M’zaka zaposachedwapa, anthu ochulukirachulukira apereka chidwi kwambiri pa ntchito ya chithandizo cha okosijeni pazaumoyo. Kuchiza kwa okosijeni si njira yokhayo yofunikira yachipatala muzamankhwala, komanso njira yamankhwala apanyumba.
Kodi Oxygen Therapy ndi chiyani?
Thandizo la okosijeni ndi njira yachipatala yomwe imatsitsimutsa kapena kukonza hypoxic m'thupi mwa kuwonjezera kuchuluka kwa okosijeni mumpweya wokokedwa.
N'chifukwa chiyani mukufunikira mpweya?
Amagwiritsidwa ntchito makamaka pofuna kuthetsa mikhalidwe yomwe imachitika panthawi ya hypoxia, monga chizungulire, palpitations, chifuwa cha chifuwa, kutsekemera, etc. Amagwiritsidwanso ntchito pochiza matenda akuluakulu. Panthawi imodzimodziyo, mpweya ungathandizenso kuti thupi likhale lolimba komanso limalimbikitsa metabolism.
Zotsatira za Oxygen
Kukoka mpweya wa okosijeni kungathandize kuti mpweya wabwino wa magazi ukhale wabwino komanso kuti mpweya wa wodwalayo ubwerere mwakale mwamsanga. Nthawi zambiri amalimbikira mu chithandizo cha okosijeni, amatha kuchepetsa vutoli. Kuphatikiza apo, mpweya ukhoza kusintha magwiridwe antchito a minyewa ya wodwalayo, chitetezo chamthupi komanso kagayidwe kachakudya.
Contraindications ndi zizindikiro kwa mpweya
Palibe zotsutsana mtheradi pakukoka mpweya
Oxygen ndi oyenera hypoxemia pachimake kapena aakulu, monga: kutentha, matenda m`mapapo, COPD, congestive mtima kulephera, m`mapapo mwanga embolism, mantha ndi pachimake m`mapapo kuvulala, carbon monoxide kapena cyanide poizoni, mpweya embolism ndi zina.
Mfundo za oxygen
Mfundo za mankhwala: Oxygen iyenera kugwiritsidwa ntchito ngati mankhwala apadera pa chithandizo cha okosijeni, ndipo kuperekedwa kwa mankhwala kapena dongosolo la dokotala la mankhwala okosijeni.
De-scalation mfundo: Kwa odwala omwe ali ndi hypoxemia yoopsa yazifukwa zosadziwika, mfundo yochepetsera-kukwera iyenera kutsatiridwa, ndipo chithandizo cha okosijeni kuchokera ku ndende yotsika kwambiri mpaka kutsika kwambiri kuyenera kusankhidwa molingana ndi momwe zimakhalira.
Mfundo yokhazikika pazifukwa: Sankhani zomwe mukufuna kulandira mpweya wabwino malinga ndi matenda osiyanasiyana. Kwa odwala omwe ali pachiwopsezo chosunga mpweya woipa wa okosijeni, chandamale yokhazikika ya okosijeni ndi 88% -93%, ndipo kwa odwala omwe alibe chiwopsezo chosunga mpweya woipa wa carbon dioxide, cholinga chokhazikika cha oxygen ndi 94-98%.
Zomwe zimagwiritsidwa ntchito nthawi zambiri zida zopumira mpweya
- chubu la oxygen
Mpweya womwe umagwiritsidwa ntchito kwambiri pazachipatala, Gawo la voliyumu ya okosijeni lomwe limakokedwa ndi chubu la okosijeni limagwirizana ndi kuchuluka kwa mpweya wa okosijeni, koma chubu cha okosijeni sichingasungunuke mokwanira, ndipo wodwalayo sangathe kulekerera kuthamanga kwambiri kuposa 5L / min.
- Chigoba
- Chigoba wamba: Itha kupereka gawo louziridwa la okosijeni wa 40-60%, ndipo kuchuluka kwa mpweya kuyenera kukhala kosachepera 5L / min. Ndiwoyenera kwa odwala omwe ali ndi hypoxemia ndipo alibe chiopsezo cha hypercapnia.
