Iindaba

"Ummelwane wam ufunyenwe ene-Covid-positive kwaye ungeniswe kwisibhedlele esikufutshane", litshilo ilungu leqela le-WhatsApp kwiintsuku ezimbalwa ezidlulileyo.Elinye ilungu labuza ukuba ukwisixhobo sokuphefumla?Ilungu lokuqala laphendula lathi ngenene likwi-'Oxygen Therapy'.Kwangena ilungu lesithathu lisithi, “Owu!oko akukho kubi kakhulu.Umama ebesebenzisa i-Oxygen concentrator phantse iminyaka emi-2 ngoku. "Elinye ilungu elinolwazi ligqabaze lathi, “Ayifani.I-Oxygen concentrator yi-Low Flow Oxygen Therapy kunye neziphi izibhedlele ezisebenzisayo ukunyanga izigulana ezibukhali, lunyango oluPhezulu lwe-Oxygen. "

Wonke umntu wazibuza, yintoni kanye kanye umahluko phakathi kweVentilator kunye nonyango lwe-Oxygen-UkuHamba okuPhezulu okanye ukuHamba okuPhantsi?!

Wonke umntu uyazi ukuba kwi-ventilator kunzulu.Kuyingozi kangakanani ukuba kunyango lwe-oxygen?

Unyango lweoksijini vs ukuVela umoya kwi-COVID19

Unyango lwe-oksijini luye lwaba ligama le-buzz kunyango lwabaguli be-COVID19 kwezi nyanga zidlulileyo.Ngo-Matshi-Meyi ka-2020 wabona ukukhala okuphambeneyo kwiiVentilators eIndiya nakwihlabathi liphela.Oorhulumente kunye nabantu kwihlabathi liphela bafunde malunga nendlela i-COVID19 enokukhokelela ngayo ekuthotyweni kweoksijini emzimbeni ngokuthe cwaka.Kwaphawulwa ukuba ezinye izigulane eziphefumulayo zine-oksijini ye-oxygen okanye amanqanaba e-SpO2 ancitshiswe ukuya kwi-50-60%, ngelixa befika kwi-Hospital Emergency Room ngaphandle kokuziva enye into.

Uluhlu oluqhelekileyo lwe-oxygen saturation luyi-94-100%.Ukugcwala kweoksijini <94% ichazwa njenge'Hypoxia'.I-Hypoxia okanye i-Hypoxemia inokubangela ukuphefumla kwaye ikhokelele kuxinzelelo olubukhali lokuphefumla.Wonke umntu ubukhulu becala wayecinga ukuba iiVentilators ziyimpendulo yezigulana ze-Covid19.Nangona kunjalo, amanani amva nje abonise ukuba bamalunga ne-14% kuphela abantu abane-COVID-19 abakhula ngokuphakathi ukuya kwisifo esiqatha kwaye bafuna ukulaliswa esibhedlele kunye nenkxaso yeoksijini, kunye ne-5% kuphela abafuna ukwamkelwa kwiYunithi yoNonophelo kunye nonyango oluxhasayo kubandakanya intubation kunye ukungena komoya.

Ngamanye amazwi, i-86% yabo bavavanyiweyo ukuba banayo i-COVID19 mhlawumbi bane-asymptomatic okanye babonisa iimpawu ezithambileyo ukuya kweziphakathi.

Aba bantu abafuni nyango lweoksijini okanye ukungena komoya, kodwa i-14% ekhankanywe ngasentla iyalufuna.I-WHO icebisa unyango olongezelelweyo lweoksijini ngokukhawuleza kwizigulana ezinoxinzelelo lokuphefumla, i-hypoxia/hypoxaemia okanye ukothuka.Injongo yonyango lwe-oksijini kukubuyisela inqanaba lokugcwala kweoksijini libuyele kwi>94%.

Yintoni ekufuneka uyazi malunga noNyango oluPhezulu lwe-Oxygen

Nje ukuba wena okanye lowo umthandayo ukwinqanaba le-14% elikhankanywe ngasentla - unokufuna ukwazi ngakumbi ngonyango lwe-oxygen.

Unokufuna ukwazi ukuba unyango lwe-oxygen lwahluke njani kwi-ventilator.

Zeziphi izixhobo ezahlukeneyo zeoksijini kunye neenkqubo zokuhambisa?

Zisebenza njani?Ngawaphi amacandelo ahlukeneyo?

Zahluke njani ezi zixhobo kubuchule bazo?

Zahluke njani kwiingenelo nakwiingozi?

