amakuru

Ubuvuzi bwa Oxygene ni bumwe mu buryo bukoreshwa cyane mu buvuzi bwa kijyambere, ariko haracyari imyumvire itari yo ku byerekeranye no kuvura ogisijeni, kandi gukoresha nabi ogisijeni bishobora gutera uburozi bukomeye;

Isuzuma rya Clinical of tissue hypoxia

Kugaragara kwa clinique hypoxia tissue biratandukanye kandi bidasanzwe, hamwe nibimenyetso bigaragara cyane birimo dyspnea, guhumeka nabi, tachycardia, guhumeka neza, guhinduka vuba mumitekerereze, hamwe na arththmia. Kugirango hamenyekane hypoxia ya tissue (visceral), serumu lactate (yazamuye mugihe cya ischemia no kugabanya umusaruro wumutima) na SvO2 (byagabanutse mugihe cyo kugabanuka k'umutima, anemia, hypoxemia arterial, hamwe nigipimo kinini cya metabolike) bifasha mugusuzuma amavuriro. Nyamara, lactate irashobora kuzamurwa mugihe kitari hypoxique, bityo rero ntishobora kwisuzumisha hashingiwe gusa ku kuzamuka kwa lakate, kuko lactate nayo ishobora kuzamurwa mugihe cyiyongera rya glycolysis, nko gukura vuba kubyimba bibi, sepsis kare, indwara ziterwa na metabolike, hamwe nubuyobozi bwa catecholamine. Izindi ndangagaciro za laboratoire zerekana imikorere mibi yumubiri nazo ni ngombwa, nka creinine hejuru, troponine, cyangwa imisemburo yumwijima.

Isuzumabumenyi rya ogisijeni ya arterial

Cyanose. Ubusanzwe Cyanose ni ikimenyetso kibaho mugihe cyanyuma cya hypoxia, kandi akenshi ntigishobora kwizerwa mugupima hypoxemia na hypoxia kuko ntigishobora kubaho muri anemia no gutembera neza kwamaraso, kandi biragoye kubantu bafite uruhu rwijimye kumenya cyanose.

Gukurikirana impiswi. Igenzura ridashobora gukurikiranwa ryakoreshejwe cyane mugukurikirana indwara zose, kandi ikigereranyo cya SaO2 cyitwa SpO2. Ihame ryo kugenzura pulse oximetry ni itegeko rya Bill, rivuga ko kwibumbira hamwe kw'ibintu bitazwi mu gisubizo bishobora kugenwa no kwinjiza urumuri. Iyo urumuri runyuze mubice byose, ibyinshi byinjizwa nibintu byumubiri hamwe namaraso. Nyamara, hamwe na buri mutima utera, amaraso ya arterial agenda atembera ya pulsatile, bigatuma monitor ya pulse oximetry ishobora kumenya impinduka zinjira mumucyo muburebure bubiri: 660 nanometero (umutuku) na nanometero 940 (infrared). Igipimo cyo kwinjiza gemoglobine yagabanutse na hemoglobine ya ogisijeni iratandukanye kuri ubu burebure bwombi. Nyuma yo gukuramo iyinjizwa ryimitsi idafite pulsatile, ubunini bwa ogisijeni ya hemoglobine ugereranije na hemoglobine yose irashobora kubarwa.

Hariho imbogamizi zo gukurikirana pulse oximetry. Ikintu cyose kiri mumaraso gikurura ubu burebure burashobora kubangamira gupima neza, harimo na hemoglobinopathies yungutse - carboxyhemoglobin na methemoglobinemia, methylene ubururu, hamwe na genoglobine zimwe na zimwe. Kwinjiza karboxyhemoglobine ku burebure bwa nanometero 660 isa n'iya ogisijeni ya hemoglobine; Kwinjiza gake cyane kumurongo wa 940 nanometero. Kubwibyo, tutitaye ku kugereranya kwinshi kwa karubone monoxide yuzuye ya hemoglobine na ogisijeni yuzuyemo hemoglobine, SpO2 izahoraho (90% ~ 95%). Muri methemoglobinemia, iyo icyuma cya heme gihinduwe okiside kuri ferrous, methemoglobine iringaniza coefficient zo kwinjiza uburebure bubiri. Ibisubizo muri SpO2 biratandukanye gusa murwego rwa 83% kugeza kuri 87% murwego rwagutse rwa methemoglobine. Muri iki gihe, harasabwa uburebure bune bwumucyo kugirango hapimwe ogisijeni yamaraso ya arterial kugirango itandukane muburyo bune bwa hemoglobine.