- Kupumula pang'ono ndi masks osungirako okosijeni osapumiranso: Kwa masks opuma pang'ono ndi kusindikizidwa bwino, pamene mpweya wotuluka ndi 6-10L / min, gawo la voliyumu ya okosijeni wouziridwa likhoza kufika 35-60%. Kuthamanga kwa mpweya wa masks osapumira kuyenera kukhala osachepera 6L / min. Sali oyenera kwa omwe ali ndi chiopsezo chosunga CO2. kwa odwala omwe ali ndi matenda osatha a m'mapapo.
- Chigoba cha Venturi: Ndi chipangizo chosinthika chokwera kwambiri chomwe chimatha kupereka mpweya wokwanira 24%, 28%, 31%, 35%, 40% ndi 60%. Ndi oyenera odwala hypoxic ndi hypercapnia.
- Chida cha transnasal high flow oxygen therapy: Zipangizo zothandizira okosijeni za m'mphuno zimaphatikizapo makina a mpweya wa cannula ndi zosakaniza za oxygen. Izo makamaka ntchito pachimake kupuma kulephera, sequential mpweya mankhwala pambuyo extubation, bronchoscopy ndi zina olanda ntchito. Mu matenda ntchito kwambiri zoonekeratu zotsatira ndi odwala pachimake hypoxic kupuma kulephera.
Njira ya nasal oxygen tube operation
Malangizo ogwiritsira ntchito: Lowetsani pulagi ya m'mphuno pa chubu chokokera mpweya wa okosijeni m'mphuno, tembenuzani chubucho kuchokera kuseri kwa khutu kupita kutsogolo kwa khosi ndikuchiyika kukhutu.
Zindikirani: Oxygen imaperekedwa kudzera mu chubu cha mpweya wa oxygen pa liwiro lalikulu la 6L / min. Kuchepetsa kuthamanga kwa mpweya kumatha kuchepetsa kuchitika kwa kuuma kwa mphuno ndi kusamva bwino. Kutalika kwa chubu chokokera mpweya sikuyenera kukhala motalika kwambiri kuti chiteteze kuopsa kwa kukomoka ndi kukomoka.
Ubwino ndi Kuipa kwa Nasal Oxygen Cannula
Ubwino waukulu wa m'mphuno mpweya chubu mpweya mpweya mpweya ndi kuti ndi losavuta ndi yabwino, ndipo sikukhudza expectoration ndi kudya. Choyipa chake ndikuti kuchuluka kwa okosijeni sikukhazikika ndipo kumakhudzidwa mosavuta ndi kupuma kwa wodwalayo.
Momwe mungapezere okosijeni ndi chigoba wamba
Masks wamba alibe matumba osungira mpweya. Pali mabowo otulutsa mbali zonse za chigoba. Mpweya wozungulira ukhoza kuzungulira pokoka mpweya ndipo mpweya ukhoza kutulutsidwa pamene ukutuluka.
Zindikirani: Mapaipi osalumikizidwa kapena kuchepa kwa mpweya wa okosijeni kumapangitsa wodwalayo kuti alandire mpweya wokwanira ndikupumanso mpweya wotuluka. Choncho, chidwi chiyenera kuperekedwa ku kuyang'anitsitsa nthawi yeniyeni ndi kuthetsa mavuto omwe angabwere panthawi yake.
Ubwino wa okosijeni wokhala ndi masks wamba
Osakwiyitsa, kwa odwala omwe amapuma pakamwa
Itha kupereka mpweya wokhazikika wokhazikika
Kusintha kwa kapumidwe sikumasintha mayendedwe ouziridwa a oxygen
Imatha kunyowetsa okosijeni, kupangitsa kukwiya pang'ono kwa mucosa yamphuno
Mpweya wothamanga kwambiri ukhoza kulimbikitsa kuchotsa mpweya woipa wotuluka mu chigoba, ndipo kwenikweni palibe mpweya wobwerezabwereza wa carbon dioxide.
