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Oxygen therapy ndiyo imwe yenzira dzinowanzo shandiswa mukurapa kwemazuva ano, asi kuchine maonero asiriwo pamusoro pezviratidzo zveokisijeni therapy, uye kushandisa okisijeni zvisina kunaka kunogona kukonzera huturu hwakakomba.

Kuongororwa kwekiriniki yetishu hypoxia

Makiriniki ekuratidzwa kwetishu hypoxia akasiyana uye asiri chaiwo, ane zviratidzo zvinonyanya kuzivikanwa zvinosanganisira dyspnea, kupfupika kwekufema, tachycardia, kufema kunetseka, kukurumidza kushanduka kwechimiro chepfungwa, uye arrhythmia. Kuti uone kuvapo kwenyama (visceral) hypoxia, serum lactate (yakasimudzwa panguva yeischemia uye kuderedzwa kwemoyo wemwoyo) uye SvO2 (yakaderera panguva yekuderedzwa kwemoyo, kupererwa neropa, arterial hypoxemia, uye high metabolic rate) inobatsira kuongororwa kwekliniki. Zvisinei, lactate inogona kukwidziridzwa mumamiriro ezvinhu asina hypoxic, saka kuongororwa hakugoni kuitwa chete zvichienderana nekukwirira kwelactate, sezvo lactate inogonawo kukwidziridzwa mumamiriro ekuwedzera glycolysis, zvakadai sekukurumidza kukura kwemamota akaipa, kutanga sepsis, kusagadzikana kwemagetsi, uye kutonga kwekatecholamines. Dzimwe tsika dzemurabhoritari dzinoratidza kusashanda zvakanaka kwenhengo dzakakosha zvakare, senge yakakwira creatinine, troponin, kana maenzayimu echiropa.

Clinical evaluation ye arterial oxygenation mamiriro

Cyanosis. Cyanosis inowanzova chiratidzo chinoitika munguva yekupedzisira ye hypoxia, uye inowanzosavimbika pakuongorora hypoxemia uye hypoxia nokuti inogona kunge isingaiti mukushaya ropa uye kuderera kweropa kuyerera, uye zvakaoma kune vanhu vane ganda rakasviba kuti vaone cyanosis.

Pulse oximetry monitoring. Non invasive pulse oximetry monitoring yakashandiswa zvakanyanya pakuongorora zvirwere zvese, uye inofungidzirwa kuti SaO2 inonzi SpO2. Nheyo ye pulse oximetry monitoring mutemo waBill, uyo unoti kuungana kwechinhu chisingazivikanwe mumushonga kunogona kutariswa nekutorwa kwacho kwechiedza. Kana chiedza chikapfuura nemunyama chero ipi zvayo, yakawanda yacho inotorwa nenhengo dzetishu uye ropa. Zvisinei, nekurova kwemoyo wega wega, arterial blood inopinda pulsatile flow, ichibvumira pulse oximetry monitor kuti ione kuchinja kwechiedza kunyura pamawavelengths maviri: 660 nanometers (tsvuku) uye 940 nanometers (infrared). Kutorwa kwemazinga ehemoglobin yakaderedzwa uye oxygenated hemoglobin akasiyana pane aya mawavelengths maviri. Mushure mekubvisa kunyura kweasina pulsatile tishu, kuwanda kweokisijeni hemoglobin maererano nehuwandu hwehemoglobin inogona kuverengerwa.

Pane zvimwe zvinogumira pakutarisa pulse oximetry. Chero chinhu chiri muropa chinotora ayavelengths chinogona kukanganisa kuyerwa kwechiyero, kusanganisira kuwanikwa hemoglobinopathies - carboxyhemoglobin uye methemoglobinemia, methylene blue, uye mamwe genetic hemoglobin akasiyana. Kutorwa kwecarboxyhemoglobin pakureba kwe660 nanometers kwakafanana neiyo yehemoglobin ine oxygen; Kunyura kushoma pahurefu hwemasaisai e940 nanometers. Saka, zvisinei nehukama hwekabhoni monoxide saturated hemoglobin uye oxygen saturated hemoglobin, SpO2 icharamba iripo (90% ~ 95%). Mu methemoglobinemia, kana heme iron yaiswa oxidized kusvika kune ferrous state, methemoglobin inoenzana neabsorption coefficients ewavelengths maviri. Izvi zvinoguma neSpO2 inongosiyana mukati mechikamu che83% kusvika 87% mukati mehuwandu hwehuwandu hwehuwandu hwemethemoglobin. Muchiitiko ichi, mafungu mana echiedza anodiwa kuti ropa riyererwe okisijeni kusiyanisa pakati pemhando ina dzehemoglobin.

