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ʻO ka Oxygen therapy kekahi o nā ʻano hana maʻamau i ka lāʻau lapaʻau hou, akā aia nō nā kuhi hewa e pili ana i nā hōʻailona no ka oxygen therapy, a ʻo ka hoʻohana pono ʻole ʻana i ka oxygen hiki ke hoʻoulu i nā hopena ʻawaʻawa koʻikoʻi.

Ka loiloi kino o ka hypoxia kiko

ʻO nā hōʻike lapaʻau o ke kino hypoxia he ʻokoʻa a ʻaʻole kikoʻī, me nā hōʻailona koʻikoʻi e like me dyspnea, pōkole o ka hanu, tachycardia, ʻeha hanu, hoʻololi wikiwiki i ke kūlana noʻonoʻo, a me ka arrhythmia. No ka hoʻoholo ʻana i ka loaʻa ʻana o ke kino (visceral) hypoxia, serum lactate (hoʻokiʻekiʻe ʻia i ka wā ischemia a hoʻemi ʻia ka puʻuwai puʻuwai) a me SvO2 (hōʻemi ʻia i ka wā o ka hoʻemi ʻana o ka puʻuwai puʻuwai, anemia, hypoxemia arterial, a me ke kiʻekiʻe metabolic rate) he mea kōkua no ka loiloi lapaʻau. Eia nō naʻe, hiki ke hoʻokiʻekiʻe ʻia ka lactate i nā kūlana non hypoxic, no laila ʻaʻole hiki ke hana ʻia kahi hōʻailona ma muli o ke kiʻekiʻe o ka lactate, no ka mea hiki ke hoʻokiʻekiʻe ʻia ka lactate i nā kūlana o ka hoʻonui ʻana i ka glycolysis, e like me ka ulu wikiwiki ʻana o nā maʻi maʻi maʻi, sepsis mua, nā maʻi metabolic, a me ka lawelawe ʻana i nā catecholamine. He mea koʻikoʻi nō hoʻi nā waiwai keʻena hana ʻē aʻe e hōʻike ana i ka hemahema o ke kino, e like me ke kiʻekiʻe creatinine, troponin, a i ʻole nā ​​enzyme ate.

ʻO ka loiloi kauka o ke kūlana oxygenation arterial

Cyanosis. He hōʻailona maʻamau ka cyanosis i ka wā hope o ka hypoxia, a he mea paʻakikī i ka poʻe me ka ʻili ʻeleʻele ke ʻike i ka cyanosis.

Ka nānā ʻana o ka pulse oximetry. Ua hoʻohana nui ʻia ka nānā ʻana o ka pulse oximetry no ka nānā ʻana i nā maʻi āpau, a ua kapa ʻia kāna SaO2 i kapa ʻia ʻo SpO2. ʻO ke kumu o ka nānā ʻana i ka pulse oximetry ʻo ke kānāwai ʻo Bill, e ʻōlelo ana e hiki ke hoʻoholo ʻia ka ʻike ʻana o kahi mea ʻike ʻole ʻia i loko o kahi hopena ma o ka lawe ʻana i ka mālamalama. Ke hele ka malamalama ma kekahi ʻiʻo, ʻo ka hapa nui o ia mea e hoʻomoʻa ʻia e nā mea a me ke koko. Eia nō naʻe, me kēlā me kēia puʻuwai puʻuwai, ke kahe ʻana o ke kahe o ke koko, e ʻae ana i ka pulse oximetry monitor e ʻike i nā loli o ka absorption māmā ma ʻelua mau hawewe: 660 nanometers (ʻulaʻula) a me 940 nanometers (infrared). ʻOkoʻa nā helu absorption o ka hemoglobin i hoʻemi ʻia a me ka oxygenated hemoglobin ma kēia mau hawewe ʻelua. Ma hope o ka unuhi ʻana i ka absorption o nā ʻiʻo non-pulsatile, hiki ke helu ʻia ka neʻe ʻana o ka hemoglobin oxygen e pili ana i ka hemoglobin holoʻokoʻa.

Aia kekahi mau palena i ka nānā ʻana i ka pulse oximetry. Hiki i nā mea i loko o ke koko ke komo i kēia mau nalu nalu ke hoʻopilikia i ka pololei o ke ana ʻana, me ka hemoglobinopathies i loaʻa - carboxyhemoglobin a me methemoglobinemia, methylene blue, a me kekahi mau ʻano hemoglobin genetic. ʻO ka lawe ʻana o ka carboxyhemoglobin ma kahi hawewe o 660 nanometers e like me ka oxygenated hemoglobin; ʻAʻole liʻiliʻi loa i ka nalu nalu o 940 nanometers. No laila, me ka nānā 'ole o ka pili o ka carbon monoxide saturated hemoglobin a me ka oxygen saturated hemoglobin, SpO2 e noho mau (90% ~ 95%). I ka methemoglobinemia, i ka wā e hoʻoheheʻe ʻia ai ka hao heme i ke kūlana ferrous, hoʻohālikelike ka methemoglobin i nā coefficient absorption o ʻelua mau hawewe. ʻO kēia ka hopena o SpO2 e ʻokoʻa wale ana i loko o ka laulā o 83% a i 87% i loko o kahi ākea ākea o ka methemoglobin. I kēia hihia, pono ʻehā mau hawewe o ka māmā no ke ana ʻana o ka oxygen koko e hoʻokaʻawale i waena o nā ʻano ʻehā o ka hemoglobin.

