“Musakayikire konse kuti kagulu kakang’ono ka nzika zolingalira, zodzipatulira zingathe kusintha dziko.M’malo mwake, ndi yekhayo amene alipo.”
Ntchito ya Cureus ndikusintha chitsanzo chomwe chakhalapo nthawi yayitali cha kusindikiza kwachipatala, momwe kuperekera kafukufuku kungakhale kodula, kovuta, komanso nthawi yambiri.
Tchulani nkhaniyi monga: Kojima Y., Sendo R., Okayama N. et al.(Meyi 18, 2022) Chiyerekezo chokokedwa ndi okosijeni pazida zotsika komanso zothamanga kwambiri: kafukufuku woyerekeza.Kuchiza 14(5): e25122.doi:10.7759/cureus.25122
Cholinga: Kachigawo kakang'ono ka oxygen kamene kamakokedwa kamayenera kuyeza pamene mpweya waperekedwa kwa wodwalayo, chifukwa umayimira mpweya wa alveolar, womwe ndi wofunikira kuchokera kumaganizo a kupuma kwa thupi.Choncho, cholinga cha phunziroli chinali kufanizitsa kuchuluka kwa mpweya wotsekemera womwe umapezeka ndi zipangizo zosiyanasiyana zoperekera mpweya.
Njira: Chitsanzo choyerekeza cha kupuma modzidzimutsa chinagwiritsidwa ntchito.Yezerani kuchuluka kwa okosijeni wokokedwa ndi mpweya womwe umalandira kudzera m'malo otsika komanso othamanga kwambiri amphuno ndi masks osavuta a okosijeni.Pambuyo pa ma 120s a okosijeni, kachigawo kakang'ono ka mpweya wokokedwako kanayesedwa pa sekondi iliyonse kwa 30 s.Miyezo itatu idatengedwa pa chikhalidwe chilichonse.
ZOKHUDZA: Kuthamanga kwa mpweya kunachepetsa kagawo kakang'ono ka okosijeni wopangidwa ndi intracheal ndi mpweya wa okosijeni wowonjezera pamene mukugwiritsa ntchito kansalu kakang'ono ka m'mphuno, zomwe zimasonyeza kuti kupuma kwa mpweya kunachitika panthawi yopuma ndipo kungagwirizane ndi kuwonjezeka kwa kachigawo kakang'ono ka oxygen.
Mapeto.Kupuma kwa okosijeni panthawi yopuma kungayambitse kuwonjezereka kwa mpweya wa okosijeni mu danga lakufa la anatomical, zomwe zingagwirizane ndi kuwonjezeka kwa gawo la mpweya wokokedwa.Pogwiritsa ntchito mpweya wothamanga kwambiri wa nasal cannula, mpweya wambiri wotsekemera ukhoza kupezeka ngakhale pamtunda wa 10 L / min.Podziwa kuchuluka kwa mpweya wabwino, m'pofunika kukhazikitsa mlingo woyenera woyenda kwa wodwalayo ndi zochitika zenizeni, mosasamala kanthu za mtengo wa kachigawo kakang'ono ka oxygen.Mukamagwiritsa ntchito mphuno zapamphuno zotsika komanso masks osavuta a okosijeni m'malo azachipatala, zimakhala zovuta kuyerekeza kuchuluka kwa mpweya womwe wakokedwa.
Kuwongolera kwa okosijeni panthawi yovuta komanso yosatha ya kulephera kupuma ndi njira yodziwika bwino muzachipatala.Njira zosiyanasiyana zoyendetsera mpweya zimaphatikizapo cannula, cannula ya m'mphuno, chigoba cha okosijeni, chigoba cha reservoir, chigoba cha venturi, ndi kutuluka kwa nasal cannula (HFNC) [1-5].Kuchuluka kwa okosijeni mu mpweya wopumira (FiO2) ndi kuchuluka kwa okosijeni mumpweya womwe umalowa nawo mukusinthana kwa mpweya wa alveolar.Digiri ya okosijeni (P/F chiŵerengero) ndi chiŵerengero cha kuthamanga pang'ono kwa okosijeni (PaO2) kufika ku FiO2 m'magazi odutsa.Ngakhale kuti chiwerengero cha matenda a P / F chikadali chotsutsana, ndi chizindikiro chogwiritsidwa ntchito kwambiri cha oxygenation muzochita zachipatala [6-8].Chifukwa chake, ndikofunikira kudziwa kufunika kwa FiO2 popereka mpweya kwa wodwala.