Pulse oximetry monitoring inotsamira pane yakakwana pulsatile blood flow; Naizvozvo, pulse oximetry monitoring haigone kushandiswa mukuvhunduka hypoperfusion kana kushandisa isiri pulsatile ventricular assist zvishandiso (apo kubuda kwemoyo kunongoverengera chikamu chidiki chekubuda kwemoyo). Mukunyanyisa tricuspid regurgitation, kuwanda kwe deoxyhemoglobin muropa re venous kwakakwira, uye kupuruzira kweropa re venous kunogona kutungamirira kune yakaderera ropa saturation kuverenga. Mune yakanyanya arterial hypoxemia (SaO2 <75%), kururamisa kunogonawo kuderera sezvo nzira iyi isati yambove yakasimbiswa mukati mehuwandu uhwu. Chekupedzisira, vanhu vakawanda vari kuona kuti pulse oximetry monitoring inogona overestimate arterial hemoglobin saturation nekusvika 5-10 percentage points, zvichienderana nechaiyo mudziyo unoshandiswa nevanhu vakasviba ganda.

PaO2/FIO2. Chiyero chePaO2/FIO2 (chinowanzonzi P / F ratio, kubva pa400 kusvika ku500 mm Hg) chinoratidza chiyero chekuchinjana kweokisijeni isina kujairika mumapapu, uye inonyanya kukosha mumamiriro ezvinhu aya sezvo mechanical ventilation inogona kunyatsogadzirisa FIO2. AP/F reshiyo isingasviki 300 mm Hg inoratidza kukiriniki yakakosha kuchinjanisa gasi kusajairika, nepo P/F reshiyo iri pasi pe200 mm Hg inoratidza yakanyanya hypoxemia. Zvinhu zvinokanganisa chiyero cheP / F zvinosanganisira marongero emhepo, yakanaka kupera kupera simba, uye FIO2. Mhedzisiro yekuchinja muFIO2 pachiyero cheP / F inosiyana zvichienderana nemhando yekukuvara kwemapapu, shunt chikamu, uye huwandu hweFIO2 shanduko. Mukushaikwa kwePaO2, SpO2/FIO2 inogona kushanda sechiratidzo chinonzwisisika.

Alveolar arterial oxygen partial pressure (Aa PO2) musiyano. Aa PO2 chiyero chekuyera musiyano pakati peakaverengerwa alveolar oxygen partial pressure uye yakayerwa arterial oxygen partial pressure, inoshandiswa kuyera kushanda kwegasi exchange.

Iyo "yakajairika" Aa PO2 mutsauko wekufema mhepo yakadzika pagungwa inosiyana nezera, kubva pa10 kusvika 25 mm Hg (2.5+0.21 x zera [makore]). Chechipiri chinofurira chinhu FIO2 kana PAO2. Kana chimwe chezvinhu zviviri izvi chikawedzera, mutsauko muAa PO2 uchawedzera. Izvi zvinodaro nekuti kuchinjana kwegasi mualveolar capillaries kunoitika muchikamu chakati sandara (kutsetseka) kwehemoglobin okisijeni dissociation curve. Pasi pedhigirii rimwechete rekusanganisa venous, mutsauko muPO2 pakati peropa rakasanganiswa venous neropa re arterial uchawedzera. Pane zvinopesana, kana iyo alveolar PO2 yakaderera nekuda kwekusakwana kwemhepo kana kukwirira kwepamusoro, iyo Aa musiyano ichava yakaderera pane yakajairika, iyo inogona kutungamirira kune kuderera kana kutadza kuongororwa kwepulmonary dysfunction.

Oxygenation index. Oxygenation index (OI) inogona kushandiswa mune mechanically ventilated varwere kuti vaongorore inodiwa mhepo yekutsigira simba rekuchengetedza oxygenation. Inosanganisira zvinoreva airway pressure (MAP, in cm H2O), FIO2, uye PaO2 (mu mm Hg) kana SpO2, uye kana inopfuura 40, inogona kushandiswa sechiyero che extracorporeal membrane oxygenation therapy. Normal kukosha isingasviki 4 cm H2O/mm Hg; Nekuda kweiyo yunifomu kukosha kwecm H2O/mm Hg (1.36), mayunitsi kazhinji haasanganisirwe pakushuma reshiyo iyi.

