Waba uzi guhumeka ogisijeni?

Urubanza no gutondekanya Hypoxia

Kuki hariho hypoxia?

Oxygene ningingo nyamukuru ikomeza ubuzima. Iyo uturemangingo tutabonye ogisijene ihagije cyangwa bikagira ikibazo cyo gukoresha ogisijeni, bigatera impinduka zidasanzwe mumikorere ya metabolike yumubiri, iki kibazo cyitwa hypoxia.

Shingiro ryo guca hypoxia

Impamyabumenyi ya Hypoxia n'ibimenyetso

Ibyiciro bya hypoxia

Umwuka muke wa ogisijeni muri gaze ihumeka, imikorere mibi yo guhumeka hanze, imitsi iva mu mitsi, nibindi bikunze kugaragara mu ndwara zidakira zifata ibihaha n'indwara z'umutima zavutse nka tetralogi ya Fallot.

Kugabanya umubare cyangwa guhindura ibintu bya hemoglobine, nka anemia, uburozi bwa monoxyde de carbone, na methemoglobinemia.

hypoxia

hypoxia organisation

Biterwa no gukoresha bidasanzwe ogisijeni na selile tissue, nk'uburozi bwa cyanide.

Oxygene ihumeka ivura nintego yayo

Mubihe bisanzwe, abantu bazima bahumeka umwuka muburyo busanzwe kandi bagakoresha ogisijeni muri yo kugirango bakomeze metabolike. Iyo uburwayi cyangwa ibintu bimwe na bimwe bidasanzwe biganisha kuri hypoxia mu mubiri, ibikoresho bimwe na bimwe bigomba gukoreshwa mu guha ogisijene umurwayi, kongera umuvuduko wa ogisijeni wa arterial igice (PaO2) no kwiyuzuza ogisijeni (SaO2), kunoza hypoxia, guteza imbere metabolisme, no gukomeza ubuzima. Igikorwa.

Inyungu zo guhumeka umwuka wa ogisijeni

• Kuraho angina pectoris kandi wirinde indwara ya myocardial
• Irinde urupfu rutunguranye indwara z'umutima
• Kuvura neza asima
• Kuvura neza emphysema, indwara z'umutima, na bronhite idakira
• Guhumeka Oxygene bifite ingaruka zifasha kuvura diyabete: ubushakashatsi buriho bwerekana ko diyabete ifitanye isano no kubura umubiri wa ogisijeni. Abarwayi ba diyabete bafite umuvuduko ukabije wa capillary, kandi selile ntizishobora kubona ogisijeni yuzuye, bigatuma imikorere mibi ya selile na glucose metabolism. Kubera iyo mpamvu, ishyirwa mu bikorwa ry’ubuvuzi bwa ogisijeni ku barwayi ba diyabete ryashimishije abaganga.
• Guhumeka umwuka wa Oxygene birashobora kugira uruhare mu kwita ku buzima ku bantu bafite ubuzima bwiza: kwanduza ikirere, gukoresha uburyo bwo guhumeka ikirere, guhumeka umwuka wa ogisijeni buri gihe birashobora kweza sisitemu y’ubuhumekero, kunoza imikorere y’imbere, kongera ubudahangarwa bw’umubiri, no kwirinda indwara zitandukanye.

Ni ubuhe buryo bwo kuvura ogisijeni?

• Gutanga umwuka mwinshi wa ogisijeni (5-8L / min): Ikoreshwa mu kunanirwa gukabije k'ubuhumekero nko gufata imyanya y'ubuhumekero n'umutima, syndrome de syndrome de acide de l'homatique, uburozi bukabije (nk'uburozi bwa karubone monoxide cyangwa uburozi bwa gaze) ihungabana ry'ubuhumekero, n'ibindi, aho, kwibanda cyane cyangwa ogisijeni yuzuye igomba gukoreshwa buri segonda kugirango itabare, ariko ntibikwiriye gukoreshwa igihe kirekire. kwirinda uburozi bwa ogisijeni cyangwa izindi ngorane.
• Gutanga umwuka wa ogisijeni uciriritse (3-4L / min): Birakwiriye ku barwayi bafite ikibazo cyo kubura amaraso make, kubura umutima, guhungabana, n'ibindi badafite amategeko abuza kwibanda ku mwuka wa ogisijeni uhumeka.
• Gutanga umwuka wa ogisijeni muke (1-2L / min): Mubisanzwe bikoreshwa muri bronchite idakira, emphysema, indwara z'umutima, nibindi bizwi kandi ko ari indwara idakira. Umuvuduko ukabije w'amaraso wa ogisijeni igice gishobora kugabanya imbaraga zo gukurura imitsi ya sinus ya karotide mu kigo cy’ubuhumekero, bityo bikagabanya guhumeka no kongera imyuka ya dioxyde de carbone. birashoboka. Kubwibyo rero, umwuka wa ogisijeni ugomba gukoreshwa witonze, kandi guhumeka umwuka wa ogisijeni ukomeza gukoreshwa muri rusange.

