nkhani

Thandizo la okosijeni ndi imodzi mwa njira zomwe zimagwiritsidwa ntchito kwambiri m'mankhwala amakono, komabe pali malingaliro olakwika okhudza momwe angapangire chithandizo cha okosijeni, ndipo kugwiritsa ntchito mpweya molakwika kumatha kuyambitsa poizoni.

Kuwunika kwachipatala kwa minofu hypoxia

Mawonetseredwe azachipatala a minofu hypoxia ndi osiyanasiyana komanso osakhala enieni, omwe ali ndi zizindikiro zodziwika kwambiri monga kukomoka, kupuma movutikira, tachycardia, kupuma movutikira, kusintha kwachangu m'maganizo, ndi arrhythmia. Kuti mudziwe kukhalapo kwa minofu (visceral) hypoxia, serum lactate (yokwera panthawi ya ischemia ndi kuchepetsa kutulutsa mtima kwa mtima) ndi SvO2 (yotsika panthawi yomwe mtima umatulutsa, kuchepa kwa magazi m'thupi, arterial hypoxemia, ndi kuchuluka kwa kagayidwe kachakudya) ndizothandiza pakuwunika kwachipatala. Komabe, lactate imatha kukwezedwa m'malo osakhala a hypoxic, kotero kuti sangadziwike potengera kukwera kwa lactate, chifukwa lactate imathanso kukwezedwa pakachulukidwe ka glycolysis, monga kukula mwachangu kwa zotupa zowopsa, sepsis koyambirira, kusokonezeka kwa kagayidwe kachakudya, ndi ma catecholamines. Mfundo zina za labotale zomwe zimasonyeza kusagwira ntchito kwa chiwalo chapadera ndizofunikanso, monga kukwezeka kwa creatinine, troponin, kapena ma enzymes a chiwindi.

Kuwunika kwachipatala kwa arterial oxygenation status

Cyanosis. Cyanosis kawirikawiri ndi chizindikiro chomwe chimapezeka kumapeto kwa hypoxia, ndipo nthawi zambiri zimakhala zosadalirika pozindikira hypoxemia ndi hypoxia chifukwa sizingachitike mu kuchepa kwa magazi m'thupi komanso kutsekemera kwa magazi, ndipo zimakhala zovuta kuti anthu omwe ali ndi khungu lakuda azindikire cyanosis.

Kuwunika kwa pulse oximetry. Non invasive pulse oximetry monitoring yakhala ikugwiritsidwa ntchito kwambiri powunika matenda onse, ndipo akuti SaO2 yake imatchedwa SpO2. Mfundo ya pulse oximetry monitoring ndi lamulo la Bill, lomwe limati kuchuluka kwa chinthu chosadziwika mu njira yothetsera vutoli kungadziwike ndi kuyamwa kwake kwa kuwala. Kuwala kukadutsa m’minyewa iliyonse, zambiri zimatengedwa ndi zinthu za m’minyewayo komanso magazi ake. Komabe, ndi kugunda kwa mtima kulikonse, magazi amtundu wamagazi amapita ku pulsatile flow, kulola kuti pulse oximetry monitor izindikire kusintha kwa kuyamwa kwa kuwala pamafunde awiri: 660 nanometers (wofiira) ndi 940 nanometers (infrared). Mayamwidwe a hemoglobin yochepetsedwa ndi hemoglobin wokhala ndi okosijeni ndi wosiyana pamafunde awiriwa. Pambuyo pochotsa kuyamwa kwa minyewa yopanda pulsatile, kuchuluka kwa hemoglobin wokhala ndi okosijeni poyerekeza ndi hemoglobin yonse kumatha kuwerengedwa.

Pali zoletsa zina pakuwunika pulse oximetry. Chilichonse m'magazi chomwe chimayamwa mafundewa amatha kusokoneza kulondola kwa kuyeza, kuphatikiza hemoglobinopathies - carboxyhemoglobin ndi methemoglobinemia, methylene buluu, ndi mitundu ina ya hemoglobin. Kuyamwa kwa carboxyhemoglobin pa utali wa ma nanometers 660 n'kofanana ndi hemoglobini ya okosijeni; Kuyamwa pang'ono kwambiri pamtunda wa 940 nanometers. Choncho, mosasamala kanthu za kuchuluka kwa carbon monoxide saturated hemoglobin ndi oxygen saturated hemoglobin, SpO2 idzakhalabe yokhazikika (90% ~ 95%). Mu methemoglobinemia, chitsulo cha heme chikakhala ndi okosijeni kupita ku ferrous state, methemoglobin imafanana ndi mayamwidwe amitundu iwiri ya mafunde. Izi zimapangitsa kuti SpO2 ikhale yosiyana mkati mwa 83% mpaka 87% mkati mwa kuchuluka kwa methemoglobin. Pachifukwa ichi, mafunde anayi a kuwala amafunikira kuti muyeso wa okosijeni wa magazi uzitha kusiyanitsa mitundu inayi ya hemoglobini.