Igenzura rya pulse oximetry rishingiye kumaraso ahagije; Kubwibyo rero, pulse oximetry igenzura ntishobora gukoreshwa muguhungabana hypoperfusion cyangwa mugihe ukoresheje ibikoresho bidafasha umuyaga udasanzwe (aho umusaruro wumutima ubara igice gito cyibisohoka byumutima). Mugusubirana gukabije kwa tricuspid, kwibumbira hamwe kwa deoxyhemoglobine mumaraso yimitsi ni menshi, kandi gutembera kwamaraso yimitsi bishobora gutuma amaraso make ya ogisijeni yuzuye. Muri hypoxemia ikabije ya arterial (SaO2 <75%), ubunyangamugayo burashobora kugabanuka kuko ubu buhanga butigeze bwemezwa muriki cyiciro. Ubwanyuma, abantu benshi kandi benshi bamenye ko kugenzura impiswi ya oximetry bishobora kugereranya kwiyuzuza kwa arterial hemoglobine kugera ku manota 5-10%, bitewe nigikoresho cyihariye gikoreshwa nabantu bafite uruhu rwijimye.

PaO2 / FIO2. Ikigereranyo cya PaO2 / FIO2 (bakunze kwita igipimo cya P / F, kiri hagati ya 400 na 500 mm Hg) kigaragaza urugero rwo guhanahana umwuka wa ogisijeni udasanzwe mu bihaha, kandi ni ingirakamaro cyane muri urwo rwego kuko guhumeka neza bishobora gushyiraho FIO2 neza. Ikigereranyo cya AP / F kiri munsi ya 300 mm Hg cyerekana ivuriro ridasanzwe muburyo bwo guhanahana gaze, mugihe igipimo cya P / F kiri munsi ya 200 mm Hg cyerekana hypoxemia ikabije. Ibintu bigira ingaruka ku kigereranyo cya P / F harimo igenamigambi rihumeka, igitutu cyiza kirangira, na FIO2. Ingaruka zimpinduka muri FIO2 ku kigereranyo cya P / F ziratandukanye bitewe nimiterere yimvune yibihaha, agace ka shunt, hamwe nimpinduka za FIO2. Mugihe PaO2 idahari, SpO2 / FIO2 irashobora kuba nkibipimo bifatika.

Alveolar arterial ogisijeni yumuvuduko wigice (Aa PO2) itandukaniro. Ibipimo bitandukanye bya Aa PO2 ni itandukaniro riri hagati yumuvuduko wa ogisijeni wa alveolar ubarwa hamwe nigipimo cyumuvuduko wa arterial ogisijeni wapimwe, ukoreshwa mugupima imikorere yo guhana gaze.

Itandukaniro "risanzwe" Aa PO2 ryo guhumeka umwuka wikirere kurwego rwinyanja uratandukana nimyaka, kuva kuri mm 10 kugeza kuri 25 mm Hg (2,5 + 0.21 x imyaka [imyaka]). Ikintu cya kabiri kigira ingaruka ni FIO2 cyangwa PAO2. Niba kimwe muribi bintu byombi cyiyongereye, itandukaniro muri Aa PO2 riziyongera. Ni ukubera ko guhanahana gaze muri alveolar capillaries bibaho mugice gishimishije (ahahanamye) ya hemoglobine ogisijeni itandukanijwe. Kurwego rumwe rwo kuvanga imitsi, itandukaniro rya PO2 hagati yamaraso avanze namaraso arterial biziyongera. Ibinyuranye na byo, niba alveolar PO2 iri hasi kubera guhumeka bidahagije cyangwa ubutumburuke buri hejuru, itandukaniro rya Aa rizaba riri munsi yubusanzwe, ibyo bikaba bishobora gutuma umuntu adaha agaciro cyangwa asuzumwa nabi yibikorwa byimpyiko.

