanye nokuvimbela ukwelashwa kwe-oxygen
- Ubuthi be-oksijini: Ubuningi obuphephile bokugxila ekuhogeleni komoyampilo ngu-40%. Ubuthi be-oksijeni bungenzeka ngemva kokudlula u-50% amahora angu-48. Ukuvimbela: Gwema ukudonsa umoya komoya-mpilo okugxilwe kakhulu isikhathi eside.
- I-Atelectasis: Ukuvimbela: Lawula ukugcwala komoyampilo, khuthaza ukuphenduka kaningi, shintsha ukuma komzimba, futhi ukhuthaze ukuphuma kwesikhwehlela.
- Ukukhishwa kokuphefumula okomile: Ukuvimbela: Qinisa ukumswakama kwegesi ehogeliwe futhi uhogele i-aerosol njalo.
- I-posterior lens fibrous tissue hyperplasia: ibonakala kuphela ezinsaneni ezisanda kuzalwa, ikakhulukazi izingane ezisanda kuzalwa ngaphambi kwesikhathi. Ukuvimbela: Gcina ukuhlushwa komoyampilo ngaphansi kuka-40% futhi ulawule i-PaO2 ku-13.3-16.3KPa.
- Ukucindezeleka kokuphefumula: kubonakala ezigulini ezine-hypoxemia kanye nokugcinwa kwe-CO2 ngemva kokuhogela ukugxila okuphezulu komoyampilo. Ukuvimbela: I-oxygenation eqhubekayo ekugelezeni okuphansi.
Ukudakwa komoyampilo
Umqondo: Umthelela onobuthi kumaseli ezicubu obangelwa ukuhogela umoya-mpilo ku-0.5 umfutho womkhathi ubizwa ngokuthi ubuthi be-oxygen.
Ukuvela kobuthi be-oxygen kuncike ekucindezelweni okuyingxenye komoya-mpilo kunokugxilisa umoya-mpilo
Uhlobo Lokudakwa Kweoksijini
Ubuthi be-oksijeni yamaphaphu
Isizathu: Hogela umoya-mpilo cishe endaweni eyodwa yokucindezela amahora angu-8
Ukubonakaliswa komtholampilo: ubuhlungu be-retrosternal, ukukhwehlela, i-dyspnea, ukunciphisa amandla abalulekile, nokuncipha kwe-PaO2. Amaphaphu abonisa izilonda ezivuthayo, ngokungena kwamangqamuzana okuvuvukala, ukuminyana, i-edema kanye ne-atelectasis.
Ukuvimbela nokwelashwa: lawula ukugxila kanye nesikhathi sokuhogela umoya-mpilo
Ubuthi be-cerebral oxygen
Isizathu: Ukuhogela umoya-mpilo ngaphezu kwama-atmospheres angu-2-3
Ukubonakaliswa komtholampilo: ukukhubazeka kokubona nokuzwa, isicanucanu, ukudlikizela, ukuquleka kanye nezinye izimpawu zemizwa. Ezimweni ezimbi kakhulu, i-coma nokufa kungase kwenzeke.
Isikhathi sokuthumela: Dec-12-2024