Kuwunika kwa pulse oximetry kumadalira kuthamanga kwa magazi kokwanira; Choncho, kuwunika kwa pulse oximetry sikungagwiritsidwe ntchito pogwedeza hypoperfusion kapena kugwiritsa ntchito zipangizo zopanda pulsatile ventricular assist (kumene kutulutsa mtima kumangotengera gawo laling'ono la kutulutsa mtima). Mu tricuspid regurgitation kwambiri, kuchuluka kwa deoxyhemoglobin m'magazi a venous kumakhala kwakukulu, ndipo kugunda kwa magazi a venous kumatha kupangitsa kuti magazi azikhala ochepa. Mu arterial hypoxemia (SaO2 <75%), kulondola kungachepetsenso chifukwa njirayi siinayambe yatsimikiziridwa mkati mwa izi. Pomaliza, anthu ochulukirachulukira akuzindikira kuti kuwunika kwa pulse oximetry kumatha kukulitsa kuchuluka kwa hemoglobin yamagazi mpaka 5-10 peresenti, kutengera chipangizo chomwe chimagwiritsidwa ntchito ndi anthu akhungu lakuda.

PaO2/FIO2. Chiŵerengero cha PaO2/FIO2 (chomwe chimatchedwa kuti P / F chiŵerengero, kuyambira 400 mpaka 500 mm Hg) chimasonyeza kuchuluka kwa kusinthana kwa oxygen m'mapapo, ndipo n'kothandiza kwambiri pankhaniyi chifukwa mpweya wabwino umatha kukhazikitsa FIO2 molondola. Chiyerekezo cha AP/F chochepera 300 mm Hg chikuwonetsa zovuta zakusinthana kwa gasi, pomwe chiyerekezo cha P/F chochepera 200 mm Hg chikuwonetsa hypoxemia yoopsa. Zomwe zimakhudza chiŵerengero cha P / F zikuphatikizapo makonzedwe a mpweya wabwino, kuthamanga kwa mpweya wabwino, ndi FIO2. Zotsatira za kusintha kwa FIO2 pa chiŵerengero cha P/F zimasiyanasiyana malinga ndi mtundu wa kuvulala kwamapapu, kachigawo kakang'ono ka shunt, ndi kusintha kwa FIO2. Popanda PaO2, SpO2/FIO2 ikhoza kukhala njira ina yololera.

Alveolar arterial oxygen partial pressure (Aa PO2) kusiyana. Muyezo wosiyanitsa wa Aa PO2 ndi kusiyana pakati pa kuthamanga pang'ono kwa okosijeni wa alveolar ndi kuthamanga pang'ono kwa okosijeni, komwe kumagwiritsidwa ntchito kuyeza mphamvu ya kusinthana kwa mpweya.

Kusiyana "kwabwinobwino" kwa Aa PO2 pakupuma mpweya wozungulira panyanja kumasiyanasiyana ndi zaka, kuyambira 10 mpaka 25 mm Hg (2.5+0.21 x zaka [zaka]). Chachiwiri chochititsa chidwi ndi FIO2 kapena PAO2. Ngati chimodzi mwazinthu ziwirizi chikuwonjezeka, kusiyana kwa Aa PO2 kudzawonjezeka. Izi ndichifukwa choti kusinthana kwa gasi m'magawo a alveolar kumapezeka m'chigawo cha flatter (malo otsetsereka) a hemoglobin oxygen dissociation curve. Pansi pa mlingo womwewo wa kusanganikirana kwa venous, kusiyana kwa PO2 pakati pa magazi osakanikirana a venous ndi magazi a mitsempha kumawonjezeka. M'malo mwake, ngati alveolar PO2 ndi yochepa chifukwa cha mpweya wokwanira kapena kukwera kwapamwamba, kusiyana kwa Aa kudzakhala kochepa kusiyana ndi nthawi zonse, zomwe zingayambitse kuperewera kapena kusazindikira bwino kwa pulmonary dysfunction.