Panthawi ya intubation, FiO2 ikhoza kuyesedwa molondola ndi chowunikira cha oxygen chomwe chimaphatikizapo dera la mpweya wabwino, pamene mpweya umayendetsedwa ndi cannula yamphuno ndi chigoba cha okosijeni, "kuyerekeza" kokha kwa FiO2 kutengera nthawi yopuma kungayesedwe."Chiwerengero" ichi ndi chiŵerengero cha mpweya woperekedwa ndi mafunde.Komabe, izi sizimaganizira zinthu zina kuchokera pamalingaliro a physiology ya kupuma.Kafukufuku wasonyeza kuti miyeso ya FiO2 imatha kukhudzidwa ndi zinthu zosiyanasiyana [2,3].Ngakhale kuti kasamalidwe ka okosijeni panthawi yopuma kungayambitse kuwonjezeka kwa mpweya wa okosijeni m'malo akufa a anatomical monga pakamwa, pharynx ndi trachea, palibe malipoti okhudza nkhaniyi m'mabuku amakono.Komabe, asing'anga ena amakhulupirira kuti pochita zinthu izi sizofunikira kwenikweni komanso kuti "zigoli" ndizokwanira kuthana ndi zovuta zachipatala.
M'zaka zaposachedwa, HFNC yakopa chidwi kwambiri pazamankhwala azadzidzidzi komanso chisamaliro chachikulu [9].HFNC imapereka FiO2 yapamwamba ndi kutuluka kwa okosijeni ndi zopindulitsa ziwiri zazikulu - kuthamangitsidwa kwa malo akufa a pharynx ndi kuchepetsa kukana kwa nasopharyngeal, zomwe siziyenera kunyalanyazidwa polemba mpweya [10,11].Kuonjezera apo, pangakhale koyenera kuganiza kuti mtengo wa FiO2 woyezera umayimira mpweya wa mpweya mu mpweya kapena alveoli, popeza mpweya wa okosijeni mu alveoli panthawi ya kudzoza ndi wofunika kwambiri pa chiwerengero cha P / F.
Njira zoperekera okosijeni kupatula kudzidzimutsa nthawi zambiri zimagwiritsidwa ntchito pochita zachipatala.Choncho, nkofunika kusonkhanitsa deta yowonjezereka pa FiO2 yoyezedwa ndi zipangizo zoperekera okosijenizi pofuna kupewa kupitirira kwa oxygen kosafunikira komanso kuzindikira za chitetezo cha kupuma panthawi ya oxygenation.Komabe, kuyeza kwa FiO2 mu trachea yaumunthu ndikovuta.Ofufuza ena ayesa kutsanzira FiO2 pogwiritsa ntchito njira zopumira zokha [4,12,13].Chifukwa chake, mu kafukufukuyu, tidafuna kuyeza FiO2 pogwiritsa ntchito njira yofananira ya kupuma modzidzimutsa.
Uwu ndi kafukufuku woyesa yemwe safuna kuvomerezedwa chifukwa samakhudza anthu.Kuti tiyese kupuma modzidzimutsa, tinakonza njira yopumira yokhayokha potengera chitsanzo chopangidwa ndi Hsu et al.(Mkuyu 1) [12].Mpweya wabwino ndi mapapu oyesera (Dual Adult TTL; Grand Rapids, MI: Michigan Instruments, Inc.) kuchokera ku zida za anesthesia (Fabius Plus; Lübeck, Germany: Draeger, Inc.) adakonzekera kutsanzira kupuma modzidzimutsa.Zida ziwirizi zimalumikizidwa pamanja ndi zingwe zolimba zachitsulo.Mvuvu imodzi (mbali yoyendetsa) ya mapapo oyesera imalumikizidwa ndi mpweya wabwino.Mavuvu ena (mbali yodutsa) ya mapapo oyesera amalumikizidwa ndi "Model Management Model".Mpweya wolowera mpweya utangopereka mpweya watsopano kuti uyese mapapu (mbali yoyendetsa), mvuvu imakokedwa ndi kukoka mokakamiza pa mavuvu ena (mbali yongokhala).Kuyenda uku kumatulutsa mpweya kudzera mu trachea ya manikin, motero kuyerekezera kupuma modzidzimutsa.