ʻO ka nānā ʻana o ka pulse oximetry e hilinaʻi i ka lawa o ke kahe o ke koko; No laila, ʻaʻole hiki ke hoʻohana ʻia ka nānā ʻana o ka pulse oximetry i ka hypoperfusion haʻalulu a i ka wā e hoʻohana ai i nā mea kōkua ventricular non pulsatile (kahi e helu wale ai ka puʻuwai puʻuwai no kahi ʻāpana liʻiliʻi o ka puʻuwai puʻuwai). I loko o ka tricuspid regurgitation koʻikoʻi, ke kiʻekiʻe o ka deoxyhemoglobin i loko o ke koko venous, a hiki i ka pulsation o ke koko venous ke alakaʻi i ka heluhelu haʻahaʻa o ka oxygen saturation. I ka hypoxemia arterial koʻikoʻi (SaO2<75%), hiki ke emi iho ka pololei no ka mea ʻaʻole i hōʻoia ʻia kēia ʻenehana i loko o kēia pae. ʻO ka mea hope loa, ʻoi aku ka nui o ka poʻe e ʻike nei i ka nānā ʻana i ka pulse oximetry hiki ke hoʻonui i ka saturation hemoglobin arterial a hiki i ka 5-10 pakeneka, ma muli o ka mea kikoʻī i hoʻohana ʻia e nā poʻe ʻeleʻele ʻeleʻele.

PaO2/FIO2. ʻO ka ratio PaO2/FIO2 (i kapa mau ʻia ʻo ka ratio P/F, mai ka 400 a 500 mm Hg) e hōʻike ana i ke degere o ka hoʻololi ʻana o ka oxygen maʻamau i loko o ka māmā, a ʻoi aku ka maikaʻi ma kēia pōʻaiapili e like me ka hiki ke hoʻonohonoho pono ʻia e ka mechanical ventilation FIO2. ʻO ka ratio AP/F ma lalo o 300 mm Hg e hōʻike ana i nā mea ʻino o ke kinoea hoʻololi kino, aʻo ka ratio P/F ma lalo o 200 mm Hg e hōʻike ana i ka hypoxemia koʻikoʻi. ʻO nā mea e pili ana i ka ratio P/F e pili ana i nā hoʻonohonoho ventila, ke kaomi hoʻopau hopena maikaʻi, a me FIO2. ʻO ka hopena o nā hoʻololi i FIO2 ma ka ratio P/F ʻokoʻa ma muli o ke ʻano o ka ʻeha o ka ʻūmāmā, ka hapa shunt, a me ka laulā o nā loli FIO2. I ka loaʻa ʻole o PaO2, hiki i ka SpO2/FIO2 ke lawelawe ma ke ʻano he hōʻailona ʻokoʻa kūpono.

Alveolar arterial oxygen partial pressure (Aa PO2) ʻokoʻa. ʻO ke ana ʻokoʻa Aa PO2 ka ʻokoʻa ma waena o ke kaomi ʻāpana alveolar oxygen i helu ʻia a me ke ana ʻana o ke kaomi ʻāpana oxygen arterial, i hoʻohana ʻia e ana i ka pono o ka hoʻololi kinoea.

'Oko'a ka 'oko'a Aa PO2 "ma'amau" no ka hanu 'ana i ka ea ma ka 'ilikai me ka makahiki, mai 10 a 25 mm Hg (2.5+0.21 x makahiki [makahiki]). ʻO ka mea hoʻohālikelike ʻelua ʻo FIO2 a i ʻole PAO2. Inā piʻi kekahi o kēia mau mea ʻelua, e piʻi ka ʻokoʻa ma Aa PO2. ʻO kēia ke kumu no ka loaʻa ʻana o ka hoʻololi kinoea i loko o nā capillaries alveolar ma ka ʻāpana palahalaha (slope) o ke kaʻe hoʻokaʻawale o ka hemoglobin oxygen. Ma lalo o ke kēkelē like o ka hui pū ʻana, e piʻi aʻe ka ʻokoʻa o ka PO2 ma waena o ke koko venous hui ʻia a me ke koko arterial. Akā, inā haʻahaʻa ka PO2 alveolar ma muli o ka lawa ʻole o ka ventila a i ʻole ke kiʻekiʻe kiʻekiʻe, ʻoi aku ka haʻahaʻa o ka ʻokoʻa Aa ma mua o ka mea maʻamau, hiki ke alakaʻi i ka hoʻohaʻahaʻa a i ʻole ka hōʻoia pololei ʻole o ka pulmonary dysfunction.