Zeziphi izibonakaliso-Ngubani ofuna unyango lwe-oxygen kwaye ngubani ofuna iVentilator?

Funda ngakumbi ukwazi ngakumbi…

Isixhobo sonyango lweoksijini sahluke njani kwisixhobo sokuphefumla?

Ukuqonda ukuba isixhobo sonyango lwe-oxygen sahluke njani kwi-ventilator, kufuneka siqale siqonde umahluko phakathi kwe-Ventilation kunye ne-Oxygenation.

Ukungenisa umoya ngokuchasene ne-oxygen

I-Ventilation - Ukungena komoya ngumsebenzi wesiqhelo, ukuphefumula ngokuzenzekelayo, kubandakanywa neenkqubo zokuphefumla kunye nokukhupha.Ukuba isigulana asikwazi ukwenza ezi nkqubo ngokwaso, sinokufakwa kwisixhobo sokuphefumla, esisenzela sona.

Ukukhutshwa kweoksijini – Ukungena komoya kubalulekile kwinkqubo yokutshintshiselana ngegesi oko kukuthi, ukuhanjiswa kweoksijini emiphungeni kunye nokususwa kwekharbon diokside emiphungeni.Ukukhutshwa kweoksijini kuphela yinxalenye yokuqala yenkqubo yokutshintshiselana ngegesi, oko kukuthi, ukuhanjiswa kweoksijini kwizihlunu.

Umahluko phakathi koNyango lweOksijini yokuHamba okuPhezulu kunye neVentilator eyona nto ilandelayo.Unyango ngeoksijini lubandakanya ukukunika ioksijini eyongezelelweyo kuphela - umphunga wakho usawenza umsebenzi wokuthatha umoya oneoksijini eninzi kunye nokuphefumla umoya otyebileyo wecarbon-di-oxide ngaphandle.Isixhobo sokungenisa umoya asikuniki nje ioksijini eyongezelelweyo kuphela, kodwa senza umsebenzi wemiphunga yakho – phefumlela ngaphakathi nangaphandle.

Ngubani (Loluphi uhlobo lwesigulana) oludinga unyango lwe-Oxygen kwaye ngubani ofuna umoya?

Ukuze kusetyenziswe unyango olufanelekileyo, umntu kufuneka anqume ukuba umba kunye nesigulane asiyiyo i-oxygenation okanye ukungena komoya kakubi.

Ukungaphumeleli kokuphefumla kungenzeka ngenxa

umba we-oksijini okhokelela kwi-oksijini ephantsi kodwa eqhelekileyo - amanqanaba aphantsi e-carbon dioxide.Ekwaziwa njengokusilela kokuphefumla kwe-hypoxaemic - oku kwenzeka xa imiphunga ingakwazi ukufunxa ioksijini ngokwaneleyo, ngokubanzi ngenxa yezifo ezibukhali zemiphunga ezibangela ukuba ulwelo okanye isikhohlela singene kwi-alveoli (Esona sakhiwo sincinci esifana nesingxobo semiphunga esitshintshana ngeegesi).Amanqanaba ekharbhon dayoksaydi anokuba yesiqhelo okanye abephantsi njengoko isigulana sikwazi ukuphefumla kakuhle.Isigulane esinemeko enjalo - i-Hypoxaemia, iphathwa ngokubanzi ngonyango lwe-oxygen.

umba wokungena komoya obangela ioksijini ephantsi kunye namanqanaba aphezulu ekharbon diokside.Ikwabizwa ngokuba yi-hypercapnic breath failure - le meko ibangelwa kukungakwazi kwesigulane ukukhupha umoya okanye ukuphefumla, okukhokelela ekuqokeleleni kwe-carbon-di-oxide.Ukuqokelelana kweCO2 emva koko kubathintele ekuphefumleni-kwioksijini eyaneleyo.Le meko ifuna inkxaso yesixhobo sokuphefumla ukunyanga izigulana.

Kutheni izixhobo zoNyango lwe-Oxygen Flow Flow azanelanga kwiimeko ezinzima?

Kwiimeko ezinzima kutheni sifuna unyango oluhamba ngeoksijini oluhamba phezulu kunokusebenzisa izigxininisi ezilula zeoksijini?