(a) chowunikira okosijeni, (b) dummy, (c) kuyesa mapapo, (d) chipangizo chogometsa mpweya, (e) chowunikira mpweya, ndi (f) chothandizira chamagetsi.
Makonzedwe a mpweya wabwino anali motere: kuchuluka kwa mafunde 500 ml, kupuma kwa 10 kupuma / mphindi, inspiratory to expiratory ratio (inhalation / expiration ratio) 1: 2 (nthawi yopuma = 1 s).Pazoyeserera, kutsatiridwa kwa mapapo oyeserera kunayikidwa ku 0.5.
Chowunikira okosijeni (MiniOx 3000; Pittsburgh, PA: American Medical Services Corporation) ndi manikin (MW13; Kyoto, Japan: Kyoto Kagaku Co., Ltd.) adagwiritsidwa ntchito ngati njira yoyendetsera mpweya.Oxygen yoyera inayikidwa pamitengo ya 1, 2, 3, 4 ndi 5 L/min ndipo FiO2 inayesedwa pa aliyense.Kwa HFNC (MaxVenturi; Coleraine, Northern Ireland: Armstrong Medical), zosakaniza za mpweya wa okosijeni zidaperekedwa m'mavoliyumu a 10, 15, 20, 25, 30, 35, 40, 45, 50, 55, ndi 60 L, ndi FiO2 anali. amawunikidwa pa nkhani iliyonse.Kwa HFNC, kuyesa kunachitika pa 45%, 60% ndi 90% ya oxygen.
Oxygen yowonjezera (BSM-6301; Tokyo, Japan: Nihon Kohden Co.) inayesedwa 3 masentimita pamwamba pa maxillary incisors ndi mpweya woperekedwa kudzera mu cannula ya m'mphuno (Finefit; Osaka, Japan: Japan Medicalnext Co.) (Chithunzi 1).) Intubation pogwiritsa ntchito mpweya wabwino wamagetsi (HEF-33YR; Tokyo, Japan: Hitachi) powombera mpweya kuchokera pamutu wa manikin kuti athetse kupuma kwa msana, ndipo FiO2 inayesedwa patatha mphindi ziwiri.
Pambuyo pa masekondi a 120 akukhala ndi mpweya, FiO2 inayesedwa sekondi iliyonse kwa masekondi 30.Ventilate manikin ndi labotale pambuyo muyeso uliwonse.FiO2 idayesedwa nthawi za 3 pachikhalidwe chilichonse.Kuyesera kunayamba pambuyo poyesa chida chilichonse choyezera.
Mwachikhalidwe, mpweya umayesedwa kudzera mu cannulas za m'mphuno kuti FiO2 iyesedwe.Njira yowerengera yomwe idagwiritsidwa ntchito pakuyesaku idasiyana malinga ndi zomwe zimapuma modzidzimutsa (Table 1).Ziwerengero zimawerengedwa potengera momwe kupuma kumakhalira mu chipangizo cha anesthesia (kuchuluka kwa mafunde: 500 ml, kupuma: 10 mpweya / min, inspiratory to expiratory ratio {inhalation: exhalation ratio} = 1: 2).
"Ziwerengero" zimawerengedwa pa mlingo uliwonse wa mpweya.Cannula ya m'mphuno inagwiritsidwa ntchito kupereka mpweya ku LFNC.
Kusanthula konse kunachitika pogwiritsa ntchito pulogalamu ya Origin (Northampton, MA: OriginLab Corporation).Zotsatira zimawonetsedwa ngati ± kutembenuka kokhazikika (SD) kwa kuchuluka kwa mayeso (N) [12].Tasonkhanitsa zotsatira zonse kukhala magawo awiri a decimal.
