labarai

Maganin iskar oxygen yana daya daga cikin hanyoyin da aka fi amfani da su a cikin maganin zamani, amma har yanzu akwai rashin fahimta game da alamomin maganin oxygen, kuma rashin amfani da iskar oxygen na iya haifar da mummunar halayen guba.

Clinical kimantawa na nama hypoxia

Bayyanar cututtuka na nama hypoxia sun bambanta kuma ba takamaiman ba, tare da mafi yawan alamun bayyanar cututtuka ciki har da dyspnea, shortness na numfashi, tachycardia, damuwa na numfashi, saurin canje-canje a yanayin tunani, da arrhythmia. Don ƙayyade kasancewar nama (visceral) hypoxia, maganin lactate (mai girma a lokacin ischemia da rage yawan fitarwa na zuciya) da SvO2 (raguwa a lokacin rage yawan ƙwayar zuciya, anemia, hypoxemia na arterial, da kuma yawan adadin kuzari) suna taimakawa wajen kimantawa na asibiti. Duk da haka, ana iya haɓaka lactate a cikin yanayin da ba hypoxic ba, don haka ba za a iya yin ganewar asali ba kawai bisa lactate hawan, kamar yadda lactate kuma za a iya haɓaka a cikin yanayin ƙara yawan glycolysis, irin su saurin girma na ciwace-ciwacen ƙwayar cuta, farkon sepsis, cututtuka na rayuwa, da gudanarwa na catecholamines. Sauran ƙimar dakin gwaje-gwaje waɗanda ke nuna takamaiman tabarbarewar gabobin jiki suma suna da mahimmanci, kamar haɓakar creatinine, troponin, ko enzymes hanta.

Ƙimar asibiti na yanayin oxygenation na arterial

Cyanosis. Cyanosis yawanci alama ce da ke faruwa a ƙarshen mataki na hypoxia, kuma sau da yawa ba a dogara da shi ba wajen gano cutar hypoxemia da hypoxia saboda bazai iya faruwa a cikin anemia da rashin zubar jini ba, kuma yana da wuya ga masu launin fata su gane cyanosis.

Pulse oximetry saka idanu. An yi amfani da saka idanu na oximetry na bugun jini mara amfani don sa ido kan duk cututtuka, kuma ana kiran saO2 da aka kiyasta SpO2. Ka'idar sa ido kan bugun jini oximetry ita ce dokar Bill, wacce ta bayyana cewa tattarawar wani abu da ba a sani ba a cikin mafita ana iya ƙaddara ta hanyar ɗaukar haske. Lokacin da haske ya ratsa ta kowane nau'in nama, yawancin nama yana shanye shi da abubuwan nama da jini. Duk da haka, tare da kowane bugun zuciya, jinin jijiya yana jurewa bugun jini, yana barin mai duba bugun jini don gano canje-canje a cikin shanyewar haske a tsawon zango biyu: 660 nanometers (ja) da 940 nanometers (infrared). Yawan sha na raguwar haemoglobin da haemoglobin oxygenated sun bambanta a waɗannan tsayin igiyoyin biyu. Bayan an cire tsotsar kyallen da ba na bugun jini ba, ana iya ƙididdige yawan haemoglobin oxygenated dangane da jimlar haemoglobin.