Helu hoʻoheheʻe. Hiki ke hoʻohana ʻia ka Oxygenation index (OI) i nā poʻe maʻi i hoʻokuʻu ʻia me ka mechanically e loiloi i ka ikaika o ke kākoʻo ʻana i ka ea no ka mālama ʻana i ka oxygenation. Loaʻa iā ia ke kaomi ʻana o ke ea (MAP, i cm H2O), FIO2, a me PaO2 (i mm Hg) a i ʻole SpO2, a inā ʻoi aku ia ma mua o 40, hiki ke hoʻohana ʻia ma ke ʻano he maʻamau no ka extracorporeal membrane oxygenation therapy. Ka waiwai maʻamau ma lalo o 4 knm H2O/mm Hg; Ma muli o ka waiwai like o cm H2O/mm Hg (1.36), ʻaʻole i hoʻokomo pinepine ʻia nā ʻāpana i ka wā e hōʻike ana i kēia ratio.

Nā hōʻailona no ka lāʻau oxygen acute
Ke pilikia nā maʻi i ka hanu ʻana, koi pinepine ʻia ka oxygen supplementation ma mua o ka ʻike ʻana o ka hypoxemia. Ke emi iho ke kaomi ʻāpana ʻāpana o ka oxygen (PaO2) ma lalo o 60 mm Hg, ʻo ka hōʻailona maopopo loa no ka lawe ʻana o ka oxygen he arterial hypoxemia, ka mea maʻamau e pili ana i ka arterial oxygen saturation (SaO2) a i ʻole peripheral oxygen saturation (SpO2) o 89% a 90%. Ke hāʻule ka PaO2 ma lalo o 60 mm Hg, hiki i ke koko o ka oxygen saturation ke emi loa, e alakaʻi ana i ka emi nui o ka ʻike o ka oxygen arterial a hiki ke hoʻoulu i ka hypoxia kino.

Ma waho aʻe o ka hypoxemia arterial, pono paha ka hoʻonui ʻana o ka oxygen i nā hihia liʻiliʻi. ʻO ka maʻi anemia koʻikoʻi, trauma, a me nā mea maʻi koʻikoʻi o ke kaʻina hiki ke hōʻemi i ka hypoxia kiko ma o ka hoʻonui ʻana i nā pae oxygen arterial. No nā poʻe maʻi me ka carbon monoxide (CO), hiki ke hoʻonui i ka oxygen i hoʻoheheʻe ʻia i loko o ke koko, hoʻololi i ka CO i hoʻopaʻa ʻia i ka hemoglobin, a hoʻonui i ka hapa o ka hemoglobin oxygenated. Ma hope o ka hanu ʻana i ka oxygen maʻemaʻe, ʻo ka hapalua o ke ola o ka carboxyhemoglobin he 70-80 mau minuke, aʻo ka hapalua o ke ola i ka hanu ʻana i ka ea ambient he 320 mau minuke. Ma lalo o nā kūlana oxygen hyperbaric, ua pōkole ka hapalua o ke ola o ka carboxyhemoglobin i lalo o 10 mau minuke ma hope o ka inha ʻana i ka oxygen maʻemaʻe. Hoʻohana pinepine ʻia ka oxygen hyperbaric i nā kūlana kiʻekiʻe o ka carboxyhemoglobin (>25%), ischemia naʻau, a i ʻole nā ​​​​mea ʻino ʻole.

ʻOiai ka nele o ka ʻikepili kākoʻo a i ʻole ka ʻikepili pololei ʻole, hiki i nā maʻi ʻē aʻe ke pōmaikaʻi mai ka hoʻonui ʻana i ka oxygen. Hoʻohana pinepine ʻia ka lāʻau oxygen no ka cluster headache, sickle cell pain crisis, hōʻoluʻolu i ka ʻeha hanu me ka hypoxemia, pneumothorax, a me ka mediastinal emphysema (hoʻoikaika ʻana i ka ea o ka umauma). Aia kekahi mau hōʻike e hōʻike ana e hiki i ka oxygen kiʻekiʻe intraoperative ke hoʻemi i ka ulu ʻana o nā maʻi maʻi ma kahi o ke kaʻina hana. Eia nō naʻe, ʻaʻole ʻike ʻia ka hoʻonui ʻana i ka oxygen e hōʻemi pono i ka nausea / luaʻi postoperative.

Me ka hoʻomaikaʻi ʻana i ka hiki ke hāʻawi i ka oxygen outpatient, ke hoʻonui nei ka hoʻohana ʻana i ka lāʻau oxygen lōʻihi (LTOT). Ua maopopo loa nā kūlana no ka hoʻokō ʻana i ka lāʻau oxygen lōʻihi. Hoʻohana mau ʻia ka lāʻau oxygen lōʻihi no ka maʻi pulmonary obstructive maʻi (COPD).
ʻElua mau haʻawina e pili ana i nā maʻi me ka COPD hypoxemic e hāʻawi i ka ʻikepili kākoʻo no LTOT. ʻO ka haʻawina mua ʻo ia ka Nocturnal Oxygen Therapy Trial (NOTT) i mālama ʻia i ka makahiki 1980, kahi i hoʻokaʻawale ʻia ai nā poʻe maʻi i ka pō (ma ka liʻiliʻi he 12 mau hola) a i ʻole ka lāʻau oxygen mau. Ma 12 a me 24 mau mahina, ʻoi aku ka nui o ka make o ka poʻe maʻi i loaʻa i ka oxygen therapy i ka pō. ʻO ka lua o ka hoʻokolohua ʻo ka Medical Research Council Family Trial i mālama ʻia ma 1981, kahi i hoʻokaʻawale ʻia ai nā maʻi i ʻelua pūʻulu: ʻo ka poʻe i loaʻa ʻole ka oxygen a i ʻole ka poʻe i loaʻa i ka oxygen no ka liʻiliʻi o 15 mau hola i kēlā me kēia lā. E like me ka hōʻike NOTT, ʻoi aku ka kiʻekiʻe o ka make ma ka hui anaerobic. ʻO nā kumuhana o nā ho'āʻoʻelua he mau maʻi puhiʻole i loaʻa ka lāʻau lapaʻau kiʻekiʻe loa a loaʻa nā kūlana kūpaʻa, me kahi PaO2 ma lalo o 55 mm Hg, aiʻole nā ​​maʻi me ka polycythemia a iʻole ka maʻi puʻuwai puʻuwai me ka PaO2 ma lalo o 60 mm Hg.