Oxygenation index. Oxygenation index (OI) angagwiritsidwe ntchito mwa odwala omwe ali ndi mpweya wokwanira kuti awone momwe mpweya umafunikira kuti ukhale ndi mpweya wabwino. Zimaphatikizapo kuthamanga kwa mpweya (MAP, mu masentimita H2O), FIO2, ndi PaO2 (mu mm Hg) kapena SpO2, ndipo ngati kupitirira 40, kungagwiritsidwe ntchito ngati muyeso wa extracorporeal membrane oxygenation therapy. Mtengo wabwinobwino wosakwana 4 cm H2O/mm Hg; Chifukwa cha yunifolomu ya masentimita H2O/mm Hg (1.36), mayunitsi nthawi zambiri samaphatikizidwa pofotokoza chiŵerengerochi.

Zizindikiro pachimake mpweya mankhwala
Odwala akamavutika kupuma, nthawi zambiri amafunikira oxygen supplementation asanazindikire kuti ali ndi hypoxemia. Pamene kupanikizika pang'ono kwa okosijeni (PaO2) kumakhala pansi pa 60 mm Hg, chisonyezero chodziwika bwino cha kutengeka kwa okosijeni ndi hypoxemia ya arterial hypoxemia, yomwe imafanana ndi mpweya wa okosijeni (SaO2) kapena peripheral oxygen saturation (SpO2) ya 89% mpaka 90%. PaO2 ikatsika pansi pa 60 mm Hg, kuchulukitsidwa kwa okosijeni m'magazi kumatha kuchepa kwambiri, zomwe zimapangitsa kuti pakhale kuchepa kwakukulu kwa okosijeni wam'magazi ndikupangitsa kuti minofu hypoxia iwonongeke.

Kuphatikiza pa arterial hypoxemia, kuwonjezera kwa okosijeni kungakhale kofunikira nthawi zina. Kuperewera kwa magazi m'thupi, kuvulala, komanso odwala opaleshoni amatha kuchepetsa hypoxia ya minofu powonjezera mpweya wa okosijeni. Kwa odwala omwe ali ndi poizoni wa carbon monoxide (CO) , kuwonjezera mpweya wa okosijeni kungapangitse mpweya wosungunuka m'magazi, m'malo mwa CO womangidwa ku hemoglobini, ndikuwonjezera gawo la hemoglobin ya okosijeni. Pambuyo pokoka mpweya wabwino, theka la moyo wa carboxyhemoglobin ndi mphindi 70-80, pomwe theka la moyo pakupuma mpweya wozungulira ndi mphindi 320. Pansi pa zinthu za okosijeni wa hyperbaric, theka la moyo wa carboxyhemoglobin umafupikitsidwa mpaka mphindi zosakwana 10 mutakoka mpweya wabwino. Mpweya wa hyperbaric nthawi zambiri umagwiritsidwa ntchito ngati pali kuchuluka kwa carboxyhemoglobin (> 25%), mtima wa ischemia, kapena kusokonezeka kwamalingaliro.

Ngakhale kusowa kwa deta yothandizira kapena deta yolakwika, matenda ena angapindulenso ndi kuwonjezera mpweya. Thandizo la okosijeni nthawi zambiri limagwiritsidwa ntchito pamutu wa masango, vuto la ululu wa cellle cell, mpumulo wa kupuma popanda hypoxemia, pneumothorax, ndi mediastinal emphysema (kupititsa patsogolo kuyamwa kwa mpweya pachifuwa). Pali umboni wosonyeza kuti kuphatikizika kwa okosijeni wambiri kumatha kuchepetsa kuchuluka kwa matenda pamalo opangira opaleshoni. Komabe, kuwonjezera mpweya sikukuwoneka kuti kumachepetsa nseru/kusanza kwapambuyo pa opaleshoni.

Ndi kusintha kwa mphamvu yoperekera mpweya kwa odwala kunja, kugwiritsa ntchito mankhwala a oxygen kwa nthawi yayitali (LTOT) akuwonjezekanso. Miyezo yogwiritsira ntchito chithandizo cha okosijeni kwa nthawi yayitali ndi yomveka bwino. Chithandizo cha nthawi yayitali cha okosijeni chimagwiritsidwa ntchito kwambiri pa matenda osachiritsika a pulmonary (COPD).
Maphunziro awiri pa odwala omwe ali ndi hypoxemic COPD amapereka deta yothandizira LTOT. Kafukufuku woyamba anali Nocturnal Oxygen Therapy Trial (NOTT) yomwe inachitidwa mu 1980, momwe odwala adapatsidwa mwachisawawa usiku (osachepera maola 12) kapena mankhwala opitirira oxygen. Pa miyezi 12 ndi 24, odwala omwe amangolandira chithandizo cha okosijeni usiku amakhala ndi chiwopsezo chachikulu cha kufa. Kuyesera kwachiwiri kunali Medical Research Council Family Trial yomwe inachitidwa mu 1981, momwe odwala adagawidwa mwachisawawa m'magulu awiri: omwe sanalandire mpweya kapena omwe adalandira mpweya kwa maola osachepera 15 patsiku. Mofanana ndi mayeso a NOTT, chiwerengero cha imfa mu gulu la anaerobic chinali chokwera kwambiri. Mitu ya mayesero onsewa anali odwala osasuta omwe adalandira chithandizo chokwanira ndipo anali ndi zikhalidwe zokhazikika, ndi PaO2 pansi pa 55 mm Hg, kapena odwala omwe ali ndi polycythemia kapena matenda a mtima a pulmonary omwe ali ndi PaO2 pansi pa 60 mm Hg.