Kuti muwerenge "chiwerengero", kuchuluka kwa mpweya wopumira m'mapapo mu mpweya umodzi ndi wofanana ndi kuchuluka kwa mpweya mkati mwa cannula yamphuno, ndipo ena onse ali kunja kwa mpweya.Choncho, ndi kupuma kwa 2 s, mpweya woperekedwa ndi cannula ya m'mphuno mu 2 s ndi 1000/30 ml.Mlingo wa okosijeni womwe umapezeka kuchokera kumpweya wakunja unali 21% wa kuchuluka kwa mafunde (1000/30 ml).FiO2 yomaliza ndi kuchuluka kwa okosijeni woperekedwa ku voliyumu yamadzi.Choncho, "chiwerengero" cha FiO2 chikhoza kuwerengedwa mwa kugawa kuchuluka kwa mpweya womwe umagwiritsidwa ntchito ndi mphamvu yamadzi.
Musanayezedwe chilichonse, chowunikira cha okosijeni cha intracheal chinali 20.8% ndipo chowunikira cha okosijeni chowonjezera chinasinthidwa pa 21%.Gulu 1 likuwonetsa mayendedwe a FiO2 LFNC pamlingo uliwonse wotuluka.Miyezo iyi ndi yokwera nthawi 1.5-1.9 kuposa "zowerengeka" (Table 1).Kuchuluka kwa okosijeni kunja kwa mkamwa ndikwambiri kuposa mpweya wamkati (21%).Mtengo wapakati unachepa usanayambike kutuluka kwa mpweya kuchokera ku fan yamagetsi.Miyezo iyi ndi yofanana ndi "makhalidwe oyerekeza".Ndi mpweya, pamene mpweya wa okosijeni kunja kwa pakamwa uli pafupi ndi mpweya wa chipinda, mtengo wa FiO2 mu trachea ndi wapamwamba kuposa "mtengo wowerengeka" woposa 2 L / min.Ndi kapena popanda mpweya, kusiyana kwa FiO2 kunachepa pamene kuchuluka kwa kuyenda kumawonjezeka (Chithunzi 2).
Table 2 ikuwonetsa kuchuluka kwa FiO2 pamlingo uliwonse wa okosijeni wa chigoba chosavuta cha okosijeni (Ecolite oxygen mask; Osaka, Japan: Japan Medicalnext Co., Ltd.).Izi zimachulukitsidwa ndi kuchuluka kwa oxygen (Table 2).Pogwiritsa ntchito mpweya womwewo, FiO2 ya LFNK ndi yapamwamba kuposa ya mask osavuta a oxygen.Pa 1-5 L / min, kusiyana kwa FiO2 kuli pafupi 11-24%.
Gulu 3 likuwonetsa pafupifupi FiO2 mitengo ya HFNC pamlingo uliwonse wotuluka komanso kuchuluka kwa okosijeni.Miyezo iyi inali pafupi ndi momwe mpweya wa okosijeni umayendera mosasamala kanthu kuti kuthamanga kunali kotsika kapena kokwera (Table 3).
Makhalidwe a Intracheal FiO2 anali apamwamba kuposa 'kuyerekeza' ndipo ma FiO2 opitilira muyeso anali apamwamba kuposa mpweya wakuchipinda mukamagwiritsa ntchito LFNC.Airflow yapezeka kuti imachepetsa intracheal ndi extraoral FiO2.Zotsatirazi zikusonyeza kuti kupuma kwa kupuma kunachitika panthawi ya kupuma kwa LFNC.Ndi kapena popanda mpweya, kusiyana kwa FiO2 kumachepa pamene kuthamanga kumawonjezeka.Chotsatirachi chikusonyeza kuti chinthu china chikhoza kugwirizanitsidwa ndi FiO2 yapamwamba mu trachea.Kuphatikiza apo, adawonetsanso kuti oxygenation imawonjezera kuchuluka kwa okosijeni m'malo akufa a anatomical, zomwe zitha kukhala chifukwa cha kuchuluka kwa FiO2 [2].Nthawi zambiri zimavomerezedwa kuti LFNC sichimayambitsa kupuma pakupuma.Zikuyembekezeka kuti izi zitha kusokoneza kwambiri kusiyana pakati pa miyeso ndi "zoyerekeza" zama cannulas amphuno.