Hōʻike kēia mau hoʻokolohua ʻelua ʻoi aku ka maikaʻi o ka hoʻonui ʻana i ka oxygen ma mua o 15 mau hola i ka lā ma mua o ka loaʻa ʻole ʻana o ka oxygen, a ʻoi aku ka maikaʻi o ka hoʻomaʻamaʻa oxygen ma mua o ka mālama ʻana i ka pō. ʻO nā pae hoʻohui no kēia mau hoʻāʻo ke kumu no nā hui ʻinikua olakino a me ATS e hoʻomohala i nā alakaʻi LTOT. Maikaʻi ka manaʻo e ʻae ʻia ʻo LTOT no nā maʻi cardiovascular hypoxic ʻē aʻe, akā aia i kēia manawa ka nele o nā hōʻike hoʻokolohua kūpono. ʻAʻole ʻike ʻia kahi hoʻokolohua multicenter hou i ka hopena o ka oxygen therapy i ka make a i ʻole ka maikaʻi o ke ola no nā poʻe maʻi COPD me hypoxemia ʻaʻole i kūpono i nā pae hoʻomaha a i ʻole ma muli o ka hoʻoikaika kino.

Ke kuhikuhi nei nā kauka i ka hoʻonui ʻana i ka oxygen i ka pō i nā poʻe maʻi i ʻike i ka emi nui o ka saturation oxygen koko i ka wā hiamoe. I kēia manawa ʻaʻohe hōʻike maopopo e kākoʻo i ka hoʻohana ʻana i kēia ala i nā poʻe maʻi me ka apnea moe obstructive. No nā poʻe maʻi me ka obstructive sleep apnea a i ʻole obesity hypopnea syndrome e alakaʻi ana i ka hanu ʻino i ka pō, ʻo ka hoʻoulu ʻana i ke kaomi maikaʻi non-invasive ma mua o ka hoʻonui ʻana i ka oxygen ke ʻano lapaʻau nui.

ʻO kekahi pilikia e noʻonoʻo ai inā makemake ʻia ka hoʻohui ʻana o ka oxygen i ka wā e hele ai i ka ea. ʻO ka hapa nui o nā mokulele ʻoihana e hoʻonui i ke kaomi ʻana i kahi kiʻekiʻe e like me 8000 kapuaʻi, me ka hoʻoulu ʻana o ka oxygen ma kahi o 108 mm Hg. No nā poʻe maʻi me nā maʻi ʻāʻī, hiki ke hoʻemi ʻia ka inhaled oxygen tension (PiO2) i ka hypoxemia. Ma mua o ka huakaʻi, pono nā mea maʻi e hana i kahi loiloi olakino piha, me ka hoʻāʻo ʻana i ke koko koko. Inā ʻo ≥ 70 mm Hg (SpO2>95%) ka PaO2 o ka mea maʻi ma ka honua, a laila ʻoi aku ko lākou PaO2 i ka wā lele ma mua o 50 mm Hg, i manaʻo ʻia he lawa no ka hoʻokō ʻana i ka hoʻoikaika kino liʻiliʻi. No nā poʻe maʻi me SpO2 haʻahaʻa a i ʻole PaO2, hiki ke noʻonoʻo ʻia kahi hoʻāʻo hele wāwae 6 mau minuke a i ʻole hypoxia simulation test, maʻamau e hanu ana i ka 15% oxygen. Inā loaʻa ka hypoxemia i ka wā e holo ana i ka ea, hiki ke lawelawe ʻia ka oxygen ma o ka cannula nasal e hoʻonui ai i ka lawe ʻana i ka oxygen.

Ke kumu biochemical o ka make ʻana o ka oxygen

Hoʻokumu ʻia ka ʻona o ka oxygen e ka hana ʻana o nā ʻano oxygen reactive (ROS). ʻO ka ROS he radical manuahi i loaʻa i ka oxygen me kahi electron orbital unpaired i hiki ke hana me nā protein, lipids, a me nā waikawa nucleic, e hoʻololi i ko lākou ʻano a hoʻopilikia i nā kelepona. I ka wā maʻamau mitochondrial metabolism, hana ʻia kahi liʻiliʻi o ROS ma ke ʻano he molele hōʻailona. Hoʻohana pū nā cell immune i ka ROS e pepehi i nā pathogens. Aia ka ROS i ka superoxide, hydrogen peroxide (H2O2), a me nā radical hydroxyl. ʻOi aku ka nui o ka ROS ma mua o nā hana pale kelepona, e alakaʻi ana i ka make a i ʻole ka hoʻoulu ʻana i ka pōʻino cell.