Icyerekezo cya Oxygene. Indangantego ya Oxygene (OI) irashobora gukoreshwa mu barwayi bahumeka neza kugira ngo isuzume imbaraga zikenewe zo guhumeka kugira ngo ogisijeni ikomeze. Harimo umuvuduko wumuyaga (MAP, muri cm H2O), FIO2, na PaO2 (muri mm Hg) cyangwa SpO2, kandi iyo irenze 40, irashobora gukoreshwa nkigipimo cyo kuvura okisijeni ya membrane idasanzwe. Agaciro gasanzwe kari munsi ya cm 4 H2O / mm Hg; Bitewe nagaciro kamwe ka cm H2O / mm Hg (1.36), ubusanzwe ibice ntabwo birimo mugihe cyo gutanga raporo.

Ibimenyetso byo kuvura ogisijeni ikaze
Iyo abarwayi bafite ikibazo cyo guhumeka, hakenerwa inyongera ya ogisijeni mbere yo gusuzuma hypoxemia. Iyo umuvuduko wa arterial igice cya ogisijeni (PaO2) uri munsi ya mm 60 Hg, ikimenyetso kigaragara cyerekana gufata ogisijeni ni hypoxemia ya arterial, ubusanzwe ihura na ogisijeni ya ogisijeni (SaO2) cyangwa kuzura ogisijeni ya peripheri (SpO2) ya 89% kugeza 90%. Iyo PaO2 igabanutse munsi ya mm 60 Hg, kuzura ogisijeni mu maraso birashobora kugabanuka cyane, bigatuma igabanuka ryinshi rya ogisijeni ya arterial kandi bishobora gutera hypoxia tissue.

Usibye hypoxemia arterial, inyongera ya ogisijeni irashobora gukenerwa mubihe bidasanzwe. Anemia ikabije, ihahamuka, hamwe n’abarwayi bakomeye babaga barashobora kugabanya hypoxia ya tissue mu kongera urugero rwa ogisijeni ya arterial. Ku barwayi bafite ubumara bwa karubone (CO), kongeramo ogisijeni birashobora kongera umwuka wa ogisijeni ushonga mu maraso, ugasimbuza CO uhujwe na hemoglobine, kandi ukongera umubare wa ogisijeni wa hemoglobine. Nyuma yo guhumeka umwuka mwiza wa ogisijeni, igice cya kabiri cyubuzima bwa carboxyhemoglobine ni iminota 70-80, mugihe igice cyubuzima iyo uhumeka umwuka wibidukikije ni iminota 320. Mugihe cya hyperbaric ogisijeni, igice cya kabiri cyubuzima bwa carboxyhemoglobine kigabanywa kugeza munsi yiminota 10 nyuma yo guhumeka ogisijeni nziza. Hyperbaric ogisijeni ikoreshwa mubihe bifite urugero rwinshi rwa karubisihemuoglobine (> 25%), ischemia yumutima, cyangwa amarangamutima adasanzwe.

Nubwo habuze amakuru ashyigikira cyangwa amakuru adahwitse, izindi ndwara nazo zishobora kungukirwa no kuzuza ogisijeni. Ubuvuzi bwa Oxygene bukoreshwa cyane mu kubabara umutwe, ikibazo cy’ububabare bw’umuhoro, kugabanya ububabare bw’ubuhumekero nta hypoxemia, pneumothorax, na emphysema mediastinal (guteza imbere umwuka wo mu gatuza). Hariho ibimenyetso byerekana ko ogisijeni ikora cyane ishobora kugabanya kwandura indwara zanduye. Ariko, kuzuza ogisijeni ntabwo bisa nkigabanya neza isesemi nyuma yo kubagwa / kuruka.

Hamwe nogutezimbere ubushobozi bwo gutanga ogisijeni yo hanze, gukoresha imiti ya ogisijeni yigihe kirekire (LTOT) nayo iriyongera. Ibipimo byo gushyira mu bikorwa imiti ndende ya ogisijeni bimaze gusobanuka neza. Ubuvuzi bw'igihe kirekire bwa ogisijeni bukoreshwa cyane mu ndwara zidakira zifata ibihaha (COPD).
Ubushakashatsi bubiri ku barwayi bafite hypoxemic COPD butanga amakuru yunganira LTOT. Ubushakashatsi bwa mbere ni Ikigeragezo cya Oxygene Therapy (NotT) cyakozwe mu 1980, aho abarwayi bahawe ku bushake haba nijoro (byibuze amasaha 12) cyangwa kuvura ogisijeni ikomeza. Ku mezi 12 na 24, abarwayi bahabwa imiti ivura ogisijeni nijoro gusa bafite impfu nyinshi. Ubushakashatsi bwa kabiri ni Ubushakashatsi bw’ubuvuzi bw’ubuvuzi bwakozwe mu 1981, aho abarwayi bagabanyijwemo amatsinda abiri ku buryo butemewe: abatarahawe ogisijeni cyangwa abahawe ogisijeni byibuze amasaha 15 ku munsi. Bisa na NOTT ikizamini, umubare wimpfu mumatsinda ya anaerobic wari hejuru cyane. Ibigeragezo byombi byagaragaye ni abarwayi batanywa itabi bavuwe cyane kandi bafite ubuzima buhamye, bafite PaO2 iri munsi ya mm 55 Hg, cyangwa abarwayi bafite polycythemia cyangwa indwara zifata umutima zifata PaO2 munsi ya mm 60 Hg.