Zviratidzo zveacute oxygen therapy
Kana varwere vachinetseka kufema, oxygen supplementation inowanzodiwa isati yaonekwa ye hypoxemia. Kana iyo arterial partial pressure yeokisijeni (PaO2) iri pasi pe60 mm Hg, chiratidzo chakajeka chekutora okisijeni ndeye arterial hypoxemia, iyo inowanzoenderana ne arterial oxygen saturation (SaO2) kana peripheral oxygen saturation (SpO2) ye89% kusvika 90%. Kana PaO2 inodonha pasi pe60 mm Hg, kuzara kweokisijeni muropa kunogona kuderera zvakanyanya, zvichikonzera kuderera kukuru kweiyo arterial oxygen yemukati uye zvinogona kukonzera tishu hypoxia.

Mukuwedzera kune arterial hypoxemia, oxygen supplementation inogona kudiwa muzviitiko zvisingawanzoitiki. Yakanyanya kupererwa neropa, kukuvara, uye kuvhiya kwakakosha varwere kunogona kuderedza tishu hypoxia nekuwedzera arterial okisijeni mazinga. Kune varwere vane kabhoni monoxide (CO) chepfu, kuwedzera okisijeni kunogona kuwedzera iyo yakanyungudika yeokisijeni muropa, kutsiva CO inosungwa kuhemoglobin, uye kuwedzera chikamu cheokisijeni hemoglobin. Mushure mekufema mweya weokisijeni wakachena, hafu yehupenyu hwecarboxyhemoglobin ndeye 70-80 maminetsi, nepo hafu yehupenyu kana uchifema ambient mweya maminetsi mazana matatu nemakumi maviri. Pasi pe hyperbaric okisijeni mamiriro, hafu yehupenyu hwecarboxyhemoglobin inopfupikiswa kusvika isingasviki maminetsi gumi mushure mekufema mweya wakachena. Hyperbaric okisijeni inowanzoshandiswa mumamiriro ezvinhu ane huwandu hwe carboxyhemoglobin (> 25%), cardiac ischemia, kana kusagadzikana kwekunzwa.

Pasinei nekushaikwa kwe data inotsigira kana data isina kururama, zvimwe zvirwere zvinogonawo kubatsirwa nekuwedzera oksijeni. Oxygen therapy inowanzoshandiswa kurwisana nemusoro wesumbu, chirwere chekurwadziwa kwechirwere, kusununguka kwekushungurudzika kwekufema pasina hypoxemia, pneumothorax, uye mediastinal emphysema (kukurudzira kutorwa kwemhepo yechipfuva). Pane humbowo hunoratidza kuti intraoperative yakakwira okisijeni inogona kuderedza kuitika kwehutachiona hwenzvimbo yekuvhiya. Nekudaro, kuwedzera okisijeni hakuite senge kudzikisa zvinobudirira postoperative kusvotwa / kurutsa.

Nekuvandudzwa kwekunze kwekunze kweokisijeni, kushandiswa kwenguva refu yeokisijeni therapy (LTOT) iri kuwedzerawo. Izvo zviyero zvekushandisa kwenguva yakareba oxygen therapy zvatove zvakajeka. Kurapa kweokisijeni kwenguva refu kunowanzoshandiswa kune chronic obstructive pulmonary disease (COPD).
Zvidzidzo zviviri zvevarwere vane hypoxemic COPD zvinopa tsigiro data yeLTOT. Chidzidzo chekutanga chaive Nocturnal Oxygen Therapy Trial (NOTT) yakaitwa muna 1980, umo varwere vakagoverwa kune imwe nguva yeusiku (inenge maawa 12) kana kuenderera mberi kweokisijeni therapy. Pamwedzi ye12 ne24, varwere vanongogamuchira kurapwa kweokisijeni usiku vane huwandu hwekufa. Chiyedzo chechipiri chaive Medical Research Council Family Trial yakaitwa muna 1981, umo varwere vakakamurwa zvisina tsarukano kuita mapoka maviri: avo vasina kugamuchira okisijeni kana avo vakagamuchira okisijeni kweanenge maawa gumi nemashanu pazuva. Zvakafanana nebvunzo yeNOTT, chiyero chekufa muboka reanaerobic chaive chakakwira zvakanyanya. Zvidzidzo zvezviedzo zvose zvakanga zvisina kusvuta varwere vakagamuchira kurapwa kwakanyanya uye vaiva nemamiriro ezvinhu akadzikama, ane PaO2 pasi pe55 mm Hg, kana varwere vane polycythemia kana chirwere chemwoyo chepulmonary nePaO2 pasi pe60 mm Hg.