Akwai wasu iyakoki don saka idanu oximetry na bugun jini. Duk wani abu a cikin jini wanda ke ɗaukar waɗannan tsawon tsayin raƙuman ruwa na iya tsoma baki tare da daidaiton aunawa, gami da samuwar haemoglobinopathies - carboxyhemoglobin da methemoglobinemia, methylene blue, da wasu bambance-bambancen haemoglobin na kwayoyin halitta. Shayewar carboxyhemoglobin a tsawon nanometers 660 yayi kama da na haemoglobin oxygenated; Ƙarƙashin sha a tsawon nanometer 940. Sabili da haka, ba tare da la'akari da haɗin kai na carbon monoxide cikakken haemoglobin da oxygen cikakken haemoglobin, SpO2 zai kasance akai-akai (90% ~ 95%). A cikin methemoglobinemia, lokacin da ƙarfe na ƙarfe ya zama oxidized zuwa yanayin ferrous, methemoglobin yana daidaita ƙimar sha na tsawon zango biyu. Wannan yana haifar da SpO2 kawai yana bambanta tsakanin kewayon 83% zuwa 87% a cikin kewayon taro mai faɗi na methemoglobin. A wannan yanayin, ana buƙatar tsawon tsayi huɗu na haske don auna iskar oxygen ta jijiya don bambanta tsakanin nau'ikan haemoglobin huɗu.

Kulawar oximetry na bugun jini ya dogara da isassun kwararar jini na bugun jini; Don haka, ba za a iya amfani da saka idanu na oximetry na bugun jini ba a cikin gigin-tsufa ko lokacin amfani da na'urorin taimako marasa bugun jini (inda fitarwar zuciya kawai ke da ƙaramin yanki na fitarwar zuciya). A cikin mai tsanani tricuspid regurgitation, maida hankali na deoxyhemoglobin a cikin venous jini yana da girma, da kuma bugun jini na venous zai iya haifar da low jini oxygen jikewa karatu. A cikin hypoxemia mai tsanani na jijiya (SaO2<75%), daidaito kuma na iya raguwa saboda wannan dabarar ba ta taɓa samun inganci ba a cikin wannan kewayon. A ƙarshe, ƙarin mutane suna fahimtar cewa saka idanu na oximetry na bugun jini na iya wuce kima jikewar haemoglobin jijiya da maki 5-10, ya danganta da takamaiman na'urar da mutane masu duhun fata ke amfani da su.

PaO2/FIO2. Matsakaicin PaO2/FIO2 (wanda aka fi sani da P/F rabo daga 400 zuwa 500 mm Hg) yana nuna ma'aunin iskar oxygen mara kyau a cikin huhu, kuma yana da amfani sosai a cikin wannan mahallin kamar yadda iskar injin na iya saita FIO2 daidai. Matsakaicin AP/F ƙasa da 300 mm Hg yana nuna ƙarancin musanyar iskar gas na asibiti, yayin da rabon P/F ƙasa da 200 mm Hg yana nuna hypoxemia mai tsanani. Abubuwan da ke shafar ma'auni na P / F sun haɗa da saitunan samun iska, matsananciyar ƙarewar ƙarewa, da FIO2. Tasirin canje-canje a cikin FIO2 akan rabon P / F ya bambanta dangane da yanayin raunin huhu, juzu'in shunt, da kewayon canje-canje na FIO2. Idan babu PaO2, SpO2/FIO2 na iya zama madaidaicin madaidaicin mai nuna alama.

Bambanci tsakanin Alveolar arterial oxygen partial pressure (Aa PO2). Aa PO2 bambancin ma'auni shine bambanci tsakanin matsi na ɓangaren oxygen na alveolar da aka auna da ma'auni na iskar oxygen da aka auna, ana amfani da shi don auna ingancin musayar gas.

Bambancin "al'ada" Aa PO2 don shakar iska a matakin teku ya bambanta da shekaru, daga 10 zuwa 25 mm Hg (2.5 + 0.21 x shekaru [shekaru]). Abu na biyu mai tasiri shine FIO2 ko PAO2. Idan ɗayan waɗannan abubuwan biyu ya ƙaru, bambancin Aa PO2 zai ƙaru. Wannan shi ne saboda musayar iskar gas a cikin alveolar capillaries yana faruwa a cikin ɓangarorin ɓangarorin ( gangare) na haemoglobin oxygen dissociation curve. A ƙarƙashin irin wannan nau'i na haɗuwa da venous, bambanci a cikin PO2 tsakanin jinin jini mai gauraye da jinin jijiya zai karu. Akasin haka, idan alveolar PO2 yana da ƙasa saboda rashin isasshen iska ko tsayi mai tsayi, bambancin Aa zai zama ƙasa da na al'ada, wanda zai iya haifar da rashin fahimta ko rashin ganewar asali na rashin aikin huhu.