Njira ya okosijeni ya Venturi mask
Chigoba cha Venturi chimagwiritsa ntchito mfundo yosakanikirana ya jet kusakaniza mpweya wozungulira ndi mpweya. Posintha kukula kwa dzenje la oxygen kapena mpweya, mpweya wosakanikirana wa Fio2 wofunikira umapangidwa. Pansi pa chigoba cha Venturi chili ndi zolembera zamitundu yosiyanasiyana, zomwe zimayimira ma apertures osiyanasiyana.
ZINDIKIRANI: Masks a Venturi amapangidwa ndi mitundu yopangidwa ndi wopanga, kotero chisamaliro chapadera chimafunika kuti mukhazikitse bwino kuchuluka kwa mpweya wa okosijeni monga momwe zafotokozedwera.
High otaya nasal cannula njira
Perekani mpweya wothamanga kwambiri kuposa 40L / min, kugonjetsa mpweya wosakwanira wotuluka chifukwa cha cannulas wamba wamphuno ndi masks chifukwa cha kuchepa kwa kayendedwe kake. Mpweya wa okosijeni umatenthedwa komanso umanyowa pofuna kupewa kusokonezeka kwa odwala komanso kuvulala kwapachaka. Amachepetsa atelectasis ndikuwonjezera mphamvu yotsalira yogwira ntchito, kuwongolera kupuma bwino komanso kuchepetsa kufunikira kwa endotracheal intubation ndi mpweya wabwino wamakina.
Njira zogwirira ntchito: choyamba, gwirizanitsani chubu cha okosijeni ku payipi ya okosijeni ya chipatala, gwirizanitsani chubu cha mpweya ndi payipi ya mpweya wa chipatala, ikani mpweya wofunikira pa chosakaniza cha mpweya wa okosijeni, ndikusintha kuthamanga kwa mita yothamanga kuti mutembenuzire pamwamba. -flow nose Catheter imalumikizidwa ndi dera lopumira kuti liwonetsetse kuti mpweya wokwanira ukuyenda kudzera m'mphuno. Lolani mpweya kuti utenthe ndi kunyowa musanawonjeze wodwala, kuyika pulagi yamphuno m'mphuno ndi kuteteza cannula (nsonga sikuyenera kusindikiza mphuno)
Zindikirani: Musanagwiritse ntchito kansalu yamphuno yothamanga kwambiri kwa wodwala, iyenera kukhazikitsidwa motsatira malangizo a wopanga kapena motsogoleredwa ndi katswiri.
Chifukwa chiyani mumagwiritsa ntchito humidification pokoka mpweya?
Oxygen wamankhwala ndi okosijeni weniweni. Gasi ndi wouma ndipo alibe chinyezi. Oxygen youma adzakhumudwitsa wodwalayo chapamwamba kupuma thirakiti mucosa, mosavuta kuchititsa kusapeza wodwalayo, ndipo ngakhale kuwononga mucosal. Choncho, pofuna kupewa izi, botolo la humidification liyenera kugwiritsidwa ntchito popereka mpweya.
Ndi madzi ati omwe ayenera kuwonjezeredwa ku botolo la humidification?
Madzi a humidification ayenera kukhala madzi oyera kapena madzi ojambulira, ndipo akhoza kudzazidwa ndi madzi ozizira owiritsa kapena madzi osungunuka.
Ndi odwala ati omwe amafunikira chithandizo cha oxygen kwa nthawi yayitali?
Pakalipano, anthu omwe amatenga okosijeni kwa nthawi yayitali makamaka amaphatikizapo odwala omwe ali ndi hypoxia osatha chifukwa cha kulephera kwa mtima, monga odwala omwe ali ndi COPD yapakati ndi yotsiriza, mapeto a interstitial pulmonary fibrosis ndi kulephera kwapamtima kumanzere. Nthawi zambiri anthu okalamba ndi amene amadwala matendawa.
Kugawa kwa oxygen
Low otaya mpweya kupuma mpweya ndende 25-29%, 1-2L/mphindi, oyenera odwala hypoxia limodzi ndi carbon dioxide posungira, monga matenda obstructive m`mapapo mwanga matenda, mtundu II kupuma kulephera, cor pulmonale, m`mapapo mwanga edema, postoperative odwala, odwala ndi mantha, chikomokere kapena ubongo matenda, etc.