Zviyedzo zviviri izvi zvinoratidza kuti kuwedzera okisijeni kweanopfuura maawa gumi nemashanu pazuva kuri nani pane kusawana oxygen zvachose, uye kuramba uchirapa okisijeni kuri nani pane kungorapa husiku. Maitiro ekusanganisirwa emiedzo iyi ndiyo hwaro hwemakambani einishuwarenzi ekurapa aripo uye ATS kugadzira mirairo yeLTOT. Zvinonzwisisika kufungidzira kuti LTOT inogamuchirwawo kune dzimwe hypoxic cardiovascular disease, asi pane ikozvino kushayikwa kwehuchapupu hunokosha hwekuedza. Muyedzo wechangobva kuitika wemulticenter hauna kuwana mutsauko mukukanganiswa kweokisijeni therapy pakufa kana hupenyu hwehupenyu hwevarwere veCOPD vane hypoxemia iyo isina kusangana nemaitiro ekuzorora kana kungokonzerwa nekurovedza muviri.

Dzimwe nguva vanachiremba vanorayira kuti varwere vawane oxygen yokuwedzera usiku panguva yokurara. Ikozvino hapana humbowo hwakajeka hunotsigira kushandiswa kweiyi nzira kune varwere vane obstructive sleep apnea. Kune varwere vane obstructive sleep apnea kana obesity hypopnea syndrome inotungamira mukutadza kufema kwehusiku, kusiri-invasive positive pressure ventilation pane kuwedzera oxygen ndiyo nzira huru yekurapa.

Imwe nyaya yekufunga nezvayo ndeyekuti oxygen supplementation inodiwa panguva yekufamba nendege. Ndege zhinji dzekutengesa dzinowanzo wedzera kudzvanywa kwekabhini kusvika pakakwirira yakaenzana ne8000 tsoka, ine inhaled tension yeokisijeni inosvika 108 mm Hg. Kune varwere vane zvirwere zvemapapu, kuderera kweiyo inhaled oxygen tension (PiO2) inogona kukonzera hypoxemia. Vasati vafamba, varwere vanofanira kuongororwa kuongororwa kwehutano, kusanganisira arterial blood gas test. Kana PaO2 yemurwere pasi iri ≥ 70 mm Hg (SpO2> 95%), ipapo PaO2 yavo panguva yekubhururuka inogona kudarika 50 mm Hg, iyo inowanzoonekwa seyakakwana kutarisana nekuita zvishoma. Kune varwere vane yakaderera SpO2 kana PaO2, 6-miniti yekufamba bvunzo kana hypoxia simulation bvunzo inogona kutariswa, kazhinji kufema 15% okisijeni. Kana hypoxemia ikaitika panguva yekufamba nemhepo, okisijeni inogona kupihwa kuburikidza nemhino cannula kuwedzera kudyiwa kweokisijeni.

Biochemical hwaro hweokisijeni chepfu

Oxygen toxicity inokonzerwa nekugadzirwa kweiyo reactive oxygen marudzi (ROS). ROS iokisijeni inotorwa mahara radical ine unpaired orbital electron inogona kuita nemapuroteni, lipids, uye nucleic acids, ichichinja chimiro chavo uye ichikonzera kukuvara kweserura. Munguva yakajairwa mitochondrial metabolism, shoma shoma yeROS inogadzirwa senge molecule yekusaina. Maseru anodzivirira zvirwere anoshandisawo ROS kuuraya utachiona. ROS inosanganisira superoxide, hydrogen peroxide (H2O2), uye hydroxyl radicals. Yakawandisa ROS inogara ichipfuura mabasa ekudzivirira maserura, zvichitungamira kurufu kana kukonzeresa kukuvara kwesero.