Oxygenation index. Ana iya amfani da ma'aunin iskar oxygen (OI) a cikin marasa lafiya da ke da iska don tantance ƙarfin tallafin iskar da ake buƙata don kiyaye iskar oxygen. Ya haɗa da ma'anar matsa lamba ta iska (MAP, a cikin cm H2O), FIO2, da PaO2 (a cikin mm Hg) ko SpO2, kuma idan ya wuce 40, ana iya amfani dashi azaman ma'auni don maganin oxygenation na extracorporeal. Ƙimar al'ada ƙasa da 4 cm H2O/mm Hg; Saboda daidaitaccen ƙimar cm H2O/mm Hg (1.36), yawanci ba a haɗa raka'a yayin ba da rahoton wannan rabo.

Alamomi ga m oxygen far
Lokacin da marasa lafiya suka sami wahalar numfashi, ana buƙatar ƙarin iskar oxygen kafin a gano cutar hypoxemia. Lokacin da karfin juzu'i na oxygen (PaO2) ya kasance ƙasa da 60 mm Hg, mafi bayyananniyar alamar iskar oxygen shine hypoxemia arterial, wanda yawanci yayi daidai da jikewar oxygen jikewa (SaO2) ko jikewar iskar oxygen (SpO2) na 89% zuwa 90%. Lokacin da PaO2 ya faɗi ƙasa da 60 mm Hg, jikewar iskar oxygen na jini na iya raguwa sosai, wanda zai haifar da raguwa mai yawa a cikin abun ciki na iskar oxygen da yuwuwar haifar da hypoxia nama.

Baya ga hypoxemia arterial, ƙarin iskar oxygen na iya zama dole a lokuta da ba kasafai ba. Anemia mai tsanani, rauni, da marasa lafiya masu mahimmanci na tiyata na iya rage hypoxia nama ta hanyar haɓaka matakan oxygen na jijiya. Ga marasa lafiya tare da guba na carbon monoxide (CO), ƙarin iskar oxygen na iya ƙara narkar da abun ciki na iskar oxygen a cikin jini, maye gurbin CO da aka ɗaure zuwa haemoglobin, kuma ƙara yawan haemoglobin oxygenated. Bayan shakar iskar oxygen mai tsafta, rabin rayuwar carboxyhemoglobin shine mintuna 70-80, yayin da rabin rayuwar lokacin numfashin iska shine mintuna 320. A ƙarƙashin yanayin oxygen na hyperbaric, rabin rayuwar carboxyhemoglobin yana raguwa zuwa ƙasa da mintuna 10 bayan shakar iskar oxygen mai tsabta. Ana amfani da iskar oxygen ta hyperbaric gabaɗaya a cikin yanayi tare da manyan matakan carboxyhemoglobin (> 25%), ischemia na zuciya, ko rashin daidaituwa.

Duk da rashin bayanan tallafi ko bayanan da ba daidai ba, wasu cututtuka kuma na iya amfana daga ƙarin iskar oxygen. Ana amfani da maganin iskar oxygen don tari ciwon kai, rikicin ciwon sikila, sauƙaƙan damuwa na numfashi ba tare da hypoxemia ba, pneumothorax, da emphysema na mediastinal (yana haɓaka shar iska mai ƙirji). Akwai shaidun da ke nuna cewa babban iskar oxygen na ciki zai iya rage yawan kamuwa da cututtuka na wurin tiyata. Duk da haka, ƙara yawan iskar oxygen baya da alama ba zai iya rage tashin zuciya / amai ba.