Pakuthamanga kochepa kwa 1-5 L / min, FiO2 ya chigoba chodziwika bwino inali yochepa kusiyana ndi ya cannula ya m'mphuno, mwina chifukwa chakuti mpweya wa okosijeni suwonjezeka mosavuta pamene gawo la chigoba limakhala malo akufa kwa anatomically.Kutuluka kwa okosijeni kumachepetsa kusungunuka kwa mpweya m'chipinda ndikukhazikitsa FiO2 pamwamba pa 5 L/min [12].Pansi pa 5 L/min, zotsika za FiO2 zimachitika chifukwa cha kuchepetsedwa kwa mpweya wachipinda komanso kupuma kwa malo akufa [12].M'malo mwake, kulondola kwa ma mita oyenda kwa okosijeni kumatha kusiyana kwambiri.MiniOx 3000 imagwiritsidwa ntchito poyang'anira kuchuluka kwa okosijeni, komabe chipangizocho sichikhala ndi nthawi yokwanira yoyezera kusintha kwa mpweya wotuluka (opanga amatchula masekondi 20 kuti awonetsere 90% yankho).Izi zimafuna chowunikira cha oxygen choyankha mwachangu nthawi.
Muzochitika zenizeni zachipatala, morphology ya mphuno, pakamwa, ndi pharynx imasiyana pakati pa munthu ndi munthu, ndipo mtengo wa FiO2 ukhoza kusiyana ndi zotsatira zomwe zapezedwa mu phunziroli.Kuonjezera apo, kupuma kwa odwala kumasiyana, ndipo kugwiritsira ntchito mpweya wambiri kumapangitsa kuti mpweya ukhale wochepa mu mpweya wopuma.Izi zingayambitse kutsika kwa FiO2.Choncho, n'zovuta kuyesa FiO2 yodalirika mukamagwiritsa ntchito LFNK ndi masks ophweka a okosijeni muzochitika zenizeni zachipatala.Komabe, kuyesaku kukuwonetsa kuti malingaliro a danga lakufa la anatomical komanso kupuma kobwerezabwereza kumatha kukhudza FiO2.Chifukwa cha kupezeka kumeneku, FiO2 ikhoza kuwonjezeka kwambiri ngakhale pamayendedwe otsika, malingana ndi mikhalidwe osati "kuyerekezera".
Bungwe la British Thoracic Society limalimbikitsa kuti madokotala apereke mpweya wa okosijeni malinga ndi momwe akufunira komanso kuti ayang'anire wodwalayo kuti apitirizebe kukwaniritsa cholinga chake [14].Ngakhale kuti "mtengo wowerengeka" wa FiO2 mu phunziroli unali wochepa kwambiri, ndizotheka kukwaniritsa FiO2 yeniyeni yapamwamba kuposa "mtengo wowerengeka" malinga ndi momwe wodwalayo alili.
Mukamagwiritsa ntchito HFNC, mtengo wa FiO2 uli pafupi ndi kuchuluka kwa mpweya wa okosijeni mosasamala kanthu za kuthamanga.Zotsatira za phunziroli zimasonyeza kuti ma FiO2 apamwamba amatha kupindula ngakhale pakuyenda kwa 10 L / min.Maphunziro ofananawo sanawonetse kusintha kwa FiO2 pakati pa 10 ndi 30 L [12,15].Kuthamanga kwakukulu kwa HFNC kumanenedwa kuti kumathetsa kufunika koganizira zakufa kwa anatomical [2,16].Malo akufa a anatomical amatha kuthamangitsidwa ndi mpweya wabwino kwambiri kuposa 10 L/min.Dysart et al.Zikuganiziridwa kuti njira yoyamba yochitira VPT ingakhale kuthamangitsidwa kwa malo akufa a nasopharyngeal cavity, motero kuchepetsa malo onse akufa ndikuwonjezera kuchuluka kwa mpweya wabwino (ie, alveolar ventilation) [17].