Zoyeserera ziwirizi zikuwonetsa kuti kuwonjezera mpweya kwa maola opitilira 15 patsiku ndikwabwino kuposa kusapeza mpweya, ndipo chithandizo cha okosijeni mosalekeza ndikwabwino kuposa kuchiza usiku. Njira zophatikizira zamayeserowa ndiye maziko amakampani a inshuwaransi yachipatala ndi ATS kupanga malangizo a LTOT. Ndizomveka kunena kuti LTOT imavomerezedwanso ku matenda ena a hypoxic mtima, koma pakali pano palibe umboni woyesera woyenerera. Kafukufuku waposachedwa wa multicenter sanapeze kusiyana pakati pa zotsatira za chithandizo cha okosijeni pa kufa kapena moyo wabwino kwa odwala COPD omwe ali ndi hypoxemia omwe sanakwaniritse zopumula kapena amangochitika chifukwa chochita masewera olimbitsa thupi.

Nthaŵi zina madokotala amapereka mankhwala owonjezera okosijeni usiku kwa odwala amene amatsika kwambiri m’magazi akamagona. Pakalipano palibe umboni woonekeratu wochirikiza kugwiritsa ntchito njirayi kwa odwala omwe ali ndi vuto loletsa kugona. Kwa odwala omwe ali ndi vuto lobanika kutulo kapena kunenepa kwambiri komwe kumapangitsa kuti asapume bwino usiku, njira yayikulu yochizira ndiyomwe imathandizira kuti mpweya wabwino uzikhala wopanda mpweya m'malo mowonjezera mpweya.

Nkhani inanso yoti muganizire ndi yakuti ngati pakufunika thandizo la oxygen paulendo wa pandege. Ndege zambiri zamalonda zimachulukitsa kuthamanga kwa kanyumba kufika pamtunda wofanana ndi mapazi a 8000, ndi mpweya wabwino wa mpweya wa pafupifupi 108 mm Hg. Kwa odwala omwe ali ndi matenda a m'mapapo, kuchepa kwamphamvu ya okosijeni (PiO2) kungayambitse hypoxemia. Asanayende, odwala amayenera kukayezetsa mwatsatanetsatane zachipatala, kuphatikizapo kuyezetsa magazi kwa mpweya. Ngati PaO2 ya wodwalayo pansi ndi ≥ 70 mm Hg (SpO2> 95%), ndiye kuti PaO2 yawo panthawi yothawa imatha kupitirira 50 mm Hg, yomwe nthawi zambiri imaonedwa kuti ndi yokwanira kuthana ndi masewera olimbitsa thupi ochepa. Kwa odwala omwe ali ndi SpO2 kapena PaO2 otsika, kuyesa kwa mphindi 6 kapena kuyesa kwa hypoxia kungathe kuganiziridwa, makamaka kupuma mpweya wa 15%. Ngati hypoxemia imachitika paulendo wapamlengalenga, mpweya ukhoza kuperekedwa kudzera mumphuno yamphuno kuti awonjezere mpweya.

Zamoyo zam'madzi maziko a mpweya poizoni

Kuopsa kwa okosijeni kumachitika chifukwa chopanga mitundu ya okosijeni yokhazikika (ROS). ROS ndi okosijeni yochokera ku free radical yokhala ndi ma elekitironi osasinthika a orbital omwe amatha kuchitapo kanthu ndi mapuloteni, lipids, ndi nucleic acid, kusintha mawonekedwe awo ndikuwononga ma cell. Pa kagayidwe kake ka mitochondrial, kagawo kakang'ono ka ROS kamapangidwa ngati molekyulu yowonetsera. Maselo a chitetezo cha mthupi amagwiritsanso ntchito ROS kupha tizilombo toyambitsa matenda. ROS imaphatikizapo superoxide, hydrogen peroxide (H2O2), ndi hydroxyl radicals. ROS yochulukira nthawi zonse idzapitilira ntchito zoteteza ma cell, zomwe zimabweretsa kufa kapena kuwononga ma cell.