Tare da haɓaka ƙarfin isar da iskar oxygen na marasa lafiya, yin amfani da maganin oxygen na dogon lokaci (LTOT) yana ƙaruwa. Ka'idodin aiwatar da maganin iskar oxygen na dogon lokaci sun riga sun bayyana sosai. Ana amfani da maganin iskar oxygen na dogon lokaci don cututtukan huhu na huhu (COPD).
Nazarin biyu akan marasa lafiya tare da COPD hypoxemic suna ba da bayanan tallafi don LTOT. Nazarin farko shine gwajin gwajin Oxygen Therapy (NOTT) wanda aka gudanar a cikin 1980, wanda aka sanya marasa lafiya bazuwar zuwa kowane dare (akalla 12 hours) ko ci gaba da maganin oxygen. A cikin watanni 12 da 24, marasa lafiya waɗanda kawai ke karɓar maganin iskar oxygen na dare suna da yawan mace-mace. Gwaji na biyu shine gwajin Iyali na Majalisar Bincike na Likita da aka gudanar a cikin 1981, wanda aka raba marasa lafiya ba tare da izini ba zuwa rukuni biyu: waɗanda ba su sami iskar oxygen ba ko waɗanda ke karɓar iskar oxygen na akalla sa'o'i 15 a kowace rana. Kama da gwajin NOTT, yawan mace-mace a cikin rukunin anaerobic ya fi girma sosai. Abubuwan da ke cikin gwaje-gwajen guda biyu sun kasance marasa shan taba marasa lafiya waɗanda suka sami matsakaicin magani kuma suna da yanayin kwanciyar hankali, tare da PaO2 da ke ƙasa da 55 mm Hg, ko marasa lafiya da polycythemia ko cututtukan zuciya na huhu tare da PaO2 da ke ƙasa 60 mm Hg.

Wadannan gwaje-gwajen guda biyu sun nuna cewa karin iskar oxygen fiye da sa'o'i 15 a rana ya fi dacewa da rashin samun iskar oxygen gaba daya, kuma ci gaba da maganin oxygen ya fi kawai magani da dare. Ma'auni na haɗawa don waɗannan gwaje-gwajen sune tushen kamfanonin inshora na likita na yanzu da ATS don haɓaka jagororin LTOT. Yana da kyau a yi la'akari da cewa an yarda da LTOT don wasu cututtukan zuciya na hypoxic, amma a halin yanzu akwai rashin shaidar gwaji mai dacewa. Wani gwaji na multicenter na baya-bayan nan bai sami wani bambanci ba a cikin tasirin maganin oxygen akan mace-mace ko ingancin rayuwa ga marasa lafiya na COPD tare da hypoxemia wanda bai dace da ka'idodin hutawa ba ko kuma kawai ya haifar da motsa jiki.

Likitoci a wasu lokuta suna ba da izinin ƙarin iskar oxygen na dare ga marasa lafiya waɗanda ke fuskantar raguwa mai tsanani a cikin jikewar iskar oxygen na jini yayin barci. A halin yanzu babu wata bayyananniyar shaida da za ta goyi bayan yin amfani da wannan hanyar a cikin marasa lafiya tare da barcin barci mai hanawa. Ga marasa lafiya da ke fama da matsalar barci mai hana ruwa ko kiba hypopnea ciwo wanda ke haifar da ƙarancin numfashi na dare, iska mai ƙarfi mara ƙarfi maimakon iskar oxygen shine babban hanyar magani.