Ubu bushakashatsi bubiri bwerekana ko kuzuza ogisijeni mu masaha arenga 15 kumunsi aribyiza kuruta kutabona ogisijeni, kandi kuvura ogisijeni ikomeza ni byiza kuruta kuvura nijoro. Ibipimo ngenderwaho muri ibi bigeragezo nibyo shingiro ryamasosiyete yubwishingizi bwubuvuzi hamwe na ATS kugirango batezimbere umurongo wa LTOT. Nibyiza kwemeza ko LTOT yemerwa nizindi ndwara ziterwa na hypoxic cardiovasculaire, ariko kuri ubu harabura ibimenyetso bifatika byubushakashatsi. Ikigeragezo giheruka gukorwa cyagaragaje ko nta tandukaniro riri hagati y’ingaruka zo kuvura ogisijeni ku rupfu cyangwa ubuzima bw’abarwayi ba COPD barwaye hypoxemia itujuje ibisabwa kugira ngo baruhuke cyangwa byatewe gusa n’imyitozo.

Rimwe na rimwe, abaganga bategeka inyongera ya ogisijeni nijoro ku barwayi bagabanuka cyane mu maraso ya ogisijeni mu gihe cyo gusinzira. Kugeza ubu nta bimenyetso bifatika byemeza ikoreshwa ry'ubu buryo ku barwayi bafite ikibazo cyo gusinzira nabi. Ku barwayi bafite ikibazo cyo gusinzira kibuza apnea cyangwa syndrome de hypopnea umubyibuho ukabije biganisha ku guhumeka nabi nijoro, guhumeka neza kudatera imbaraga kuruta kongeramo ogisijeni nuburyo nyamukuru bwo kuvura

Ikindi kibazo ugomba gusuzuma ni ukumenya niba hakenewe inyongera ya ogisijeni mugihe cyindege. Indege nyinshi zubucuruzi zongera umuvuduko wa kabine ku butumburuke bungana na metero 8000, hamwe na ogisijeni ihumeka igera kuri mm 108 Hg. Ku barwayi barwaye ibihaha, kugabanuka kwa umwuka wa ogisijeni uhumeka (PiO2) birashobora gutera hypoxemia. Mbere yo gukora ingendo, abarwayi bagomba kwisuzumisha byuzuye mubuvuzi, harimo no gupima gaze ya arterial. Niba PaO2 yumurwayi hasi ari mm 70 mm Hg (SpO2> 95%), noneho PaO2 yabo mugihe cyo guhaguruka birashoboka ko irenga mm 50 Hg, mubisanzwe bifatwa nkibihagije kugirango bahangane nibikorwa bike byumubiri. Ku barwayi bafite SpO2 cyangwa PaO2, hasuzumwa ikizamini cyo kugenda iminota 6 cyangwa hypoxia simulation, mubisanzwe bahumeka ogisijeni 15%. Niba hypoxemia ibaye mugihe cyurugendo rwindege, ogisijeni irashobora gutangwa binyuze mumazuru kugirango yongere ogisijeni.

Ibinyabuzima shingiro byuburozi bwa ogisijeni

Ubumara bwa Oxygene buterwa no gukora ubwoko bwa ogisijeni ikora (ROS). ROS ni ogisijeni ikomoka kuri radical yubusa hamwe na electron ya orbital idafite uburinganire ishobora gukora hamwe na poroteyine, lipide, na acide nucleic, guhindura imiterere yabyo no kwangiza selile. Mugihe cya metabolisme isanzwe ya mitochondrial, ROS ikorwa nka molekile yerekana. Immune selile nayo ikoresha ROS kugirango yice virusi. ROS ikubiyemo superoxide, hydrogen peroxide (H2O2), na hydroxyl radicals. ROS ikabije izahora irenga ibikorwa byo kwirwanaho, biganisha ku rupfu cyangwa kwangiza selile.