Kafukufuku wam'mbuyomu wa HFNC adagwiritsa ntchito catheter kuyeza FiO2 mu nasopharynx, koma FiO2 inali yotsika kuposa kuyesa uku [15,18-20].Ritchie et al.Zanenedwa kuti mtengo wowerengeka wa FiO2 umayandikira 0.60 pamene mpweya wothamanga umakwera pamwamba pa 30 L / min panthawi ya kupuma kwa mphuno [15].M'malo mwake, ma HFNC amafunikira kuchuluka kwa 10-30 L/min kapena kupitilira apo.Chifukwa cha katundu wa HFNC, mikhalidwe ya m'mphuno imakhala ndi zotsatira zazikulu, ndipo HFNC nthawi zambiri imatsegulidwa paziwongola dzanja zambiri.Ngati kupuma kukuyenda bwino, kuchepa kwa kuthamanga kungafunike, chifukwa FiO2 ikhoza kukhala yokwanira.
Zotsatirazi zimachokera pamayesero ndipo sizikutanthauza kuti zotsatira za FiO2 zitha kugwiritsidwa ntchito mwachindunji kwa odwala enieni.Komabe, kutengera zotsatirazi, pankhani ya intubation kapena zida zina kupatula HFNC, FiO2 mfundo zitha kuyembekezeka kusiyanasiyana kutengera momwe zinthu ziliri.Popereka okosijeni ndi LFNC kapena chigoba chosavuta cha oxygen m'malo azachipatala, chithandizo chimangoyang'aniridwa ndi "peripheral arterial oxygen saturation" (SpO2) mtengo pogwiritsa ntchito pulse oximeter.Ndi chitukuko cha kuchepa kwa magazi m'thupi, kuyang'anira bwino kwa wodwalayo kumalimbikitsidwa, mosasamala kanthu za SpO2, PaO2 ndi mpweya wokwanira m'magazi a mitsempha.Kuphatikiza apo, Downes et al.ndi Beasley et al.Zanenedwa kuti odwala osakhazikika angakhaledi pachiopsezo chifukwa cha kugwiritsira ntchito prophylactic ya mankhwala okosijeni kwambiri [21-24].Panthawi ya kuwonongeka kwa thupi, odwala omwe amalandira chithandizo cha okosijeni kwambiri amakhala ndi mawerengedwe apamwamba a oximeter, omwe angasokoneze kuchepa kwapang'onopang'ono kwa chiŵerengero cha P / F ndipo motero sangachenjeze ogwira ntchito panthawi yoyenera, zomwe zimapangitsa kuwonongeka komwe kumafuna kuthandizidwa ndi makina.thandizo.Poyamba zinkaganiziridwa kuti FiO2 yapamwamba imapereka chitetezo ndi chitetezo kwa odwala, koma chiphunzitsochi sichigwira ntchito pazochitika zachipatala [14].
Choncho, kusamala kuyenera kuchitidwa ngakhale popereka mpweya wa okosijeni mu nthawi ya opaleshoni kapena kumayambiriro kwa kupuma.Zotsatira za kafukufukuyu zikuwonetsa kuti miyeso yolondola ya FiO2 imatha kupezeka ndi intubation kapena HFNC.Mukamagwiritsa ntchito LFNC kapena chigoba chosavuta cha oxygen, mpweya wa prophylactic uyenera kuperekedwa kuti muteteze kupuma pang'ono.Zidazi sizingakhale zoyenera pamene kuunika kozama kwa kupuma kumafunika, makamaka pamene zotsatira za FiO2 ndizofunikira.Ngakhale pamayendedwe otsika, FiO2 imawonjezeka ndi kutuluka kwa okosijeni ndipo imatha kubisa kulephera kupuma.Kuphatikiza apo, ngakhale mutagwiritsa ntchito SpO2 pochiza pambuyo pa opaleshoni, ndikofunikira kuti pakhale kutsika kotsika momwe mungathere.Izi ndi zofunika kuti azindikire msanga kupuma kulephera.Kuthamanga kwa oxygen kumawonjezera chiopsezo cha kulephera kuzindikira msanga.Mlingo wa okosijeni uyenera kuzindikirika pambuyo pozindikira kuti ndi ziti zomwe zikufunika kusintha ndikuwongolera mpweya.Malingana ndi zotsatira za phunziroli lokha, sizikulimbikitsidwa kuti musinthe lingaliro la kayendetsedwe ka mpweya.Komabe, timakhulupirira kuti malingaliro atsopano omwe aperekedwa mu phunziroli ayenera kuganiziridwa mwa njira zomwe zimagwiritsidwa ntchito pochita zachipatala.Kuonjezera apo, podziwa kuchuluka kwa okosijeni omwe amalangizidwa ndi malangizowo, m'pofunika kukhazikitsa kayendedwe koyenera kwa wodwalayo, mosasamala kanthu za mtengo wa FiO2 wa miyeso yokhazikika yopuma.