Ubwinshi bwa Oxygene hamwe na ogisijeni itemba

Ubwinshi bwa Oxygene: Umubare wa ogisijeni uri mu kirere. Umwuka wa ogisijeni mu kirere gisanzwe ni 20,93%

• Umwuka muke wa ogisijeni <35%
• Hagati ya ogisijeni yo hagati 35% -60%
• Umwuka mwinshi wa ogisijeni> 60%

Imisemburo ya Oxygene: bivuga umuvuduko wa ogisijeni wahinduwe ku barwayi, igice L / min.

Oxygene yibanze ya ogisijeni ihinduka

• Urumogi rwo mu mazuru, ubwinshi bw'amazuru: Ubunini bwa Oxygene (%) = 21 + 4X umwuka wa ogisijeni (L / min)
• Isoko ya ogisijeni itanga (ifunguye kandi ifunze): umuvuduko utemba ugomba kuba urenze 6 L / min
• Ubuhumekero bworoshye: umuvuduko wa ogisijeni 6 L / min, umwuka wa ogisijeni uhumeka hafi 46% -60%
• Ventilator: Oxygene yibanze = 80X ya ogisijeni itemba (L / min) / ingano yumuyaga + 20

Itondekanya rya ogisijeni ivura-Ukurikije uburyo bwo gutanga ogisijeni

Ibintu ugomba kumenya mugihe ukoresheje ogisijeni

• Gukoresha neza ogisijeni: Shyira mu bikorwa neza “bine birinda”: ​​gukumira umutingito, gukumira inkongi y'umuriro, kwirinda ubushyuhe, no kwirinda amavuta. Nibura metero 5 uvuye ku ziko na metero 1 uvuye gushyushya. Umwuka wa ogisijeni ntushobora gukoreshwa. Iyo icyerekezo cyerekana umuvuduko wa 5kg / cm2, ntigishobora kongera gukoreshwa.
• Kurikiza byimazeyo inzira ya ogisijeni ikora: Mugihe ukoresheje ogisijeni, ugomba kubanza kuyikoresha. Iyo uhagaze, banza ukure catheter hanyuma uzimye ogisijeni. Mugihe uhinduye umuvuduko uri hagati, ugomba kubanza gutandukanya ogisijeni na catheter ya mazuru, ugahindura umuvuduko mbere yo guhuza.
• Reba ingaruka zo gukoresha ogisijeni: cyanose iragabanuka, umuvuduko wumutima uratinda kurusha mbere, dyspnea iraruhuka, imitekerereze iratera imbere, hamwe nibigenda byerekana ibimenyetso bitandukanye byo gusesengura gazi yamaraso, nibindi.
• Hindura urumogi rwamazuru hamwe nigisubizo cyumunsi buri munsi (1 / 3-1 / 2 byuzuye amazi yatoboye cyangwa sterile)
• Menya neza ko byihutirwa: silinderi idakoreshwa cyangwa irimo ubusa igomba kumanikwa hamwe nibimenyetso "byuzuye" cyangwa "ubusa".

Ibyingenzi byingenzi byo guhumeka umwuka wa ogisijeni

• Witegereze neza ingaruka zo kuvura ogisijeni: Niba ibimenyetso nka dyspnea bigabanutse cyangwa byoroheje, kandi umutima utera ni ibisanzwe cyangwa wegereye ibisanzwe, byerekana ko kuvura ogisijeni bifite akamaro. Bitabaye ibyo, impamvu igomba kuboneka no gukemurwa mugihe.
• Umwuka mwinshi wa ogisijeni ntugomba gutangwa igihe kirekire. Muri rusange abantu bemeza ko niba umwuka wa ogisijeni ari> 60% kandi ugakomeza amasaha arenga 24, uburozi bwa ogisijeni burashobora kubaho.
• Ku barwayi bafite ubukana bukabije bw'indwara zidakira zifata ibihaha, hagomba gutangwa muri rusange (ni ukuvuga ubukana buke buke).
• Witondere gushyushya no gukonjesha: Kugumana ubushyuhe bwa 37 ° C hamwe nubushuhe bwa 95% kugeza 100% mumyanya yubuhumekero nikintu gikenewe kugirango imikorere isanzwe yimikorere ya mucociliary.
• Irinde kwanduza no guhagarika imiyoboro: Ibintu bigomba guhinduka no gusukurwa no kwanduzwa buri gihe kugirango wirinde kwandura. Catheters hamwe nizuru ryizuru bigomba kugenzurwa umwanya uwariwo wose kugirango harebwe niba byahagaritswe namasohoro kandi bigasimburwa mugihe kugirango habeho kuvura neza ogisijeni.