Kuti muchepetse kuwonongeka komwe kumayendetsedwa ndi m'badwo wa ROS, makina oteteza antioxidant a maselo amatha kusokoneza ma radicals aulere. Superoxide dismutase imasintha superoxide kukhala H2O2, yomwe imasinthidwa kukhala H2O ndi O2 ndi catalase ndi glutathione peroxidase. Glutathione ndi molekyulu yofunikira yomwe imalepheretsa kuwonongeka kwa ROS. Mamolekyu ena a antioxidant amaphatikizapo alpha tocopherol (vitamini E), ascorbic acid (vitamini C), phospholipids, ndi cysteine. Minofu ya m'mapapo a munthu imakhala ndi ma extracellular antioxidants ndi superoxide dismutase isoenzymes, zomwe zimapangitsa kuti zisakhale zapoizoni zikapezeka ndi mpweya wambiri poyerekeza ndi minofu ina.

Hyperoxia induced ROS mediated mapapu kuvulala kumatha kugawidwa m'magawo awiri. Choyamba, pali exudative gawo, yodziwika ndi imfa ya alveolar mtundu 1 epithelial maselo ndi endothelial maselo, interstitial edema, ndi kudzazidwa exudative neutrophils mu alveoli. Pambuyo pake, pali gawo lochulukitsa, pomwe ma cell a endothelial ndi mtundu wa 2 epithelial cell amachulukira ndikuphimba nembanemba yapansi yomwe idawonekera kale. Makhalidwe a nthawi yochira kuvulala kwa okosijeni ndi kuchuluka kwa fibroblast ndi interstitial fibrosis, koma capillary endothelium ndi alveolar epithelium imakhalabe ndi maonekedwe abwino.
Clinical mawonetseredwe a m`mapapo mwanga mpweya kawopsedwe

Mulingo wowonekera womwe chiwopsezo umachitika sichinadziwikebe. Ngati FIO2 ili yochepera 0.5, kawopsedwe kachipatala sikachitika. Kafukufuku woyambirira wa anthu apeza kuti kukhudzana ndi mpweya pafupifupi 100% kungayambitse kusokonezeka kwamalingaliro, nseru, ndi bronchitis, komanso kuchepetsa mphamvu ya mapapu, kufalikira kwa mapapu, kutsata mapapu, PaO2, ndi pH. Nkhani zina zokhudzana ndi kawopsedwe wa okosijeni ndi monga absorptive atelectasis, hypercapnia yopangidwa ndi okosijeni, acute kupuma kwapang'onopang'ono (ARDS), ndi neonatal bronchopulmonary dysplasia (BPD).
Kusokonezeka kwa atelectasis. Nayitrojeni ndi mpweya wosagwira ntchito womwe umafalikira pang'onopang'ono m'magazi poyerekeza ndi mpweya, motero umathandizira kuti alveolar ikule. Mukamagwiritsa ntchito mpweya wa 100%, chifukwa cha kuchuluka kwa mayamwidwe a okosijeni kupitilira kuchuluka kwa mpweya watsopano, kusowa kwa nayitrogeni kumatha kupangitsa kuti alveolar agwa m'malo omwe ali ndi chiŵerengero chochepa cha mpweya wabwino wa alveolar (V / Q). Makamaka panthawi ya opaleshoni, opaleshoni ndi ziwalo zingayambitse kuchepa kwa ntchito ya m'mapapo yotsalira, kulimbikitsa kugwa kwa airways yaing'ono ndi alveoli, zomwe zimapangitsa kuti atelectasis ayambe mofulumira.

Hypercapnia yopangidwa ndi oxygen. Odwala kwambiri a COPD amatha kudwala kwambiri hypercapnia akakumana ndi kuchuluka kwa okosijeni panthawi yamavuto awo. Njira ya hypercapnia iyi ndikuti kuthekera kwa hypoxemia kuyendetsa kupuma kumalephereka. Komabe, mwa wodwala aliyense, pali njira zina ziwiri zomwe zimaseweredwa mosiyanasiyana.
Hypoxemia mwa odwala COPD ndi chifukwa cha kuchepa kwa mpweya wa alveolar (PAO2) m'dera la V / Q. Pofuna kuchepetsa kukhudzidwa kwa madera otsika a V/Q pa hypoxemia, machitidwe awiri a pulmonary circulation - hypoxic pulmonary vasoconstriction (HPV) ndi hypercapnic pulmonary vasoconstriction - adzasamutsa kutuluka kwa magazi kumalo opuma mpweya wabwino. Pamene oxygen supplementation ikuwonjezera PAO2, HPV imachepa kwambiri, kuonjezera kutsekemera m'maderawa, zomwe zimapangitsa kuti madera omwe ali ndi V / Q otsika. Minofu ya m'mapapo iyi tsopano ili ndi okosijeni wochuluka koma ili ndi mphamvu zochepa zochotsera CO2. Kuchulukitsa kwamafuta am'mapapowa kumabwera pamtengo woperekera malo okhala ndi mpweya wabwino, womwe sungathe kutulutsa CO2 yambiri monga kale, zomwe zimatsogolera ku hypercapnia.