No ka kaupalena ʻana i ka pōʻino i hoʻopili ʻia e ka hanauna ROS, hiki i ka mīkini pale antioxidant o nā cell ke hoʻopau i nā radical manuahi. Hoʻololi ʻo Superoxide dismutase i ka superoxide i H2O2, a laila hoʻololi ʻia i H2O a me O2 e ka catalase a me ka glutathione peroxidase. ʻO Glutathione kahi mole koʻikoʻi e kaupalena ana i ka pōʻino ROS. ʻO nā molekole antioxidant ʻē aʻe he alpha tocopherol (vitamin E), ascorbic acid (vitamin C), phospholipids, a me ka cysteine. Aia i loko o ka ʻiʻo o ka ʻāʻī o ke kanaka ka nui o nā antioxidants extracellular a me nā isoenzymes superoxide dismutase, e hoʻemi ʻia ka mea ʻawaʻawa ke ʻike ʻia i nā kiʻekiʻe o ka oxygen i hoʻohālikelike ʻia me nā ʻiʻo ʻē aʻe.

Hiki ke hoʻokaʻawale ʻia ka hōʻeha ʻana o ka maʻi maʻi ROS i hoʻokomo ʻia i ka Hyperoxia i ʻelua mau pae. ʻO ka mea mua, aia ka māhele exudative, iʻikeʻia e ka makeʻana o nā pūnaewele epithelial alveolar type 1 a me nā pūnaewele endothelial, interstitial edema, a me ka hoʻopihaʻana i nā neutrophils exudative i loko o ka alveoli. Ma hope iho, aia kahi māhele hoʻonui, i ka manawa e hoʻonui ai nā pūnaewele endothelial a me keʻano 2 epithelial cell a uhi i ka membrane basement i hōʻike muaʻia. ʻO nā hiʻohiʻona o ka manawa hoʻōla ʻeha o ka oxygen he fibroblast proliferation a me interstitial fibrosis, akā mālama mau ka endothelium capillary a me ka epithelium alveolar i kahi hiʻohiʻona maʻamau.
Nā hōʻike maʻi o ka toxicity oxygen pulmonary

ʻAʻole maopopo loa ka pae hoʻolaha i loaʻa ai ka ʻona. Ke emi ka FIO2 ma lalo o 0.5, ʻaʻole hiki ke loaʻa ka lāʻau lapaʻau. Ua ʻike ʻia nā haʻawina mua o ke kanaka ʻo ka ʻike ʻana i kahi kokoke i ka 100% oxygen hiki ke hoʻoulu i nā mea ʻino, nausea, a me ka bronchitis, a me ka hoʻohaʻahaʻa ʻana i ka nui o ka māmā, ka hiki ke hoʻopuehu pū, ka mālama ʻana i ka māmā, PaO2, a me ka pH. ʻO nā pilikia ʻē aʻe e pili ana i ka ʻona o ka oxygen ʻo ia ka absorptive atelectasis, oxygen induced hypercapnia, acute respiratory distress syndrome (ARDS), a me neonatal bronchopulmonary dysplasia (BPD).
Absorbent atelectasis. ʻO ka Nitrogen he kinoea inert e laha mālie loa i loko o ke kahe koko i hoʻohālikelike ʻia me ka oxygen, no laila ke pāʻani nei i kahi kuleana i ka mālama ʻana i ka hoʻonui alveolar. I ka hoʻohana ʻana i ka 100% oxygen, ma muli o ka nui o ka lawe ʻana o ke kinoea hou, hiki i ka nele o ka nitrogen ke alakaʻi i ka hāʻule ʻana o ka alveolar ma nā wahi me ka ratio haʻahaʻa alveolar ventilation perfusion ratio (V/Q). ʻOi loa i ka wā o ka ʻoki ʻana, hiki i ka anesthesia a me ka lolo ke alakaʻi i ka emi ʻana o ke koena o ka māmā, e hāpai ana i ka hāʻule ʻana o nā ala ea liʻiliʻi a me ka alveoli, e hopena i ka hoʻomaka wikiwiki ʻana o ka atelectasis.