Wani batun da za a yi la'akari shi ne ko ana buƙatar ƙarin iskar oxygen yayin tafiya ta iska. Yawancin jiragen sama na kasuwanci suna ƙara matsa lamba na gida zuwa tsayi daidai da ƙafa 8000, tare da iskar iskar oxygen ta kusan 108 mm Hg. Ga marasa lafiya da cututtukan huhu, raguwar iskar oxygen da ake shaka (PiO2) na iya haifar da hypoxemia. Kafin tafiya, ya kamata majiyyata su yi cikakken kimantawar likita, gami da gwajin iskar gas na jijiya. Idan PaO2 na mai haƙuri a ƙasa yana da ≥ 70 mm Hg (SpO2> 95%), to PaO2 a lokacin jirgin yana yiwuwa ya wuce 50 mm Hg, wanda galibi ana la'akari da isa don jure ƙarancin motsa jiki. Ga marasa lafiya da ƙananan SpO2 ko PaO2, ana iya ɗaukar gwajin tafiya na minti 6 ko gwajin simintin hypoxia, yawanci yana numfashi 15% oxygen. Idan hypoxemia ya faru a lokacin tafiya ta iska, ana iya gudanar da iskar oxygen ta hanyar cannula na hanci don ƙara yawan iskar oxygen.

Tushen biochemical na guba na oxygen

Rashin iskar oxygen yana faruwa ne ta hanyar samar da nau'in oxygen mai amsawa (ROS). ROS shine iskar oxygen da aka samu kyauta tare da electron orbital maras guda wanda zai iya amsawa tare da sunadarai, lipids, da acid nucleic, yana canza tsarin su kuma yana haifar da lalacewar salula. A lokacin al'ada mitochondrial metabolism, an samar da ƙaramin adadin ROS azaman ƙwayar sigina. Kwayoyin rigakafi kuma suna amfani da ROS don kashe ƙwayoyin cuta. ROS ya haɗa da superoxide, hydrogen peroxide (H2O2), da radicals hydroxyl. Yawan ROS da yawa zai wuce ayyukan tsaro na salula, wanda ke haifar da mutuwa ko haifar da lalacewar tantanin halitta.

Don iyakance lalacewa ta hanyar tsarar ROS, tsarin kariya na antioxidant na sel na iya kawar da radicals kyauta. Superoxide dismutase yana jujjuya superoxide zuwa H2O2, wanda aka canza zuwa H2O da O2 ta catalase da glutathione peroxidase. Glutathione wani muhimmin kwayar halitta ne wanda ke iyakance lalacewar ROS. Sauran kwayoyin antioxidant sun hada da alpha tocopherol (bitamin E), ascorbic acid (bitamin C), phospholipids, da cysteine. Naman huhu na ɗan adam ya ƙunshi babban adadin antioxidants na waje da superoxide dismutase isoenzymes, yana mai da shi ƙasa da guba lokacin da aka fallasa shi zuwa mafi girma na iskar oxygen idan aka kwatanta da sauran kyallen takarda.

Hyperoxia da ROS ya haifar da raunin huhu mai tsaka-tsaki za a iya raba shi zuwa matakai biyu. Da fari dai, akwai lokacin exudative, halin mutuwar alveolar nau'in 1 epithelial sel da endothelial sel, interstitial edema, da kuma cika exudative neutrophils a cikin alveoli. Bayan haka, akwai lokacin yaduwa, lokacin da ƙwayoyin endothelial da nau'in sel na epithelial na 2 suna yaduwa kuma suna rufe murfin ginshiƙan da aka fallasa a baya. Halayen lokacin raunin iskar oxygen shine yaduwa na fibroblast da fibrosis na tsaka-tsaki, amma endothelium capillary da alveolar epithelium har yanzu suna kula da kamanni na al'ada.
Bayyanar cututtuka na cututtukan oxygen na huhu na huhu