Izihlunu emizimbeni yethu zifuna ioksijini ukuze siphile.Ukunqongophala kweoksijini okanye i-hypoxia kwiithishu ixesha elide (ngaphezu kwemizuzu ye-4) kunokubangela ukulimala kakhulu ekugqibeleni kukhokelela ekufeni.Ngelixa ugqirha unokuthatha ixesha lokuvavanya izizathu ezisisiseko, ukwandisa ukuhanjiswa kweoksijini okwangoku kunokuthintela ukufa okanye ukukhubazeka.

Umntu omdala oqhelekileyo uphefumla kwiilitha ezingama-20-30 zomoya ngomzuzu phantsi kwenqanaba lomsebenzi ophakathi.I-21% yomoya esiwuphefumlayo yioksijini, okt malunga neelitha ezi-4-6 ngomzuzu.I-FiO2 okanye iqhekeza le-oksijini ephefumlelweyo kule meko yi-21%.

Nangona kunjalo, kwiimeko ezinzima ukunyibilika kweoksijini egazini kunokuba sezantsi.Nangona i-oksijini ephefumlelweyo / i-inhaled i-oxygen i-100%, i-oksijini enyibilikileyo inokubonelela kuphela kwisithathu sesithathu sokuphumla kweemfuno ze-oxygen.Ngoko ke, enye indlela yokujongana ne-tissue hypoxia kukunyusa iqhekeza le-oksijini ephefumlelweyo (i-Fio2) ukusuka kwi-21 eqhelekileyo.Kwiimeko ezininzi ezinzima, ugxininiso lwe-oksijini ephefumlelweyo ye-60-100% kwixesha elifutshane (ukuya kwiiyure ezingama-48) kunokusindisa ubomi de unyango olukhethekileyo lunokugqitywa kwaye lunikezelwe.

Ukufaneleka kweZixhobo ze-Oxygen ezihamba ngokuPhantsi zoNonophelo oluPhezulu

Iinkqubo zokuqukuqela ezisezantsi zinesantya esisezantsi kunesantya sokuqukuqela okuphefumlelayo (Ukuqukuqela okuqhelekileyo okuphefumlelayo kuphakathi kwe-20-30litres/ngomzuzu njengoko kukhankanyiwe ngasentla).Iinkqubo zokuhamba okuphantsi ezifana ne-oxygen concentrators zivelisa izinga lokuhamba kwe-5-10 ilitha / m.Nangona banikezela nge-oxygen concentration ukuya kuthi ga kwi-90%, ekubeni isigulane sidinga ukuphefumla umoya wegumbi ukwenza i-balance inspiratory flow imfuneko - i-FiO2 iyonke ingaba ngcono kune-21% kodwa isenokungonelanga.Ukongezelela, kumazinga okuhamba kwe-oksijini ephantsi (<5 l / min) ukuphefumla okubalulekileyo komoya ophelileyo kunokwenzeka ngenxa yokuba umoya okhutshiweyo awugxothwanga ngokwaneleyo kwimaski yobuso.Oku kubangela ukugcinwa okuphezulu kwekhabhon diokside kwaye kunciphise ukuthatyathwa ngakumbi komoya omtsha/ioksijini.

Kwakhona xa i-oksijeni ihanjiswa ngesantya sokuhamba kwe-1-4 l / min nge-mask okanye i-nasal prongs, i-oropharynx okanye i-nasopharynx (i-airways) inika u-humidification ngokwaneleyo.Kwizinga eliphezulu lokuhamba okanye xa i-oxygen ihanjiswa ngokuthe ngqo kwi-trachea, i-humidification yangaphandle eyongezelelweyo iyadingeka.Iinkqubo zokuqukuqela okuphantsi azixhotyiselwanga ukwenza oko.Ukongeza, i-FiO2 ayinakusetwa ngokuchanekileyo kwiLF.

Kuyo yonke inkqubo ye-oksijini ephantsi ayinakulungela iimeko ezinzima ze-hypoxia.

Ukufaneleka kweZixhobo ze-Oxygen ezihamba ngokuPhakamileyo zoNonophelo oluPhezulu

Iinkqubo zokuHamba okuPhakamileyo zezo zinokungqamana okanye zigqithise izinga lokuqukuqela elikhuthazayo – okt 20-30 ilitha/ngomzuzu.Iinkqubo zokuHamba okuPhakamileyo ezikhoyo namhlanje zinokuvelisa amazinga okuqukuqela naphi na phakathi kwe-2-120 yeelitha/ngomzuzu kakhulu njengee-ventilators.I-FiO2 inokusetwa ngokuchanekileyo kwaye ibekwe iliso.I-FiO2 inokuba phantse i-90-100%, kuba isigulane asifuni kuphefumla nayiphi na umoya we-atmospheric kwaye ilahleko yegesi ayinanto.Ukuphefumla kwakhona kwerhasi ephelelweyo akuyongxaki kuba imaski igungxulwa ngamazinga aphezulu okuhamba.Bakwaphucula intuthuzelo yesigulana ngokugcina ukufuma kunye nobushushu obaneleyo kwirhasi ukuthambisa indawo yempumlo.