Hypercapnia i hoʻokomo ʻia i ka oxygen. Hiki i nā poʻe maʻi COPD koʻikoʻi i ka hypercapnia koʻikoʻi ke ʻike ʻia i nā kiʻekiʻe kiʻekiʻe o ka oxygen i ka wā e piʻi ai ko lākou kūlana. ʻO ke ʻano o kēia hypercapnia ʻo ia ka hiki o ka hypoxemia e hoʻokau i ka hanu. Eia nō naʻe, i kēlā me kēia mea maʻi, aia ʻelua mau hana ʻē aʻe e pāʻani ana i nā pae like ʻole.
ʻO ka hypoxemia i nā maʻi COPD ka hopena o ka haʻahaʻa haʻahaʻa alveolar haʻahaʻa o ka oxygen (PAO2) ma ka wahi haʻahaʻa V/Q. I mea e hōʻemi ai i ka hopena o kēia mau ʻāpana V/Q haʻahaʻa i ka hypoxemia, ʻelua mau hopena o ke kahe ʻana o ka pulmonary - hypoxic pulmonary vasoconstriction (HPV) a me hypercapnic pulmonary vasoconstriction - e hoʻoneʻe i ke kahe o ke koko i nā wahi i hoʻomaha maikaʻi ʻia. Ke hoʻonui ka oxygen supplementation i ka PAO2, e emi nui ka HPV, e hoʻonui i ka perfusion i kēia mau wahi, e hopena i nā wahi me ka haʻahaʻa V/Q. Ua waiwai kēia mau ʻiʻo māmā i ka oxygen akā ʻoi aku ka nāwaliwali o ka hiki ke hoʻopau i ka CO2. ʻO ka hoʻonuiʻia o ka perfusion o kēia mau māmā māmā e hele mai i ke kumukūʻai o ka mōhaiʻana i nā wahi me ka maikaʻi o ka ventila, hikiʻole ke hoʻokuʻu i ka nui o CO2 e like me ka wā ma mua, e alakaʻi ana i ka hypercapnia.

ʻO kekahi kumu ʻo ka hopena Haldane nāwaliwali, ʻo ia hoʻi ka hoʻohālikelike ʻana i ke koko oxygenated, hiki i ke koko deoxygenated ke lawe i ka CO2 hou aʻe. Ke hoʻopau ʻia ka hemoglobin, hoʻopaʻa ia i nā protons (H+) a me CO2 ma ke ʻano o nā amino esters. I ka emi ʻana o ka neʻe ʻana o ka deoxyhemoglobin i ka wā o ka oxygen therapy, ke emi nei ka hiki ke hoʻopaʻa ʻia o CO2 a me H+, a laila e hoʻonāwaliwali ai i ke koko venous e lawe i ka CO2 a alakaʻi i ka piʻi ʻana o PaCO2.

I ka hāʻawi ʻana i ka oxygen i nā poʻe maʻi me ka hoʻopaʻa CO2 mau a i ʻole nā ​​​​mea maʻi kiʻekiʻe, ʻoi aku ka nui o ka hypoxemia, he mea nui loa ia e hoʻoponopono maikaʻi i ka FIO2 e mālama i ka SpO2 ma ka laulā o 88% ~ 90%. Hōʻike nā hōʻike he nui i ka hiki ʻole ke hoʻoponopono i ka O2 hiki ke alakaʻi i nā hopena ʻino; ʻO kahi haʻawina randomized i mālama ʻia i nā poʻe maʻi me ka exacerbation nui o CODP i ko lākou hele ʻana i ka haukapila ua hōʻoia ʻole i kēia. Ke hoʻohālikelikeʻia me nā maʻi me kaʻole o ka oxygen, ua hāʻawiʻia nā maʻi e hoʻonui i ka oxygen e mālama i ka SpO2 i loko o ka laulā o 88% a hiki i ka 92% i emi iho ka nui o ka make (7% vs. 2%).

ARDS a me BPD. Ua ʻike lōʻihi ka poʻe e pili ana ka ʻona o ka oxygen me ka pathophysiology o ARDS. I loko o nā mammals non-kanaka, ʻike ʻia i ka 100% oxygen hiki ke alakaʻi i ka diffuse alveolar pōʻino a i ka hopena o ka make. Eia nō naʻe, paʻakikī ka ʻike ʻana i ka hōʻike pololei o ka ʻona o ka oxygen i nā poʻe maʻi me nā maʻi maʻi ʻeha koʻikoʻi. Eia kekahi, hiki i nā maʻi inflammatory ke hoʻoulu i ka upregulation o ka hana pale antioxidant. No laila, ʻaʻole i hōʻike ka hapa nui o nā haʻawina i ka pilina ma waena o ka hoʻolaha ʻana o ka oxygen nui a me ka hōʻeha ʻeha ʻeha a i ʻole ARDS.

ʻO ka maʻi pulmonary hyaline membrane kahi maʻi i hoʻokumu ʻia e ka nele o nā mea hana o ka ʻili, ʻike ʻia e ka hāʻule ʻana o ka alveolar a me ka mumū. ʻO nā keiki hānau mua me ka maʻi membrane hyaline e koi pinepine i ka inhalation o ka oxygen kiʻekiʻe. Manaʻo ʻia ka ʻona o ka oxygen he kumu nui i ka pathogenesis o BPD, ʻoiai e kū mai ana i nā keiki hānau hou ʻaʻole makemake i ka ea uila. Hiki i nā keiki hānau hou ke ma'alahi i ka pō'ino o ka oxygen no ka mea 'a'ole i ho'omohala a 'o'o ko lākou mau hana pale antioxidant cellular; ʻO ka retinopathy o ka prematurity kahi maʻi e pili ana i ka hypoxia / hyperoxia stress, a ua hōʻoia ʻia kēia hopena i ka retinopathy o ka prematurity.
Ka hopena synergistic o ka pulmonary oxygen toxicity