Ibipimo byo gukumira no kuvura ibibazo bisanzwe biterwa no guhumeka umwuka wa ogisijeni

Ingorabahizi 1: Amaso yumye

Kwirinda no kuvura: Umwuka wa ogisijeni uva mu bikoresho bitanga umwuka wa ogisijeni urumye. Nyuma yo guhumeka, irashobora gukama mucosa yubuhumekero no gutuma ururenda rwuma kandi bigoye gusohoka. Amazi yamenetse agomba kongerwamo icupa ry’amazi, kandi hagomba kongerwamo amazi meza kugirango umwuka wa ogisijeni ugabanuke.

Ingorabahizi 2: Kwiheba

Kwirinda no kuvura: Mugihe cya hypoxemia, igabanuka rya PaO2 rirashobora gukurura imiti ya chimoreceptors ya periferique, gushimisha byimazeyo ikigo cyubuhumekero, no kongera umwuka uhumeka. Niba umurwayi yishingikirije kuri ibyo byishimo kugirango akomeze guhumeka igihe kirekire (nk'abarwayi bafite indwara z'umutima zifata ibihaha ndetse no kunanirwa mu myanya y'ubuhumekero ya II), guhumeka umwuka wa ogisijeni mwinshi bishobora gukuraho ubwo buryo bwa refleks, bikabuza guhumeka bidatinze, ndetse bigatera no guhumeka guhagarara . Niyo mpamvu, birakenewe gutanga umuvuduko muke, ogisijeni igenzurwa cyane no kugenzura impinduka muri PaO2 kugirango PaO2 yumurwayi igere kuri 60mmHg.

Ingorabahizi 3: Aborptive atelectasis

Kwirinda no kuvura: Nyuma yuko umurwayi ahumeka umwuka wa ogisijeni mwinshi, azote nyinshi muri alveoli irasimburwa. Iyo bronchus imaze guhagarikwa, umwuka wa ogisijeni uri muri alveoli urashobora kwinjizwa vuba n’amaraso atembera, bigatuma alveoli isenyuka kandi igatera atelectasis. Kubwibyo, gukumira inzitizi zubuhumekero ningenzi. Mu ngamba zirimo gushishikariza abarwayi guhumeka neza no gukorora, gushimangira imyanda, guhindura imyanya y'umubiri kenshi, no kugabanya umwuka wa ogisijeni (<60%). Abarwayi kuri ventilateur barashobora gukumirwa hiyongereyeho igitutu cyiza-kirangira (PEEP).

Ingorabahizi 4: Retrolental fibrous tissue hyperplasia

Kwirinda no kuvura: Nyuma yo gukoresha ogisijeni yibanda cyane, umuvuduko ukabije wa ogisijeni wa arterial (PaO2 igera kuri 140mmHg) nimpamvu nyamukuru itera ibyago byo gutera fibrous tissue hyperplasia yibana bavutse (cyane cyane impinja zitaragera). Kubwibyo rero, umwuka wa ogisijeni ukivuka ugomba kugenzurwa cyane munsi ya 40%, kandi igihe cyo guhumeka umwuka wa ogisijeni kigomba kugenzurwa.

Ingorane 5: Uburozi bwa Oxygene

Kugaragara kwa Clinical:

• Ibimenyetso byuburozi bwa ogisijeni ihumeka: ububabare bwinyuma, inkorora yumye hamwe na dyspnea igenda itera imbere, kugabanya imbaraga zingenzi
• Ibimenyetso byuburozi bwubwonko bwubwonko: ubumuga bwo kutabona no kutumva, isesemi, guhungabana, syncope nibindi bimenyetso byubwonko. Mu bihe bikomeye, koma n'urupfu birashobora kubaho.
• Kugaragaza uburozi bwa ocular okisijene: retinal atrophy. Niba impinja zidashyitse zifata ogisijeni igihe kinini muri incubator, retina izaba ifite imiyoboro myinshi yamaraso, fibroblast infiltration, hamwe no gukwirakwiza fibre retrolental, bishobora gutera ubuhumyi.