Ngokubanzi, iinkqubo zokuhamba okuphezulu azikwazi nje ukuphucula i-oxygenation njengoko kufuneka kwiimeko ezinzima, kodwa zinciphisa umsebenzi wokuphefumla, kubangela ubunzima obuncinci kwimiphunga yesigulane.Ngenxa yoko, zilungele kakuhle le njongo kwiimeko ezinzima zokuphefumla.

Ngawaphi aMalungu okuHamba okuPhakamileyo kwe-Nasal Cannula vs iVentilator?

Siye sabona ukuba ubuncinane inkqubo yonyango lwe-oksijeni ephezulu (i-HFOT) iyafuneka ukunyanga iimeko zokungaphumeleli kokuphefumula.Makhe sijonge ukuba yahluke njani inkqubo yokuHamba okuPhezulu (HF) kwisixhobo sokungenisa umoya.Ngawaphi amacandelo ahlukeneyo abo matshini bobabini kwaye bahluke njani ekusebenzeni kwabo?

Bobabini oomatshini kufuneka baqhagamshelwe kumthombo weoksijini esibhedlele njengombhobho okanye isilinda.Inkqubo yonyango ye-oksijini ehamba ngokukhawuleza ilula - iquka a

ijenereyitha yokuhamba,

iblender yomoya-oxygen,

i-humidifier,

ityhubhu eshushu kunye

isixhobo sokuhambisa umz. i-cannula yeempumlo.

I-Ventilator iyasebenza

I-ventilator kwelinye icala ibanzi ngakumbi.Ayibandakanyi kuphela onke amacandelo e-HFNC, ngaphezu koko ineenkqubo zokuphefumla, zokulawula kunye nokubeka iliso kunye kunye nee-alamu zokwenza umoya okhuselekileyo, olawulwayo, olungelelanisiweyo wesigulane.

Ezona parameters zibalulekileyo kwiprogram yokungenisa umoya ngoomatshini zezi:

Imo yokungena komoya, (ivolumu, uxinzelelo okanye kabini),

Indlela (elawulwayo, encediswayo, exhasa ukungena komoya), kunye

Iiparamitha zokuphefumla.Iiparamitha eziphambili ngumthamo we-tidal umthamo kunye nomzuzu wemizuzu kwiindlela zomthamo, uxinzelelo oluphezulu (kwiindlela zoxinzelelo), ukuphindaphinda kokuphefumula, uxinzelelo lwesiphelo esilungileyo sokuphelelwa umoya, ixesha lokuphefumula, ukuhamba kokuphefumula, umlinganiselo wokuphefumula, ixesha lokumisa, i-trigger sensitivity, inkxaso. uxinzelelo, kunye nokuphefumla okubangela uvakalelo njl.njl.

I-Alarms - Ukubona iingxaki kwi-ventilator kunye noshintsho kwisigulane, ii-alamu zomthamo we-tidal kunye nomzuzu, uxinzelelo oluphezulu, ukuphindaphinda kokuphefumula, i-FiO2, kunye ne-apnea ziyafumaneka.

Uthelekiso olusisiseko lwe-ventilator kunye ne-HFNC

Uthelekiso phakathi kweVentilator kunye neHFNC

Ukuthelekisa okubonakalayo kweHFNC kunye neVentilator

Ukungenisa umoya vs HFNC - Izibonelelo kunye neengozi

Ukungena komoya kusenokuba ngu-Invasive okanye ungaphazamisi.Kwimeko yokungena komoya ongenelelayo ityhubhu ifakwa ngomlomo ukuya emiphungeni ukunceda ekungeneni komoya.Oogqirha bayathanda ukuyiphepha intubation kangangoko banako ngenxa yeziphumo ezinokuthi zibe nocimo kwisigulana kunye nobunzima bokuzilawula.

Intubation ngelixa ingekho nzulu ngokwayo, inokubangela

Ukwenzakala kwimiphunga, uqhoqhoqho okanye umqala njl njl kunye/okanye

Kunokubakho umngcipheko wokwakhiwa kweFluids,

Umnqweno okanye

Iingxaki zemiphunga.