Nui nā lāʻau lapaʻau e hiki ke hoʻonui i ka ʻona o ka oxygen. Hoʻonui ka oxygen i ka ROS i hana ʻia e bleomycin a hoʻopau i ka bleomycin hydrolase. I loko o nā hamsters, hiki ke hoʻonui i ke kaomi ʻāpana oxygen kiʻekiʻe i ka bleomycin i hoʻokomo ʻia i ka ʻeha māmā, a ua hōʻike pū nā hōʻike hihia i ka ARDS i nā maʻi i loaʻa i ka lāʻau bleomycin a ua ʻike ʻia i ka FIO2 kiʻekiʻe i ka wā perioperative. Eia naʻe, ʻaʻole i hōʻike ka hoʻāʻo ʻana i kahi pilina ma waena o ka hoʻolaha ʻana o ka oxygen kiʻekiʻe, ka ʻike mua ʻana i ka bleomycin, a me ka maʻi pulmonary postoperative koʻikoʻi. ʻO ka Paraquat kahi lāʻau lāʻau lapaʻau e hoʻonui ai i ka ʻona o ka oxygen. No laila, i ka wā e hana ai i nā poʻe maʻi me ka paraquat poisoning a me ka ʻike ʻana i ka bleomycin, pono e hoʻemi ʻia ka FIO2 e like me ka hiki. ʻO nā lāʻau lapaʻau ʻē aʻe e hoʻonui ai i ka ʻona o ka oxygen, ʻo ia ka disulfiram a me ka nitrofurantoin. ʻO ka nele o ka protein a me ka meaʻai hiki ke alakaʻi i ka pōʻino o ka oxygen kiʻekiʻe, ʻo ia paha ma muli o ka nele o ka thiol i loaʻa nā amino acids i koʻikoʻi no ka glutathione synthesis, a me ka nele o nā huaora antioxidant A a me E.
ʻO ka ʻona o ka oxygen ma nā ʻōnaehana ʻē aʻe

Hiki i ka Hyperoxia ke hoʻoulu i nā mea ʻawaʻawa i nā kino ma waho o ka māmā. Ua hōʻike ʻia kahi haʻawina hui nui multicenter retrospective cohort i kahi hui ma waena o ka piʻi ʻana o ka make a me ke kiʻekiʻe o ka oxygen kiʻekiʻe ma hope o ka holomua ʻana o ka cardiopulmonary resuscitation (CPR). Ua ʻike ʻia ka haʻawina ʻo nā mea maʻi me PaO2 ʻoi aku ka nui ma mua o 300 mm Hg ma hope o ka CPR i loaʻa i ka lākiō o ka make ma ka haukapila o 1.8 (95% CI, 1.8-2.2) i hoʻohālikelike ʻia i nā poʻe maʻi me ka oxygen koko maʻamau a i ʻole hypoxemia. ʻO ke kumu o ka piʻi ʻana o ka nui o ka make ʻana, ʻo ia ka hoʻohaʻahaʻa ʻana i ka hana o ka ʻōnaehana nerve waena ma hope o ka hopu ʻia ʻana o ka naʻau i hoʻokumu ʻia e ROS i hoʻopili ʻia i ka ʻeha reperfusion oxygen kiʻekiʻe. Ua hōʻike pū kekahi noiʻi hou i ka piʻi ʻana o ka nui o ka make i nā poʻe maʻi me ka hypoxemia ma hope o ka intubation i loko o ke keʻena pilikia, kahi pili pili i ke kiʻekiʻe o ka PaO2 kiʻekiʻe.

No nā poʻe maʻi me ka ʻeha lolo a me ka hahau ʻana, ʻaʻohe pono o ka hāʻawi ʻana i ka oxygen i ka poʻe me ka hypoxemia. Uaʻikeʻia kahi haʻawina i hanaʻia e kahi kikowaena trauma i ka hoʻohālikelikeʻana i nā poʻe maʻi me ka nui o ka oxygen koko maʻamau,ʻo nā poʻe maʻi me kaʻeha lolo o ka lolo i loaʻa ka oxygen kiʻekiʻe (PaO2> 200 mm Hg) i loaʻa ka nui o ka make a me ka Glasgow Coma Score ma lalo o ka hoʻokuʻuʻana. ʻO kekahi haʻawina e pili ana i nā poʻe maʻi e loaʻa ana i ka hyperbaric oxygen therapy i hōʻike i ka prognosis neurological maikaʻi ʻole. Ma kahi ho'āʻo multicenter nui, ʻo ka hoʻonui ʻana i ka oxygen i nā poʻe maʻi maʻi maʻi maʻi me ka hypoxemia (saturation ʻoi aku ma mua o 96%) ʻaʻohe pōmaikaʻi i ka make a i ʻole ka wānana hana.