Kugirango ugabanye ibyangiritse byahujwe nigisekuru cya ROS, uburyo bwo kurinda antioxydeant selile burashobora kwangiza radicals yubuntu. Superoxide dismutase ihindura superoxide muri H2O2, hanyuma igahinduka H2O na O2 na catalase na glutathione peroxidase. Glutathione ni molekile yingenzi igabanya kwangirika kwa ROS. Izindi molekile za antioxydeant zirimo alpha tocopherol (vitamine E), aside aside (vitamine C), fosifolipide, na sisitemu. Ibihaha by'umuntu birimo intungamubiri nyinshi za antioxydants na superoxide disutase isoenzymes, bigatuma itagira uburozi iyo ihuye na ogisijeni nyinshi ugereranije nizindi ngingo.

Hyperoxia yatewe na ROS ikomeretsa ibihaha irashobora kugabanywamo ibice bibiri. Ubwa mbere, hariho icyiciro cya exudative, cyaranzwe nurupfu rwubwoko bwa alveolar selile 1 epithelial selile na endothelial selile, edema interstinterial, hamwe no kuzuza neutrophile exudative muri alveoli. Ibikurikiraho, hariho icyiciro cyo gukwirakwira, mugihe ingirabuzimafatizo ya endoteliyale hamwe nubwoko bwa 2 epiteliyale selile ikwirakwira kandi igapfundikanya ibyumba byo hasi byerekanwe mbere. Ibiranga igihe cyo gukira kwa ogisijeni ni ikwirakwizwa rya fibroblast na fibrosis interstitial, ariko capillary endothelium na epitelium ya alveolar iracyafite isura isanzwe.
Kugaragara kwa clinique yubumara bwa ogisijeni

Urwego rugaragaramo uburozi buboneka ntirurasobanuka neza. Iyo FIO2 iri munsi ya 0.5, uburozi bwamavuriro muri rusange ntibubaho. Ubushakashatsi bwakozwe bwa mbere bwabantu bwerekanye ko guhura na ogisijeni hafi 100% bishobora gutera ibyiyumvo bidasanzwe, isesemi, na bronchite, ndetse no kugabanya ubushobozi bwibihaha, ubushobozi bwo gukwirakwiza ibihaha, kubahiriza ibihaha, PaO2, na pH. Ibindi bibazo bifitanye isano n'uburozi bwa ogisijeni harimo atelectasis ikurura, ogisijeni iterwa na hypercapnia, syndrome de syndrome de acute respiratory (ARDS), na dysplasia ya neonatal bronchopulmonary dysplasia (BPD).
Absorbent atelectasis. Azote ni gaze ya inert ikwirakwira buhoro buhoro mu maraso ugereranije na ogisijeni, bityo ikagira uruhare mu gukomeza kwaguka kwa alveolar. Iyo ukoresheje ogisijeni 100%, kubera igipimo cya ogisijeni irenze igipimo cyo gutanga gaze nshya, kubura azote birashobora gutuma alveolar isenyuka mubice bifite igipimo cyo hasi cya alveolar ihumeka neza (V / Q). Cyane cyane mugihe cyo kubagwa, anesthesia na paralise birashobora gutuma igabanuka ryimikorere yibihaha isigaye, bigatera gusenyuka kwimyuka mito na alveoli, bikaviramo gutangira vuba atelectasis.