Ukungeniswa komoya okungangeneleliyo

Ukungeniswa komoya okungangeneleliyo yinto ekhethwayo kangangoko kunokwenzeka.I-NIV ibonelela ngoncedo lokungena komoya okuzenzekelayo ngokufaka uxinzelelo olulungileyo kwimiphunga ngaphandle, ngesigqubuthelo sobuso esisetyenziswa ngokuqhelekileyo esidityaniswe nenkqubo yokufuma, isifudumezi esishushu okanye isitshintshisi sobushushu nokufuma, kunye nesixhobo sokungenisa umoya.Eyona ndlela isetyenziswa ngokuqhelekileyo idibanisa inkxaso yoxinzelelo (PS) yokuphefumla kunye ne-positive end-expiratory pressure (PEEP), okanye usebenzise nje uxinzelelo oluqhubekayo lwe-airway (CPAP).Ukuxhaswa kwengcinezelo kuyahlukahluka kuxhomekeke ekubeni isigulane siphefumula okanye siphuma kunye nomzamo wabo wokuphefumula.

I-NIV iphucula utshintshiselwano lwegesi kunye nokunciphisa umgudu okhuthazayo ngoxinzelelo oluhle.Ibizwa ngokuba "yi-non-invasive" kuba ihanjiswa ngaphandle kwe-intubation.I-NIV isenokuba nesiphumo sokunyuka kwamaza amaza akhuthazwa yinkxaso yoxinzelelo kwaye oko kunokuba mbi kakhulu ukwenzakala kwemiphunga esele ikhona.

Inzuzo yeHFNC

Olunye uncedo lokuhambisa ioksijini ephumayo ephezulu ngenkanula yeempumlo kukugungxula ngokuqhubekayo indawo engaphezulu yomoya efileyo ngokucocwa ngcono kweCO2.Oku kunciphisa umsebenzi wokuphefumla kwisigulane kwaye kuphucula i-oxygenation.Ukongezelela, unyango oluphezulu lwe-oksijeni luqinisekisa i-FiO2 ephezulu.I-HFNC ibonelela ngentuthuzelo yesigulana esilungileyo ngokuhamba kwerhasi eshushu kunye nefumile eziswa ngeempumlo zempumlo ngesantya esizinzileyo.Isantya sokuhamba rhoqo kwegesi kwinkqubo ye-HFNC ivelisa uxinzelelo oluguquguqukayo kwiindlela zomoya ngokomgudu wokuphefumula wesigulane.Xa kuthelekiswa nesiqhelo (i-Low Flow) unyango lwe-oxygen okanye i-ventilation engekho, ukusetyenziswa kwe-oksijini yonyango ephezulu kunokunciphisa imfuno ye-intubation.

IiNzuzo zeHFNC

Izicwangciso zonyango kwisigulane esinemeko yokuphefumula ngokukhawuleza zijolise ekunikeni i-oxygen eyaneleyo.Kwangaxeshanye kubalulekile ukugcina okanye ukomeleza umsebenzi wemiphunga yesigulane ngaphandle koxinzelelo lwemisipha yokuphefumla.

I-HFOT ke ngoko inokuthathwa njengesicwangciso somgca wokuqala we-oxygenation kwezi zigulana.Nangona kunjalo, ukuthintela nayiphi na ingozi ngenxa yokulibaziseka komoya / intubation, ukubekwa esweni rhoqo kubalulekile.

Isishwankathelo sezibonelelo kunye nobungozi be-HFNC vs Ukungenisa umoya

Izibonelelo vs umngcipheko we-ventilator kunye ne-HFNC

Ukusetyenziswa kwe-HFNC kunye nee-ventilators kunyango lwe-COVID

Ngokumalunga ne-15% yeemeko ze-COVID-19 kuqikelelwa ukuba zifuna unyango lwe-oksijini kwaye ngaphantsi kwe-1/3rd kubo kunokufuneka ukuba baye kwindawo yokuphefumla.Njengoko kukhankanyiwe ngaphambili, abongi ababalulekileyo bayayinqanda i-intubation kangangoko banako.Unyango lwe-oksijeni lubhekwa njengomgca wokuqala wenkxaso yokuphefumula kwiimeko ze-hypoxia.Imfuno ye-HFNC ke ngoko inyukile kwiinyanga zamva nje.Iimpawu ezidumileyo zeHFNC kwimarike nguFisher & Paykel, Hamilton, Resmed, BMC njl.