Kudzikamisa kukuvadzwa kunoyananiswa nechizvarwa cheROS, iyo antioxidant kuchengetedza mashandiro emaseru inogona kudzikamisa radicals emahara. Superoxide dismutase inoshandura superoxide kuita H2O2, inozoshandurwa kuita H2O uye O2 necatalase uye glutathione peroxidase. Glutathione imorekuru rakakosha rinomisa kukuvara kweROS. Mamwe mamorekuru e antioxidant anosanganisira alpha tocopherol (vitamin E), ascorbic acid (vitamin C), phospholipids, uye cysteine. Matishu emapapu emunhu ane yakanyanya kuwanda yeextracellular antioxidants uye superoxide dismutase isoenzymes, zvichiita kuti isanyanya muchetura kana yakafumurwa kune yakakwira kuwanda kweokisijeni kana ichienzaniswa nemamwe matishu.

Hyperoxia induced ROS yakapindirana kukuvara kwemapapu inogona kukamurwa kuita nhanho mbiri. Chekutanga, pane exudative phase, inoratidzwa nekufa kwealveolar type 1 epithelial cells uye endothelial cells, interstitial edema, uye kuzadza exudative neutrophils mualveoli. Zvadaro, pane chikamu chekuwedzera, panguva iyo endothelial masero uye mhando 2 epithelial masero anowedzera uye anovhara iyo yakamboonekwa yepasi membrane membrane. Hunhu hweiyo okisijeni kukuvara kupora nguva ndeye fibroblast kuwanda uye interstitial fibrosis, asi iyo capillary endothelium uye alveolar epithelium ichiri kuchengetedza chitarisiko chakajairika.
Clinical kuratidzwa kwepulmonary oxygen toxicity

The exposure level panoitika chepfu haisati yanyatsojeka. Kana FIO2 iri pasi pe0.5, kliniki toxicity kazhinji haiitike. Zvidzidzo zvepakutanga zvevanhu zvakaona kuti kuratidzwa kunosvika zana muzana okisijeni kunogona kukonzera kusagadzikana kwekunzwa, kusvotwa, uye bronchitis, pamwe nekuderedza kugona kwemapapu, kupararira kwemapapu, kutevedzera mapapu, PaO2, uye pH. Dzimwe nyaya dzine chekuita nehupfu hweokisijeni dzinosanganisira absorptive atelectasis, oxygen induced hypercapnia, acute respensipe distress syndrome (ARDS), uye neonatal bronchopulmonary dysplasia (BPD).
Absorbent atelectasis. Nitrogen igasi inert inopararira zvishoma nezvishoma muropa kana ichienzaniswa neokisijeni, nokudaro ichiita basa rekuchengetedza alveolar kuwedzera. Paunenge uchishandisa 100% okisijeni, nekuda kweyero yekutorwa kweokisijeni inodarika mwero wekuunza gasi nyowani, kushomeka kwenitrogen kunogona kukonzera kudonha kwealveolar munzvimbo dzine yakaderera alveolar ventilation perfusion ratio (V / Q). Kunyanya panguva yekuvhiyiwa, anesthesia uye kuoma mitezo kunogona kukonzera kuderera kwemaitiro emapapu akasara, kukurudzira kuparara kwemhepo duku uye alveoli, zvichiita kuti kukurumidza kutanga kweatelectasis.

Oxygen inokonzerwa hypercapnia. Varwere vakasimba veCOPD vanowanzoita hypercapnia yakanyanya kana vakaiswa kune yakakwira kuwanda kweokisijeni panguva yekuipa kwemamiriro avo. Iyo nzira yeiyi hypercapnia ndeyekuti kugona kwe hypoxemia kutyaira kufema kunodzivirirwa. Zvisinei, mune chero murwere, kune dzimwe nzira mbiri dziri kutamba kune zvakasiyana-siyana.
Iyo hypoxemia muvarwere veCOPD ndiyo mhedzisiro yekuderera kwealveolar partial pressure yeokisijeni (PAO2) munzvimbo yakaderera yeV / Q. Kuti uderedze kukanganiswa kweaya akaderera V/Q matunhu pa hypoxemia, maviri maitiro e pulmonary circulation - hypoxic pulmonary vasoconstriction (HPV) uye hypercapnic pulmonary vasoconstriction - ichaendesa kuyerera kweropa kunzvimbo dzine mhepo yakanaka. Kana okisijeni yekuwedzera ichiwedzera PAO2, HPV inoderera zvakanyanya, ichiwedzera perfusion munzvimbo idzi, zvichikonzera nzvimbo dzine yakaderera V/Q ratios. Aya matishu emapapu ave akapfuma muokisijeni asi ane hushoma kugona kubvisa CO2. Kuwedzera kunyura kweaya matishu emapapu kunouya nemutengo wekupira nzvimbo dzine mhepo iri nani, iyo isingakwanise kuburitsa yakawanda CO2 sepakutanga, zvichitungamira kune hypercapnia.