Chifukwa china ndi mphamvu yofooka ya Haldane, zomwe zikutanthauza kuti poyerekeza ndi magazi okosijeni, magazi opanda okosijeni amatha kunyamula CO2 yambiri. Hemoglobin ikatulutsidwa, imamanga ma protoni ambiri (H+) ndi CO2 mu mawonekedwe a amino esters. Pamene kuchuluka kwa deoxyhemoglobin kumachepa panthawi ya chithandizo cha okosijeni, mphamvu ya CO2 ndi H + imachepanso, motero kufooketsa mphamvu ya magazi a venous kunyamula CO2 ndikupangitsa kuti PaCO2 ichuluke.

Popereka okosijeni kwa odwala omwe ali ndi CO2 yosunga nthawi yayitali kapena odwala omwe ali pachiwopsezo chachikulu, makamaka ngati ali ndi hypoxemia yoopsa, ndikofunikira kwambiri kusintha FIO2 kukhalabe ndi SpO2 mu 88% ~ 90%. Malipoti angapo akuwonetsa kuti kulephera kuwongolera O2 kungayambitse zotsatira zoyipa; Kafukufuku wopangidwa mwachisawawa wochitidwa pa odwala omwe akuchulukirachulukira kwambiri a CODP popita kuchipatala watsimikizira izi. Poyerekeza ndi odwala omwe alibe kuletsa kwa okosijeni, odwala omwe amapatsidwa mwayi wowonjezera mpweya kuti asunge SpO2 mkati mwa 88% mpaka 92% anali ndi chiwerengero chochepa cha imfa (7% vs. 2%).

ARDS ndi BPD. Anthu adazindikira kalekale kuti kawopsedwe wa okosijeni amalumikizidwa ndi matenda a ARDS. Pazilombo zoyamwitsa zomwe si zaumunthu, kukhudzidwa ndi mpweya wa 100% kumatha kubweretsa kuwonongeka kwa alveolar ndipo pamapeto pake kufa. Komabe, umboni weniweni wa poizoni wa okosijeni kwa odwala omwe ali ndi matenda aakulu a m'mapapo ndizovuta kusiyanitsa ndi zowonongeka zomwe zimayambitsidwa ndi matenda omwe amayambitsa. Kuphatikiza apo, matenda ambiri otupa amatha kuyambitsa kukhazikitsidwa kwa chitetezo cha antioxidant. Chifukwa chake, kafukufuku wambiri walephera kuwonetsa kulumikizana pakati pa kuwonekera kwambiri kwa okosijeni ndi kuvulala kwakukulu kwamapapo kapena ARDS.

M'mapapo mwanga hyaline nembanemba matenda ndi matenda chifukwa cha kusowa pamwamba yogwira zinthu, yodziwika ndi alveolar kugwa ndi kutupa. Ana obadwa msanga omwe ali ndi matenda a hyaline nembanemba amafunikira kutulutsa mpweya wambiri. Kawopsedwe wa okosijeni amaonedwa kuti ndi chinthu chachikulu chomwe chimayambitsa matenda a BPD, ngakhale amachitika mwa makanda omwe safuna mpweya wabwino. Ana obadwa kumene amakhudzidwa kwambiri ndi kuwonongeka kwa okosijeni wambiri chifukwa ntchito zawo zotetezera ma antioxidants sizinayambe kukula ndikukula; Retinopathy of prematurity ndi matenda omwe amalumikizidwa ndi kupsinjika mobwerezabwereza kwa hypoxia / hyperoxia, ndipo izi zatsimikiziridwa mu retinopathy ya prematurity.
The synergistic zotsatira za m'mapapo mwanga mpweya kawopsedwe