Har yanzu ba a fayyace matakin bayyanar da guba ke faruwa ba. Lokacin da FIO2 ya kasa da 0.5, yawan guba na asibiti gabaɗaya baya faruwa. Nazarin ɗan adam na farko sun gano cewa fallasa kusan 100% oxygen na iya haifar da rashin daidaituwa na hankali, tashin zuciya, da mashako, da kuma rage ƙarfin huhu, ƙarfin yaduwar huhu, bin huhu, PaO2, da pH. Sauran batutuwan da suka danganci gubar iskar oxygen sun haɗa da absorptive atelectasis, oxygen induced hypercapnia, m numfashi wahala ciwo (ARDS), da kuma jariri bronchopulmonary dysplasia (BPD).
Absorbent atelectasis. Nitrogen iskar gas ce da ba ta da tushe wacce ke yaduwa a hankali a cikin jini idan aka kwatanta da oxygen, don haka yana taka rawa wajen kiyaye yaduwar alveolar. Lokacin amfani da 100% oxygen, saboda yawan iskar oxygen da ya wuce adadin isar da iskar gas, ƙarancin nitrogen zai iya haifar da rushewar alveolar a cikin yankunan da ke da ƙananan ƙwayar iska na alveolar (V/Q). Musamman a lokacin tiyata, maganin sa barci da gurɓatacce na iya haifar da raguwar ragowar aikin huhu, yana inganta rushewar ƙananan hanyoyin iska da alveoli, yana haifar da saurin farawa na atelectasis.

Oxygen ya haifar da hypercapnia. Masu fama da COPD masu tsanani suna da haɗari ga hypercapnia mai tsanani lokacin da aka fallasa su zuwa babban adadin iskar oxygen yayin da suke ci gaba da muni. Hanyar wannan hypercapnia shine ikon hypoxemia don fitar da numfashi yana hana. Duk da haka, a cikin kowane majiyyaci, akwai wasu hanyoyi guda biyu a wasa zuwa nau'i daban-daban.
Halin hypoxemia a cikin marasa lafiya na COPD shine sakamakon ƙananan ƙananan alveolar matsa lamba na oxygen (PAO2) a cikin ƙananan V / Q yankin. Don rage girman tasirin waɗannan ƙananan yankuna na V / Q akan hypoxemia, halayen guda biyu na wurare dabam dabam na huhu - hypoxic pulmonary vasoconstriction (HPV) da hypercapnic pulmonary vasoconstriction - za su canja wurin jini zuwa wurare masu kyau. Lokacin da ƙarin iskar oxygen ya karu PAO2, HPV yana raguwa sosai, ƙara yawan turare a cikin waɗannan wurare, yana haifar da yankunan da ƙananan rabo na V / Q. Waɗannan ƙwayoyin huhu yanzu suna da wadata a cikin iskar oxygen amma suna da ƙarancin ƙarfi don kawar da CO2. Ƙaƙƙarfan ƙwayar waɗannan ƙwayoyin huhu ya zo ne a farashin sadaukar da wurare masu kyau tare da samun iska mai kyau, wanda ba zai iya sakin CO2 mai yawa kamar yadda ya gabata ba, yana haifar da hypercapnia.

Wani dalili shi ne raunin Haldane mai rauni, wanda ke nufin cewa idan aka kwatanta da jinin oxygenated, jinin da aka lalata zai iya ɗaukar ƙarin CO2. Lokacin da haemoglobin ya deoxygenated, yana ɗaure ƙarin protons (H+) da CO2 a cikin sigar amino esters. Yayin da ƙaddamarwar deoxyhemoglobin ya ragu a lokacin maganin oxygen, ƙarfin buffer na CO2 da H + kuma yana raguwa, ta haka yana raunana ikon jinin jini don jigilar CO2 kuma yana haifar da karuwa a cikin PaCO2.

Lokacin ba da iskar oxygen ga marasa lafiya tare da riƙewar CO2 na yau da kullun ko marasa lafiya masu haɗari, musamman a cikin yanayin matsanancin hypoxemia, yana da matukar mahimmanci don daidaita FIO2 don kula da SpO2 a cikin kewayon 88% ~ 90%. Rahotanni masu yawa sun nuna cewa gazawar daidaita O2 na iya haifar da mummunan sakamako; Wani binciken da aka yi bazuwar da aka yi a kan marasa lafiya tare da matsanancin CODP a kan hanyarsu ta zuwa asibiti ya tabbatar da wannan babu shakka. Idan aka kwatanta da marasa lafiya ba tare da ƙuntatawa na iskar oxygen ba, marasa lafiya da aka ba da izini don ƙarin oxygen don kula da SpO2 a cikin kewayon 88% zuwa 92% yana da ƙananan yawan mace-mace (7% vs. 2%).