Chimwe chikonzero kushaya simba kweHaldane mhedzisiro, zvinoreva kuti kana ichienzaniswa neokisijeni ropa, deoxygenated ropa rinogona kutakura yakawanda CO2. Kana hemoglobin iine deoxygenated, inosunga mamwe mapurotoni (H+) uye CO2 muchimiro cheamino esters. Sezvo kuwanda kwe deoxyhemoglobin kunodzikira panguva yeokisijeni kurapwa, iyo buffering ye CO2 neH + inodzikirawo, nokudaro ichideredza kugona kweropa re venous kutakura CO2 uye zvichikonzera kuwedzera kwePaCO2.

Kana uchipa okisijeni kuvarwere vane chirwere chisingaperi cheCO2 kana varwere vane ngozi, kunyanya munyaya ye hypoxemia yakanyanyisa, zvakakosha zvikuru kugadzirisa FIO2 kuchengetedza SpO2 muhuwandu hwe88% ~ 90%. Mishumo yakawanda inoratidza kuti kukundikana kutonga O2 kunogona kutungamirira kumigumisiro yakaipa; Ongororo yakaitwa pavarwere vane CODP yakawedzera zvakanyanya munzira yavo kuenda kuchipatara yakaratidza izvi pasina mubvunzo. Kuenzaniswa nevarwere vasina kudziviswa kweokisijeni, varwere vakarongedzerwa kuti vawedzere okisijeni kuti vachengetedze SpO2 mukati me88% kusvika ku92% vaiva nehuwandu hwehuwandu hwekufa (7% vs. 2%).

ARDS uye BPD. Vanhu vagara vachiona kuti huturu hweokisijeni hwakabatana neiyo pathophysiology yeARDS. Mumhuka dzisiri dzevanhu dzinoyamwisa, kuratidzwa kune 100% okisijeni kunogona kukonzera kupararira kwekukuvara kwealveolar uye pakupedzisira kufa. Nekudaro, humbowo chaihwo hwehuturu hweokisijeni muvarwere vane hosha dzakakomba dzemapapu zvakaoma kusiyanisa kubva mukukuvadzwa kunokonzerwa nezvirwere zviri pasi. Mukuwedzera, zvirwere zvakawanda zvinoputika zvinogona kukonzera kukwidziridzwa kwe antioxidant kudzivirira basa. Nokudaro, zvidzidzo zvakawanda zvakakundikana kuratidza kuwirirana pakati pekunyanya kuratidzwa kweokisijeni uye kukuvara kwakanyanya kwemapapu kana ARDS.

Pulmonary hyaline membrane chirwere chirwere chinokonzerwa nekushayikwa kwezvinhu zvinoshanda, zvinoratidzwa nekuputika kwealveolar uye kuzvimba. Vana vachangozvarwa nguva isati yakwana vane chirwere chehyaline membrane vanowanzoda kufema kweyakanyanya kuwanda kweokisijeni. Oxygen toxicity inoonekwa sechinhu chikuru mupathogenesis yeBPD, kunyange kuitika muvana vachangoberekwa vasingade mechanical ventilation. Vachangozvarwa vanonyanya kukanganiswa nekukuvadzwa kweokisijeni yakakura nekuti mabasa avo ekudzivirira antioxidant haasati anyatsokura uye akura; Retinopathy ye prematurity chirwere chakabatana nekudzokorora hypoxia / hyperoxia kushushikana, uye chiitiko ichi chakasimbiswa mu retinopathy ye prematurity.
Iyo synergistic mhedzisiro yepulmonary oxygen toxicity