Pali mankhwala angapo omwe angapangitse kawopsedwe wa okosijeni. Oxygen imawonjezera ROS yopangidwa ndi bleomycin ndikuyambitsa bleomycin hydrolase. Mu hamster, kuthamanga kwa mpweya wambiri kungapangitse kuti bleomycin iwonongeke m'mapapo, ndipo malipoti a milandu afotokozanso za ARDS mwa odwala omwe adalandira chithandizo cha bleomycin ndipo adakumana ndi FIO2 yapamwamba panthawi ya opaleshoni. Komabe, chiyeso chomwe chikuyembekezeka chinalephera kuwonetsa kugwirizana pakati pa kukhudzidwa kwa mpweya wambiri wa okosijeni, kukhudzana ndi bleomycin m'mbuyomu, ndi vuto lalikulu la m'mapapo pambuyo pa opaleshoni. Paraquat ndi mankhwala a herbicide omwe amawonjezera kawopsedwe ka oxygen. Chifukwa chake, pochita ndi odwala omwe ali ndi poizoni wa paraquat komanso kukhudzana ndi bleomycin, FIO2 iyenera kuchepetsedwa momwe mungathere. Mankhwala ena omwe angawonjezere kawopsedwe wa okosijeni ndi disulfiram ndi nitrofurantoin. Kuperewera kwa mapuloteni ndi michere kungayambitse kuwonongeka kwa okosijeni wambiri, zomwe zitha kukhala chifukwa cha kusowa kwa thiol yokhala ndi ma amino acid omwe ndi ofunikira pakupanga kwa glutathione, komanso kusowa kwa mavitamini a antioxidant A ndi E.
Kuopsa kwa okosijeni m'machitidwe ena a ziwalo

Hyperoxia imatha kuyambitsa poizoni ku ziwalo zakunja kwa mapapu. Kafukufuku wamkulu wamagulu ambiri owonetsa anthu ambiri adawonetsa mgwirizano pakati pa kufa kwa anthu ambiri komanso kuchuluka kwa mpweya wa okosijeni pambuyo potsitsimula bwino mtima wa cardiopulmonary (CPR). Kafukufukuyu anapeza kuti odwala omwe ali ndi PaO2 oposa 300 mm Hg pambuyo pa CPR anali ndi chiopsezo cha imfa m'chipatala cha 1.8 (95% CI, 1.8-2.2) poyerekeza ndi odwala omwe ali ndi mpweya wabwino wa magazi kapena hypoxemia. Chifukwa cha kuchuluka kwa anthu omwe amafa ndi kuwonongeka kwa dongosolo lamanjenje lapakati pambuyo pomangidwa kwa mtima chifukwa cha ROS mediated high reperfusion reperfusion kuvulala. Kafukufuku waposachedwa adafotokozanso kuchuluka kwa kufa kwa odwala omwe ali ndi hypoxemia pambuyo polowera mu dipatimenti yodzidzimutsa, yomwe imagwirizana kwambiri ndi kuchuluka kwa PaO2 yokwezeka.

Kwa odwala omwe akuvulala muubongo ndi sitiroko, kupereka mpweya kwa omwe alibe hypoxemia kumawoneka kuti alibe phindu. Kafukufuku wochitidwa ndi malo opwetekedwa mtima adapeza kuti poyerekeza ndi odwala omwe ali ndi mpweya wabwino wa okosijeni m'magazi, odwala omwe ali ndi vuto lopweteka la ubongo omwe adalandira chithandizo cha oxygen (PaO2> 200 mm Hg) anali ndi chiwopsezo chachikulu cha kufa komanso kutsika kwa Glasgow Coma Score pakutha. Kafukufuku wina wokhudza odwala omwe amalandila chithandizo cha okosijeni wa hyperbaric adawonetsa kusazindikira bwino kwa mitsempha. M'mayesero akuluakulu a multicenter, kuonjezera mpweya kwa odwala opweteka kwambiri opanda hypoxemia (machulukidwe oposa 96%) analibe phindu pa imfa kapena kufotokozera ntchito.

Mu acute myocardial infarction (AMI), kuwonjezera kwa okosijeni ndi njira yochizira yomwe imagwiritsidwa ntchito kwambiri, koma kufunikira kwa chithandizo cha okosijeni kwa odwala otere kudakali mkangano. Oxygen ndi zofunika pa matenda a pachimake m`mnyewa wamtima infarction odwala concomitant hypoxemia, monga angapulumutse miyoyo. Komabe, mapindu a chikhalidwe cha oxygen supplementation pakalibe hypoxemia sichinawonekere. Chakumapeto kwa zaka za m'ma 1970, kuyesedwa kosawerengeka kwapawiri kunalembetsa odwala 157 omwe anali ndi infarction yovuta kwambiri ya myocardial infarction ndipo anayerekezera chithandizo cha okosijeni (6 L / min) popanda chithandizo cha okosijeni. Zinapezeka kuti odwala omwe amalandira chithandizo cha okosijeni anali ndi chiwopsezo chachikulu cha sinus tachycardia komanso kuwonjezeka kwakukulu kwa michere ya myocardial, koma panalibe kusiyana pakati pa imfa.