I loko o ka maʻi myocardial infarction (AMI), he lāʻau lapaʻau maʻamau ka hoʻonui ʻana i ka oxygen, akā paʻa mau ka waiwai o ka lāʻau oxygen no ia mau maʻi. Pono ka oxygen i ka mālama ʻana i nā maʻi maʻi myocardial infarction me ka hypoxemia concomitant, no ka mea hiki ke hoʻopakele i nā ola. Eia naʻe, ʻaʻole maopopo ka pōmaikaʻi o ka hoʻohui ʻana o ka oxygen maʻamau i ka loaʻa ʻole o ka hypoxemia. I ka hopena o nā makahiki 1970, ua hoʻopaʻa inoa ʻia kahi hoʻokolohua pālua-makapō i nā maʻi 157 me ka infarction myocardial acute ʻole a hoʻohālikelike i ka oxygen therapy (6 L / min) me ka ʻole o ka oxygen therapy. Ua ʻike ʻia ʻo ka poʻe maʻi e loaʻa ana i ka oxygen therapy i ʻoi aku ka nui o ka sinus tachycardia a me ka piʻi nui ʻana o nā enzyme myocardial, akā ʻaʻohe ʻokoʻa i ka helu make.

I ka ST segment elevation acute myocardial infarction poʻe maʻi me ka hypoxemia, nasal cannula oxygen therapy ma 8 L/min ʻaʻole maikaʻi ke hoʻohālikelike ʻia i ka inhaling ambient ea. Ma kekahi noiʻi e pili ana i ka inhalation oxygen ma 6 L / min a me ka inhalation o ka ea ambient, ʻaʻohe ʻokoʻa i ka 1-makahiki make a me ka helu helu helu i waena o nā maʻi me ka infarction myocardial acute. ʻO ka mālama ʻana i ka saturation oxygen koko ma waena o 98% a 100% a me 90% a 94% ʻaʻohe pōmaikaʻi i nā maʻi me ka hopu ʻana i ka naʻau ma waho o ka haukapila. ʻO nā hopena maikaʻi ʻole o ka oxygen kiʻekiʻe ma ka infarction myocardial acute, ʻo ia ka constriction coronary artery, hoʻopau i ka microcirculation kahe kahe o ke koko, hoʻonui i ka oxygen shunt hana, hoʻemi ʻia ka hoʻohana ʻana i ka oxygen, a hoʻonui i ka pōʻino ROS ma ka wahi reperfusion holomua.

ʻO ka mea hope loa, ua noiʻi nā hoʻokolohua lapaʻau a me nā meta-analyses i nā koina kikoʻī SpO2 kūpono no nā maʻi maʻi maʻi maʻi maʻi. ʻO kahi kikowaena hoʻokahi, wehe ʻia ka lepili randomized hoʻāʻo e hoʻohālikelike ana i ka conservative oxygen therapy (SpO2 target 94% ~ 98%) me ka lāʻau kuʻuna (SpO2 waiwai 97% ~ 100%) i mālama ʻia ma nā maʻi 434 i loko o ka hale mālama kino. Ua hoʻomaikaʻi ʻia ka nui o ka make i loko o ke keʻena mālama koʻikoʻi o nā maʻi i hoʻokaʻawale ʻia no ka mālama ʻana i ka oxygen conservative, me nā haʻahaʻa haʻahaʻa o ka haʻalulu, hāʻule ʻole o ka ate, a me ka bacteremia. ʻO kahi meta-analysis ma hope mai he 25 mau hoʻokolohua lapaʻau i kiʻi ʻia ma luna o 16000 mau maʻi maʻi maʻi me nā ʻano maʻi like ʻole, e like me ka hahau, trauma, sepsis, myocardial infarction, a me ka hōʻeha pilikia. Ua hōʻike ʻia nā hopena o kēia meta-analysis i nā poʻe maʻi e loaʻa ana i nā hoʻolālā o ka oxygen therapy conservative i hoʻonui i ka nui o ka make ma ka haukapila (pilikia pili, 1.21; 95% CI, 1.03-1.43).

Eia nō naʻe, ʻaʻole i hōʻike ʻia nā hoʻokolohua ʻelua ma hope o ka hopena o nā hoʻolālā o ka oxygen therapy conservative i ka helu o nā lā me ka ʻole o nā ventilator i nā maʻi me ka maʻi ʻāʻī a i ʻole ka 28 lā ola ola i nā maʻi ARDS. I kēia mau lā, kahi noiʻi o nā maʻi 2541 e loaʻa ana i ka mechanical ventilation ua ʻike ʻia ʻo ka hoʻonui ʻia o ka oxygen i loko o ʻekolu mau kikowaena SpO2 like ʻole (88% ~ 92%, 92% ~ 96%, 96% ~ 100%) ʻaʻole i hoʻopilikia i nā hopena e like me nā lā ola, make, hopu ʻana i ka naʻau, arrhythmia, myocardial infarction me ka ʻole o nā lā mechanical. Ma muli o kēia mau ʻikepili, ʻōlelo nā alakaʻi alakaʻi ʻo British Thoracic Society i kahi kikoʻī SpO2 ākea o 94% a 98% no ka hapa nui o nā maʻi maʻi maʻi makua. He kūpono kēia no ka mea ʻo SpO2 i loko o kēia pae (e noʻonoʻo ana i ka ± 2% ~ 3% hewa o ka pulse oximeters) pili i kahi pae PaO2 o 65-100 mm Hg, kahi palekana a lawa no nā pae oxygen koko. No nā poʻe maʻi i ka pilikia o ka hanu hanu hypercapnic, 88% a 92% kahi pahuhopu palekana e pale aku i ka hypercapnia i hoʻokumu ʻia e O2.