Tikuganiza kuti tiganizirenso za FiO2, poganizira kukula kwa chithandizo cha okosijeni ndi matenda, popeza FiO2 ndi gawo lofunikira pakuwongolera kayendetsedwe ka mpweya.Komabe, phunziroli lili ndi malire angapo.Ngati FiO2 ingayesedwe mu trachea yaumunthu, mtengo wolondola kwambiri ukhoza kupezeka.Komabe, pakali pano ndizovuta kuchita miyeso yotere popanda kusokoneza.Kufufuza kwina kogwiritsa ntchito zida zoyezera zosasokoneza ziyenera kuchitika mtsogolomu.
Mu phunziro ili, tinayeza intracheal FiO2 pogwiritsa ntchito chitsanzo cha LFNC chopumira modzidzimutsa, chigoba chosavuta cha okosijeni, ndi HFNC.Kuwongolera mpweya panthawi yopuma kungayambitse kuwonjezeka kwa mpweya wa okosijeni mu danga lakufa la anatomical, zomwe zingagwirizane ndi kuwonjezeka kwa gawo la mpweya umene umakokedwa.Ndi HFNC, gawo lalikulu la okosijeni wokokedwa limatha kupezeka ngakhale pakuyenda kwa 10 l/min.Podziwa kuchuluka kwa mpweya wabwino, ndikofunikira kukhazikitsa mlingo woyenera wa otaya kwa wodwala ndi mikhalidwe yeniyeni, osati kudalira kokha pamtengo wa gawo la mpweya wokokedwa.Kuyerekeza kuchuluka kwa okosijeni wokokedwa mukamagwiritsa ntchito LFNC ndi chigoba chosavuta cha oxygen m'malo azachipatala kungakhale kovuta.
Zomwe zapezedwa zikuwonetsa kuti kupuma komaliza kumalumikizidwa ndi kuwonjezeka kwa FiO2 mu trachea ya LFNC.Podziwa kuchuluka kwa okosijeni omwe amalangizidwa ndi malangizowo, ndikofunikira kukhazikitsa njira yoyenera kwa wodwalayo, mosasamala kanthu za mtengo wa FiO2 woyezedwa pogwiritsa ntchito njira yachikhalidwe yolimbikitsira.
Nkhani Za Anthu: Olemba onse adatsimikizira kuti palibe anthu kapena minyewa yomwe idakhudzidwa ndi phunziroli.Nkhani za Zinyama: Olemba onse adatsimikizira kuti palibe nyama kapena minyewa yomwe idakhudzidwa ndi kafukufukuyu.Kutsutsana kwa Chidwi: Mogwirizana ndi Fomu Yodziwitsa Zofanana za ICMJE, olemba onse amalengeza zotsatirazi: Malipiro / Utumiki Wautumiki: Olemba onse amalengeza kuti sanalandire thandizo la ndalama kuchokera ku bungwe lililonse pa ntchito yoperekedwa.Ubale Wazachuma: Olemba onse amalengeza kuti pakali pano kapena m'zaka zitatu zapitazi alibe maubwenzi azachuma ndi bungwe lililonse lomwe lingakhale ndi chidwi ndi ntchito yomwe yatumizidwa.Maubale Ena: Olemba onse amalengeza kuti palibe maubale kapena zochitika zina zomwe zingakhudze ntchito yotumizidwa.