Mu gawo la ST okwera pachimake myocardial infarction odwala popanda hypoxemia, m`mphuno cannula okosijeni mankhwala pa 8 L/min si kopindulitsa poyerekeza ndi kupuma mpweya wozungulira. Mu kafukufuku wina wokhudza kupuma kwa okosijeni pa 6 L/mphindi ndi kupuma kwa mpweya wozungulira, panalibe kusiyana pakati pa imfa ya chaka chimodzi ndi chiwerengero cha kuwerengedwa kwa odwala omwe ali ndi vuto la myocardial infarction. Kulamulira mpweya wa okosijeni wa magazi pakati pa 98% mpaka 100% ndi 90% mpaka 94% alibe phindu kwa odwala omwe ali ndi vuto la mtima kunja kwa chipatala. Zotsatira zowopsa za okosijeni wambiri pa acute myocardial infarction zimaphatikizapo kutsekeka kwa mitsempha yam'mitsempha, kusokoneza kugawa kwa magazi kwa microcirculation, kuchulukira kwa oxygen shunt, kuchepa kwa okosijeni, ndikuwonjezera kuwonongeka kwa ROS m'malo obwezeretsanso bwino.

Pomaliza, mayesero azachipatala ndi kusanthula kwa meta adafufuza milingo yoyenera ya SpO2 kwa odwala omwe akudwala kwambiri mchipatala. Malo amodzi, malemba otseguka oyesedwa mosasinthika poyerekeza ndi mankhwala ochiritsira okosijeni (SpO2 chandamale 94% ~ 98%) ndi mankhwala achikhalidwe (SpO2 mtengo 97% ~ 100%) adachitidwa pa odwala 434 omwe ali mu chipinda cha odwala kwambiri. Chiwopsezo cha kufa m'chipinda chosamalira odwala kwambiri cha odwala omwe amatumizidwa mwachisawawa kuti alandire chithandizo cha okosijeni chokhazikika chakwera, kutsika kwa mantha, kulephera kwa chiwindi, ndi bakiteriya. Kufufuza kwapadera komwe kunaphatikizapo mayesero 25 achipatala omwe adalembera odwala 16000 omwe ali m'chipatala omwe ali ndi matenda osiyanasiyana, kuphatikizapo stroke, trauma, sepsis, myocardial infarction, ndi opaleshoni yadzidzidzi. Zotsatira za kafukufukuyu zinasonyeza kuti odwala omwe akulandira njira zothandizira odwala okosijeni anali ndi chiwerengero chowonjezeka cha imfa m'chipatala (chiopsezo chachibale, 1.21; 95% CI, 1.03-1.43).

Komabe, mayesero awiri akuluakulu omwe adatsatira adalephera kuwonetsa kukhudzika kulikonse kwa njira zothandizira okosijeni pamasiku angapo opanda ma ventilator mwa odwala omwe ali ndi matenda a m'mapapo kapena kupulumuka kwa masiku 28 mwa odwala ARDS. Posachedwapa, kafukufuku wa odwala 2541 omwe akulandira mpweya wabwino wa makina anapeza kuti kulowetsedwa kwa okosijeni mkati mwa mitundu itatu ya SpO2 (88% ~ 92%, 92% ~ 96%, 96% ~ 100%) sizinakhudze zotsatira monga masiku opulumuka, imfa, kumangidwa kwa mtima, arrhythmia, myocardial infaction, myocardial infarction, masiku 28. Kutengera izi, malangizo a British Thoracic Society amalimbikitsa mtundu wa SpO2 wa 94% mpaka 98% kwa odwala ambiri omwe ali m'chipatala. Izi ndi zomveka chifukwa SpO2 mkati mwa izi (poganizira zolakwika za ± 2% ~ 3% za pulse oximeters) zimagwirizana ndi PaO2 ya 65-100 mm Hg, yomwe ili yotetezeka komanso yokwanira kwa mpweya wa magazi. Kwa odwala omwe ali pachiwopsezo cha kulephera kupuma kwa hypercapnic, 88% mpaka 92% ndi chandamale chotetezeka kuti apewe hypercapnia yoyambitsidwa ndi O2.