Sing'anga-otaya mpweya kupuma ndende 40-60%, 3-4L/mphindi, oyenera odwala omwe ali ndi hypoxia ndipo alibe carbon dioxide posungira
Mpweya wothamanga kwambiri wa okosijeni umakhala ndi mpweya wopitilira 60% komanso wopitilira 5L / min.. Ndiwoyenera kwa odwala omwe ali ndi hypoxia yoopsa koma osasunga mpweya woipa. Monga kupuma pachimake komanso kumangidwa kwa kuzungulira, matenda amtima obadwa nawo okhala ndi shunt kumanja kupita kumanzere, poizoni wa carbon monoxide, etc.
Nchifukwa chiyani mukufunikira mpweya pambuyo pa opaleshoni?
Anesthesia ndi ululu mosavuta kuchititsa zoletsa kupuma odwala ndi kutsogolera ku hypoxia, kotero wodwalayo ayenera kupatsidwa mpweya kuonjezera wodwalayo magazi mpweya pang`ono kuthamanga ndi machulukitsidwe, kulimbikitsa machiritso chilonda cha wodwalayo, ndi kupewa kuwonongeka kwa ubongo ndi m`mnyewa wamtima maselo. Chepetsani ululu wa pambuyo pa opaleshoni
Chifukwa chiyani musankhe mpweya wochepa wa oxygen panthawi ya chithandizo cha okosijeni kwa odwala omwe ali m'mapapo osatha?
Chifukwa matenda osachiritsika am'mapapo ndi vuto losalekeza la mpweya wotuluka m'mapapo chifukwa cha kuchepa kwa mpweya, odwala amakhala ndi magawo osiyanasiyana a hypoxemia ndi kusungidwa kwa carbon dioxide. Malinga ndi mfundo yopereka okosijeni “wodwala mpweya woipa wa carbon dioxide ukakwera, mpweya wocheperako uyenera kuperekedwa; pamene mpweya woipa wa carbon dioxide uli wabwinobwino kapena utachepa, mpweya wochuluka kwambiri ukhoza kuperekedwa.”
Chifukwa chiyani odwala omwe ali ndi vuto laubongo amasankha chithandizo cha okosijeni?
Thandizo la okosijeni lingathandize kusintha machiritso a odwala omwe ali ndi vuto la muubongo, kulimbikitsa kuchira kwa minyewa, kukonza ma cell edema ndi zotupa, kuchepetsa kuwonongeka kwa ma cell a minyewa ndi zinthu zapoizoni zomwe zimakhalapo monga ma radicals opanda okosijeni, ndikufulumizitsa kuchira kowonongeka. minofu ya ubongo.
Chifukwa chiyani mpweya wa oxygen?
“Poizoni” chifukwa chokoka mpweya wochuluka kuposa mmene thupi limafunira
Zizindikiro za poizoni wa okosijeni
Poyizoni wa okosijeni nthawi zambiri amawonekera m'mapapo, ndi zizindikiro monga edema ya m'mapapo, chifuwa, ndi kupweteka pachifuwa; chachiwiri, zikhoza kuwonetsanso ngati kusapeza bwino kwa maso, monga kuwonongeka kwa maso kapena kupweteka kwa maso. Pazovuta kwambiri, zidzakhudza dongosolo la mitsempha ndikuyambitsa matenda a ubongo. Kuonjezera apo, kupuma mpweya wochuluka kungathenso kukulepheretsani kupuma, kumayambitsa kupuma, ndi kuika moyo pachiswe.
Chithandizo cha oxygen kawopsedwe
Kupewa ndikwabwino kuposa kuchiza. Pewani chithandizo cha nthawi yayitali, chodzaza kwambiri ndi okosijeni. Zikachitika, choyamba tsitsani mpweya wa okosijeni. Chisamaliro chapadera chimafunika: chofunikira kwambiri ndikusankha molondola ndikuwongolera kuchuluka kwa okosijeni.
Kodi kupuma kwa oxygen pafupipafupi kungayambitse kudalira?