Tikufuna kuthokoza Bambo Toru Shida (IMI Co., Ltd, Kumamoto Customer Service Center, Japan) chifukwa chothandizidwa ndi phunziroli.
Kojima Y., Sendo R., Okayama N. et al.(Meyi 18, 2022) Chiyerekezo chokokedwa ndi okosijeni pazida zotsika komanso zothamanga kwambiri: kafukufuku woyerekeza.Kuchiza 14(5): e25122.doi:10.7759/cureus.25122
© Copyright 2022 Kojima et al.Iyi ndi nkhani yotseguka yopezeka yoperekedwa motsatira malamulo a Creative Commons Attribution License CC-BY 4.0.Kugwiritsa ntchito mopanda malire, kugawa, ndi kutulutsanso m'njira iliyonse ndikololedwa, malinga ngati wolemba ndi gwero loyambirira adayamikiridwa.
Iyi ndi nkhani yotseguka yofikira yomwe imagawidwa pansi pa Layisensi ya Creative Commons Attribution, yomwe imalola kugwiritsa ntchito mopanda malire, kugawa, ndi kutulutsa munjira iliyonse, malinga ngati wolemba ndi gwero atamandidwa.
(a) chowunikira okosijeni, (b) dummy, (c) kuyesa mapapo, (d) chipangizo chogometsa mpweya, (e) chowunikira mpweya, ndi (f) chothandizira chamagetsi.
Makonzedwe a mpweya wabwino anali motere: kuchuluka kwa mafunde 500 ml, kupuma kwa 10 kupuma / mphindi, inspiratory to expiratory ratio (inhalation / expiration ratio) 1: 2 (nthawi yopuma = 1 s).Pazoyeserera, kutsatiridwa kwa mapapo oyeserera kunayikidwa ku 0.5.
"Ziwerengero" zimawerengedwa pa mlingo uliwonse wa mpweya.Cannula ya m'mphuno inagwiritsidwa ntchito kupereka mpweya ku LFNC.
Scholarly Impact Quotient™ (SIQ™) ndiye njira yathu yapadera yowunikiranso anzawo akamasindikiza.Dziwani zambiri apa.
Ulalowu udzakufikitsani kutsamba lina lomwe silikugwirizana ndi Cureus, Inc. Chonde dziwani kuti Cureus alibe udindo pazokhudza zomwe zili patsamba lathu kapena masamba omwe ali nawo.
Scholarly Impact Quotient™ (SIQ™) ndiye njira yathu yapadera yowunikiranso anzawo akamasindikiza.SIQ™ imawunika kufunikira ndi mtundu wa zolemba pogwiritsa ntchito nzeru zonse za gulu lonse la Cureus.Ogwiritsa ntchito onse olembetsedwa akulimbikitsidwa kuti athandizire ku SIQ ™ ya nkhani iliyonse yosindikizidwa.(Olemba sangathe kuwerengera zolemba zawo.)
Mavoti apamwamba akuyenera kusungidwa ku ntchito zaluso zenizeni m'magawo awo.Mtengo uliwonse pamwamba pa 5 uyenera kuganiziridwa pamwamba pa avareji.Ngakhale ogwiritsa ntchito onse olembetsedwa a Cureus atha kuwerengera nkhani iliyonse yosindikizidwa, malingaliro a akatswiri a nkhani amalemera kwambiri kuposa a omwe si akatswiri.SIQ™ ya nkhani ipezeka pafupi ndi nkhaniyo itavoteredwa kawiri, ndipo iwerengedwanso ndi mphambu iliyonse yowonjezera.
Scholarly Impact Quotient™ (SIQ™) ndiye njira yathu yapadera yowunikiranso anzawo akamasindikiza.SIQ™ imawunika kufunikira ndi mtundu wa zolemba pogwiritsa ntchito nzeru zonse za gulu lonse la Cureus.Ogwiritsa ntchito onse olembetsedwa akulimbikitsidwa kuti athandizire ku SIQ ™ ya nkhani iliyonse yosindikizidwa.(Olemba sangathe kuwerengera zolemba zawo.)
Chonde dziwani kuti pochita izi mukuvomera kuti muwonjezedwe pamndandanda wathu wamakalata wamakalata amwezi uliwonse.