Kune akati wandei mishonga inogona kuwedzera oxygen toxicity. Okisijeni inowedzera iyo ROS inogadzirwa nebleomycin uye inactivates bleomycin hydrolase. Mune hamsters, high oxygen partial pressure inogona kuwedzera bleomycin inokonzera kukuvara kwemapapu, uye nyaya dzenyaya dzakatsanangurawo ARDS kune varwere vakagamuchira bleomycin kurapwa uye vakaratidzirwa kune yakakwirira yeFIO2 munguva yeperioperative. Zvisinei, muyedzo waitarisirwa wakatadza kuratidza kushamwaridzana pakati pekuratidzwa kwakanyanya kweokisijeni, kuratidzwa kwe bleomycin, uye kusashanda kwepulmonary kwakanyanya. Paraquat mushonga wesora wekutengesa unova mumwe muwedzere wehupfu hweokisijeni. Nokudaro, kana uchibata nevarwere vane paraquat chepfu uye kutarisana nebleomycin, FIO2 inofanira kuderedzwa zvakanyanya sezvinobvira. Mimwe mishonga inogona kuwedzera huturu hweokisijeni inosanganisira disulfiram uye nitrofurantoin. Kushaikwa kweprotein uye kudya kunovaka muviri kunogona kukonzeresa kukuvadzwa kweokisijeni yakakwira, izvo zvingave zvichikonzerwa nekushaikwa kwethiol ine amino acids iyo yakakosha pakuumbwa kweglutathione, pamwe nekushaikwa kwe antioxidant vhitamini A uye E.
Oxygen toxicity mune mamwe maorgan system

Hyperoxia inogona kukonzera kuita chepfu kune nhengo dziri kunze kwemapapu. Chidzidzo chikuru chevanhu vakawanda chakaratidza kushamwaridzana pakati pekuwedzera kwekufa uye yakakwirira oksijeni mazinga mushure mekubudirira kwe cardiopulmonary resuscitation (CPR). Chidzidzo chacho chakawana kuti varwere vane PaO2 yakakura kupfuura 300 mm Hg mushure meCPR vaiva nehuwandu hwekufa kwechipatara che1.8 (95% CI, 1.8-2.2) kana ichienzaniswa nevarwere vane ropa rakakwana reokisijeni kana hypoxemia. Chikonzero chekuwedzera kwehuwandu hwekufa ndiko kuparara kwepakati yenheyo system basa mushure mekusungwa kwemoyo kunokonzerwa neROS yakapindirana nepamusoro pekukuvara kweokisijeni. Ongororo ichangobva kuitika yakatsanangurawo kuwedzera kwehuwandu hwekufa kwevarwere vane hypoxemia mushure mekupinda mudhipatimendi rekukurumidzira, iro rinonyatsoenderana nehuwandu hwePaO2 yakakwirira.

Kune varwere vane kukuvara kwehuropi uye sitiroko, kupa oxygen kune avo vasina hypoxemia kunoratidzika kunge kusina pundutso. Ongororo yakaitwa nenzvimbo yekushungurudza yakawana kuti kana ichienzaniswa nevarwere vane mwero weokisijeni weropa, varwere vane kukuvara kwehuropi vakakuvara vakagamuchira okisijeni yakakura (PaO2> 200 mm Hg) kurapwa vaive nehuwandu hwekufa uye yakaderera Glasgow Coma Score pakubuda. Chimwe chidzidzo pamusoro pevarwere vanogamuchira hyperbaric oxygen therapy yakaratidza kusava neurological prognosis. Mumuyedzo wakakura wakawanda, kuwedzera okisijeni kuvarwere vane sitiroko yakaoma vasina hypoxemia (saturation yakakura kupfuura 96%) yakanga isina rubatsiro mukufa kana kushanda kwekufungidzira.

Muacute myocardial infarction (AMI), oxygen supplementation inowanzoshandiswa, asi kukosha kweokisijeni kurapwa kuvarwere vakadaro kuchiri kukakavara. Oxygen inodiwa mukurapa acute myocardial infarction varwere vane concomitant hypoxemia, sezvo inogona kuponesa hupenyu. Nekudaro, mabhenefiti echinyakare okisijeni yekuwedzera mukusavapo kwe hypoxemia haisati yanyatsojeka. Mukupera kwema1970, muedzo wakapetwa kaviri-mapofu wakanyoresa varwere ve157 vane uncomplicated acute myocardial infarction uye vakaenzanisa oxygen therapy (6 L / min) pasina oxygen therapy. Yakawanikwa kuti varwere vanogamuchira oxygen therapy vaiva nehuwandu hwepamusoro hwe sinus tachycardia uye kuwedzera kukuru kwemyocardial enzymes, asi kwakanga kusina kusiyana kwehuwandu hwekufa.