Oxygene itera hypercapnia. Abarwayi ba COPD bakunze kwibasirwa na hypercapnia ikabije iyo bahuye na ogisijeni nyinshi mu gihe ubuzima bwabo bumeze nabi. Uburyo bwiyi hypercapnia nuko ubushobozi bwa hypoxemia yo gutwara ubuhumekero bubujijwe. Nyamara, mumurwayi uwo ari we wese, hariho ubundi buryo bubiri bukinishwa kuburyo butandukanye.
Hypoxemia mu barwayi ba COPD ni ibisubizo byumuvuduko ukabije wa alveolar igice cya ogisijeni (PAO2) mukarere ka V / Q. Mu rwego rwo kugabanya ingaruka z’uturere twa V / Q nkeya kuri hypoxemia, ibintu bibiri byerekana umuvuduko wimpyiko - hypoxic pulmonary vasoconstriction (HPV) na hypercapnic pulmonary vasoconstriction - bizimura amaraso ahantu hafite umwuka mwiza. Iyo inyongera ya ogisijeni yiyongereye PAO2, HPV iragabanuka cyane, yongera parufe muri utwo turere, bivamo uduce dufite igipimo cya V / Q. Izi ngingo z'ibihaha ubu zikungahaye kuri ogisijeni ariko zifite ubushobozi buke bwo gukuraho CO2. Kwiyongera kwinshi kwi myanya yibihaha biza kubiciro byo gutamba ahantu hamwe no guhumeka neza, bidashobora kurekura CO2 nyinshi nka mbere, biganisha kuri hypercapnia.

Indi mpamvu ni ingaruka za Haldane zacitse intege, bivuze ko ugereranije namaraso ya ogisijeni, amaraso ya dexygene ashobora gutwara CO2 nyinshi. Iyo hemoglobine ihumanye, ihuza proton nyinshi (H +) na CO2 muburyo bwa est est est amino. Nkuko kwibumbira hamwe kwa deoxyhemoglobine bigabanuka mugihe cyo kuvura ogisijeni, ubushobozi bwo gukwirakwiza CO2 na H + nabwo buragabanuka, bityo bikagabanya ubushobozi bwamaraso yimitsi yo gutwara CO2 bigatuma PaCO2 yiyongera.

Iyo guha ogisijene abarwayi bafite CO2 idakira cyangwa abarwayi bafite ibyago byinshi, cyane cyane mugihe cya hypoxemia ikabije, ni ngombwa cyane guhindura neza FIO2 kugirango SpO2 ibungabunge 88% ~ 90%. Raporo nyinshi zerekana ko kunanirwa kugenzura O2 bishobora gutera ingaruka mbi; Nta gushidikanya ko ubushakashatsi bwakozwe ku barwayi bafite ubukana bukabije bwa CODP berekeza mu bitaro, nta gushidikanya ko ibi byabigaragaje. Ugereranije n’abarwayi badafite ogisijeni ibujijwe, abarwayi bahawe amahirwe yo kongeramo ogisijeni kugira ngo bakomeze SpO2 mu kigero cya 88% kugeza kuri 92% bari bafite umubare muto w’impfu (7% na 2%).

ARDS na BPD. Abantu bamaze kuvumbura ko ubumara bwa ogisijeni bufitanye isano na patrophysiologiya ya ARDS. Mu nyamaswa z’inyamabere zitari abantu, guhura na ogisijeni 100% birashobora gukurura kwangirika kwa alveolar hanyuma amaherezo agapfa. Nyamara, ibimenyetso nyabyo byerekana uburozi bwa ogisijeni ku barwayi bafite indwara zikomeye z’ibihaha biragoye gutandukanya ibyangijwe n’indwara ziterwa. Byongeye kandi, indwara nyinshi zitera indwara zirashobora gutuma habaho kugenzura imikorere ya antioxydeant. Kubwibyo, ubushakashatsi bwinshi bwananiwe kwerekana isano iri hagati yo guhura na ogisijeni ikabije no gukomeretsa ibihaha bikabije cyangwa ARDS.

Indwara ya Hyaline membrane Indwara ni indwara iterwa no kubura ibintu bikora hejuru, birangwa no gusenyuka kwa alveolar no gutwika. Abana bavutse batagejeje igihe bafite indwara ya hyaline membrane basaba guhumeka umwuka mwinshi wa ogisijeni. Ubumara bwa Oxygene bufatwa nk'impamvu ikomeye mu gutera indwara ya BPD, ndetse no mu bana bavutse badakenera guhumeka. Abana bavutse barashobora kwibasirwa cyane na ogisijeni nyinshi kubera ko ibikorwa byabo byo kwirinda antioxydeant selile bitarakura neza kandi bikuze; Retinopathie yo kutaragera ni indwara ifitanye isano na hypoxia / hyperoxia inshuro nyinshi, kandi iyi ngaruka yemejwe muri retinopathie yo kutaragera.
Ingaruka zo guhuza imbaraga z'ubumara bwa ogisijeni