Ayi, mpweya ndi wofunikira kuti thupi la munthu lizigwira ntchito nthawi zonse. Cholinga cha mpweya wa okosijeni ndicho kupititsa patsogolo mpweya wabwino m’thupi. Ngati vuto la hypoxic likuyenda bwino, mutha kusiya kutulutsa mpweya ndipo sipadzakhala kudalira.
Chifukwa chiyani kupuma kwa oxygen kumayambitsa atelectasis?
Wodwala akamakoka mpweya wochuluka kwambiri, nitrogen yambiri mu alveoli imasinthidwa. Pakakhala kutsekeka kwa bronchial, mpweya womwe uli mu alveoli womwe uli wake umatengedwa mwachangu ndi magazi oyenda m'mapapo, zomwe zimapangitsa kuti atelectasis apume. Zimawonetsedwa ndi kukwiya, kupuma ndi kugunda kwa mtima. Imathandizira, kuthamanga kwa magazi kumakwera, ndiyeno mutha kupuma movutikira komanso chikomokere.
Njira zodzitetezera: Tengani mpweya wozama kuti mupewe kutsekeka kwa mpweya
Kodi minofu ya retrolental fibrous idzachuluka pambuyo pokoka mpweya?
Zotsatira zoyipazi zimangowoneka mwa ana obadwa kumene, ndipo zimafala kwambiri mwa ana obadwa msanga. Zimayamba makamaka chifukwa cha retinal vasoconstriction, retinal fibrosis, ndipo pamapeto pake zimayambitsa khungu losasinthika.
Njira zodzitetezera: Ana obadwa kumene akagwiritsa ntchito mpweya, mpweya wa okosijeni ndi nthawi yopuma mpweya uyenera kuyendetsedwa
Kodi kupuma maganizo ndi chiyani?
Ndizofala kwa odwala omwe ali ndi vuto la kupuma kwa mtundu wa II. Popeza kuthamanga pang'ono kwa mpweya woipa wa carbon dioxide wakhala pa mlingo wapamwamba kwa nthawi yaitali, malo opumira ataya mphamvu zake za carbon dioxide. Ichi ndi chikhalidwe chomwe kuwongolera kupuma kumasungidwa makamaka ndi kukondoweza kwa zotumphukira chemoreceptors ndi hypoxia. Izi zikachitika Odwala akapatsidwa mpweya wochuluka kwambiri kuti apume, mphamvu yolimbikitsa ya hypoxia pa kupuma idzamasuka, zomwe zidzakulitsa kukhumudwa kwa malo opuma komanso kuchititsa kupuma.
Njira zodzitetezera: Perekani mpweya wochepa, wochepetsetsa mosalekeza (oxygen kutuluka 1-2L / min) kwa odwala omwe ali ndi matenda a II kupuma kuti apitirize kupuma.
Chifukwa chiyani odwala omwe akudwala kwambiri amafunikira kupuma pang'ono panthawi yopuma mpweya wabwino?
Kwa iwo omwe ali ndi vuto lalikulu komanso hypoxia yovuta kwambiri, mpweya wothamanga kwambiri ukhoza kuperekedwa pa 4-6L / min. Izi mpweya ndende akhoza kufika 37-45%, koma nthawi sayenera upambana 15-30 mphindi. Ngati ndi kotheka, gwiritsaninso ntchito mphindi 15-30 zilizonse.
Chifukwa malo opumira a wodwala wotere samakhudzidwa kwambiri ndi kukondoweza kwa kusungidwa kwa mpweya woipa m'thupi, makamaka amadalira mpweya wa hypoxic kuti alimbikitse chemoreceptors ya thupi la aortic ndi carotid sinus kuti apitirize kupuma kudzera muzochita. Ngati wodwalayo apatsidwa mpweya wochuluka, hypoxic state Akatulutsidwa, kukondoweza kwa reflex kupuma ndi thupi la aortic ndi carotid sinus kumafooketsa kapena kutha, zomwe zingayambitse kupuma ndi kuika moyo pachiswe.
Nthawi yotumiza: Oct-23-2024