Mu ST segment elevation acute myocardial infarction varwere vasina hypoxemia, nasal cannula oxygen therapy pa8 L/min haibatsiri kana ichienzaniswa nekufema mhepo yakadzikama. Mune imwe dzidzo pamusoro pekufema kweokisijeni pa6 L / min uye inhalation yemhepo yakadzika, pakanga pasina mutsauko mukufa kwegore re1 uye kuverenga kwehuwandu pakati pevarwere vane acute myocardial infarction. Kudzora kuzara kweokisijeni yeropa pakati pe98% kusvika 100% uye 90% kusvika 94% haina rubatsiro kune varwere vane mwoyo wekusungwa kunze kwechipatara. Izvo zvinogona kukuvadza zvinokonzerwa nepamusoro weokisijeni pane acute myocardial infarction zvinosanganisira coronary artery constriction, kukanganisa microcirculation kuyerera kweropa, kuwedzera kushanda kweokisijeni shunt, kuderera kwekushandiswa kweokisijeni, uye kuwedzera kweROS kukuvara munzvimbo yakabudirira reperfusion.

Chekupedzisira, miedzo yekiriniki uye meta-ongororo yakatsvaga yakakodzera SpO2 yakanangana nevarwere vari muchipatara vanorwara zvakanyanya. Imwe nzvimbo, yakavhurika label randomized kuyedza kuenzanisa kuchengetedza okisijeni therapy (SpO2 chinangwa 94% ~ 98%) nekurapa kwechinyakare (SpO2 kukosha 97% ~ 100%) yakaitwa pavarwere ve434 muchikamu chekuchengetedza kwakanyanya. Kufa kwevanhu muchikamu chekuchengetedza kwakanyanya kwevarwere vakagoverwa kuti vagamuchire kuchengetedza oksijeni kurapwa kwave nani, nekuderera kwekutya, kukundikana kwechiropa, uye bacteremia. Meta-analysis yakatevera yaisanganisira 25 miedzo yekiriniki iyo yakatsvaga pamusoro pevarwere vechipatara ve16000 vane zvirwere zvakasiyana-siyana, kusanganisira sitiroko, trauma, sepsis, myocardial infarction, uye kuvhiyiwa kwekukurumidzira. Mhedzisiro yeiyi meta-analysis yakaratidza kuti varwere vanowana kuchengetedza okisijeni kurapa nzira vaive nekuwedzera kwekufa muchipatara (ngozi yehukama, 1.21; 95% CI, 1.03-1.43).

Nekudaro, miviri yakatevera miyedzo mikuru yakatadza kuratidza chero kukanganisa kweanochengetedza okisijeni nzira dzekurapa pahuwandu hwemazuva asina mavheiri muvarwere vane chirwere chemapapu kana makumi maviri nemasere ekupona kwevarwere veARDS. Munguva ichangopfuura, chidzidzo chevarwere ve2541 vanogamuchira mechanical ventilation vakawana kuti chinangwa chekuwedzera oksijeni mukati mezvikamu zvitatu zvakasiyana zveSpO2 (88% ~ 92%, 92% ~ 96%, 96% ~ 100%) hazvina kukanganisa migumisiro yakadai semazuva ekupona, kufa, kusungwa kwemwoyo, arrhythmia, myocardial infarction, mechanical p. 28 mazuva. Kubva pane idzi data, nhungamiro yeBritish Thoracic Society inokurudzira chinangwa cheSpO2 chiyero che94% kusvika 98% kune vazhinji vakuru vari muchipatara varwere. Izvi zvinonzwisisika nokuti SpO2 mukati mechikamu ichi (tichifunga nezve ± 2% ~ 3% kukanganisa kwepulse oximeters) inoenderana nePaO2 ye65-100 mm Hg, iyo yakachengeteka uye yakakwana yeropa reokisijeni. Kune varwere vari panjodzi ye hypercapnic kufema kukundikana, 88% kusvika 92% ndiyo yakachengeteka chinangwa chekudzivirira hypercapnia inokonzerwa neO2.