Hariho imiti myinshi ishobora kongera ubumara bwa ogisijeni. Oxygene yongera ROS ikorwa na bleomycine kandi idakora hydrolase ya bleomycine. Muri hamsters, umuvuduko mwinshi wa ogisijeni urashobora kongera bleomycine yatewe no gukomeretsa ibihaha, kandi raporo zerekana ko zasobanuye ARDS ku barwayi bavuwe na blomycine kandi bahuye na FIO2 mu gihe cyo gutangira. Ariko, ibigeragezo byateganijwe ntibyashoboye kwerekana isano iri hagati ya ogisijeni nyinshi yibasiwe cyane, guhura na bleomycine, ndetse no gukora nabi cyane nyuma yo kubagwa. Paraquat ni imiti yica ibyatsi nubundi bwongera ubumara bwa ogisijeni. Kubwibyo, mugihe uhuye nabarwayi bafite uburozi bwa paraquat no guhura na bleomycine, FIO2 igomba kugabanuka cyane bishoboka. Indi miti ishobora gukaza ubumara bwa ogisijeni harimo disulfiram na nitrofurantoin. Intungamubiri za poroteyine nintungamubiri zirashobora gutera kwangirika kwa ogisijeni nyinshi, bishobora guterwa no kubura thiol irimo aside amine ifite akamaro kanini mu gusanisha glutathione, ndetse no kubura vitamine A na E.
Ubumara bwa Oxygene mu zindi sisitemu

Hyperoxia irashobora gutera uburozi kumubiri hanze yibihaha. Ubushakashatsi bunini bwa reticpective retrospective cohort bwerekanye isano iri hagati yo kongera imfu n’urwego rwa ogisijeni nyinshi nyuma yo kuvura indwara zifata umutima (CPR). Ubushakashatsi bwerekanye ko abarwayi bafite PaO2 barenga mm 300 Hg nyuma ya CPR bafite ibyago byo gupfa mu bitaro bangana na 1.8 (95% CI, 1.8-2.2) ugereranije n’abarwayi bafite ogisijeni isanzwe y’amaraso cyangwa hypoxemia. Impamvu y’ubwiyongere bw’imfu ni iyangirika ryimikorere ya sisitemu yo hagati ya nervice nyuma yo gufatwa k'umutima byatewe na ROS yifashishije imvune nyinshi ya ogisijeni. Ubushakashatsi buherutse gukorwa bwerekanye kandi ko umubare w'impfu ziyongera ku barwayi barwaye hypoxemia nyuma yo kwinjizwa mu ishami ryihutirwa, ibyo bikaba bifitanye isano rya bugufi n'urwego rwa PaO2 rwazamutse.

Ku barwayi bafite ikibazo cyubwonko nubwonko, gutanga ogisijeni kubadafite hypoxemia bisa nkaho nta nyungu. Ubushakashatsi bwakozwe n'ikigo cy’ihungabana bwerekanye ko ugereranije n’abarwayi bafite ogisijeni isanzwe y’amaraso, abarwayi bafite ikibazo cy’ubwonko bw’ubwonko bakiriye ogisijeni nyinshi (PaO2> 200 mm Hg) bafite umubare munini w’impfu ndetse n’amanota ya Glasgow Coma bakimara gusohoka. Ubundi bushakashatsi bwakozwe ku barwayi bahabwa imiti ivura hyperbaric yerekanaga imiterere mibi y’imitsi. Mu igeragezwa rinini ryinshi, kongerera ogisijeni abarwayi ba stroke batewe na hypoxemia (kwiyuzuza kurenga 96%) nta nyungu byigeze bipfa cyangwa guhanura imikorere.

Muri infarction ikaze ya myocardial (AMI), inyongera ya ogisijeni nubuvuzi bukunze gukoreshwa, ariko agaciro ko kuvura ogisijeni kubarwayi nkabo karacyafite impaka. Oxygene irakenewe mu kuvura abarwayi ba infarction acute myocardial bafite hypoxemia ihuye, kuko ishobora kurokora ubuzima. Nyamara, inyungu zo kongerera ogisijeni gakondo mugihe hypoxemia idahari ntikiramenyekana neza. Mu mpera z'imyaka ya za 70, igeragezwa ryahumye-rihumye ryanduye abarwayi 157 bafite infarcite ikaze ya myocardial kandi bagereranya imiti ya ogisijeni (6 L / min) nta muti wa ogisijeni uhari. Byagaragaye ko abarwayi bahabwa imiti ya ogisijeni bafite ikibazo kinini cya sinus tachycardia ndetse no kwiyongera kwinshi mu misemburo ya myocardial, ariko nta tandukaniro riri hagati y’imfu.

Mu gice cya ST kuzamuka cyane abarwayi ba infarction ya myocardial badafite hypoxemia, kuvura kanseri ya mazutu ya 8 L / min ntabwo ari byiza ugereranije no guhumeka umwuka w’ibidukikije. Mu bundi bushakashatsi bwakozwe ku guhumeka umwuka wa ogisijeni kuri 6 L / min no guhumeka umwuka w’ibidukikije, nta tandukaniro ryigeze rihinduka ku rupfu rw’umwaka 1 n’igipimo cy’abinjira mu barwayi bafite infarite ikaze ya myocardial. Kugenzura ubwuzure bwamaraso ya ogisijeni hagati ya 98% kugeza 100% na 90% kugeza 94% nta nyungu bifite kubarwayi bafashwe numutima hanze yibitaro. Ingaruka zishobora kwangiza ogisijeni nyinshi ku ndwara ikaze ya myocardial zirimo kugabanuka kw'imitsi ya koronari, guhagarika imiyoboro y'amaraso ya microcirculation, kongera ogisijeni ikora, kugabanuka kwa ogisijeni, no kongera ROS mu gace ka reperfusion.

Hanyuma, ibizamini byo kwa muganga hamwe na meta-isesengura ryakoze iperereza ku ndangagaciro zikwiye za SpO2 ku barwayi barwariye mu bitaro. Ikigo kimwe, gifunguye ikirango cyateganijwe kugereranya ubuvuzi bwa ogisijeni (SpO2 intego 94% ~ 98%) hamwe nubuvuzi gakondo (SpO2 agaciro 97% ~ 100%) bwakorewe ku barwayi 434 bo mu gice cyita ku barwayi bakomeye. Umubare w'impfu ziri mu gice cyita ku barwayi bakomeye ku buryo butemewe bwo kwakira imiti ya ogisijeni igabanya ubukana bwazamutse neza, hamwe no kugabanuka gukabije, kunanirwa kw'umwijima, na bacteremia. Isesengura rya meta ryakurikiyeho ryarimo ibizamini 25 by’amavuriro byinjije abarwayi barenga 16000 bari mu bitaro bafite indwara zitandukanye, harimo ubwonko, ihahamuka, sepsis, infirasiyo ya myocardial, ndetse no kubaga byihutirwa. Ibyavuye muri iri sesengura ryerekanye ko abarwayi bahabwa ingamba zo kuvura ogisijeni zita ku barwayi bafite ubwiyongere bw’impfu mu bitaro (ibyago ugereranije, 1.21; 95% CI, 1.03-1.43).

Nyamara, ibigeragezo bibiri byakurikiyeho byananiranye kwerekana ingaruka zose zatewe no gufata ingamba zo kuvura ogisijeni igabanya ubukana ku minsi itagira umuyaga uhumeka ku barwayi barwaye ibihaha cyangwa iminsi 28 yo kubaho ku barwayi ba ARDS. Vuba aha, ubushakashatsi bwakozwe ku barwayi 2541 bahabwa imashini ihumeka bwerekanye ko hiyongereyeho ogisijeni mu bice bitatu bitandukanye bya SpO2 (88% ~ 92%, 92% ~ 96%, 96% ~ 100%) ntabwo byagize ingaruka ku musaruro nko mu minsi yo kubaho, gupfa, gufatwa n'umutima, kurwara umutima, kwandura indwara ya myocardial, stroke, cyangwa pneumothorax nta guhumeka neza mu minsi 28. Hashingiwe kuri aya makuru, umurongo ngenderwaho w’umuryango w’abongereza Thoracic urasaba ko intego ya SpO2 igera kuri 94% kugeza kuri 98% ku barwayi benshi bakuze bari mu bitaro. Ibi birumvikana kuko SpO2 muriki cyiciro (urebye error 2% ~ 3% ikosa rya pulse oximeter) ihuye na PaO2 ya mm 65-100 mm Hg, ifite umutekano kandi ihagije kurwego rwa ogisijeni yamaraso. Ku barwayi bafite ibyago byo guhumeka hypercapnic, 88% kugeza 92% ni intego nziza yo kwirinda hypercapnia iterwa na O2.