ARDS da BPD. Mutane sun dade sun gano cewa gubar iskar oxygen yana da alaƙa da ilimin halittar jiki na ARDS. A cikin dabbobi masu shayarwa waɗanda ba ɗan adam ba, fallasa zuwa 100% oxygen na iya haifar da lalacewa ta alveolar kuma a ƙarshe mutuwa. Duk da haka, ainihin shaidar iskar oxygen a cikin marasa lafiya da cututtuka masu tsanani na huhu yana da wuya a bambanta daga lalacewa ta hanyar cututtuka masu tasowa. Bugu da ƙari, yawancin cututtuka masu kumburi na iya haifar da haɓaka aikin kariya na antioxidant. Sabili da haka, yawancin karatu sun kasa nuna alaƙa tsakanin wuce kima da iskar oxygen da raunin huhu ko ARDS.

Cutar ƙwayar ƙwayar ƙwayar ƙwayar ƙwayar cuta ta huhu cuta ce da ke haifar da rashin abubuwan da ke aiki a saman, wanda ke da rugujewar alveolar da kumburi. Jarirai da ba su kai ba suna fama da cutar hailan ƙwayar cuta yawanci suna buƙatar shakar iskar oxygen mai yawa. An yi la'akari da gubar iskar oxygen a matsayin babban abu a cikin pathogenesis na BPD, har ma da ke faruwa a cikin jarirai waɗanda ba sa buƙatar samun iska. Jarirai sun fi dacewa da lalacewar iskar oxygen mai girma saboda ayyukan kariya na rigakafin ƙwayoyin cuta na salula basu riga sun ci gaba da girma ba; Retinopathy na prematurity cuta ce da ke hade da maimaita hypoxia/hyperoxia damuwa, kuma an tabbatar da wannan tasirin a cikin ciwon ido na prematurity.
Sakamakon synergistic na guba na oxygen na huhu

Akwai magunguna da yawa waɗanda zasu iya haɓaka gubar iskar oxygen. Oxygen yana ƙara ROS da bleomycin ke samarwa kuma yana hana bleomycin hydrolase. A cikin hamsters, matsanancin matsanancin matsin lamba na oxygen na iya haifar da rauni na huhu na bleomycin, kuma rahotanni sun kuma bayyana ARDS a cikin marasa lafiya waɗanda suka karɓi maganin bleomycin kuma an fallasa su zuwa babban FIO2 a lokacin lokacin aiki. Koyaya, gwajin da ake shirin yi ya kasa nuna alaƙa tsakanin isar da iskar oxygen mai yawa, bayyanar da baya ga bleomycin, da rashin aikin huhu mai tsanani. Paraquat shine maganin ciyawa na kasuwanci wanda shine wani mai haɓaka iskar oxygen. Sabili da haka, lokacin da ake hulɗa da marasa lafiya tare da guba na paraquat da fallasa su zuwa bleomycin, FIO2 ya kamata a rage shi gwargwadon yiwuwar. Sauran magungunan da za su iya ƙara yawan iskar oxygen sun haɗa da disulfiram da nitrofurantoin. Karancin furotin da na gina jiki na iya haifar da lalacewar iskar oxygen mai yawa, wanda zai iya zama saboda rashin thiol mai ɗauke da amino acid waɗanda ke da mahimmanci ga haɗin glutathione, da kuma rashin bitamin A da E.
Rashin iskar oxygen a cikin sauran tsarin gabobin

Hyperoxia na iya haifar da halayen guba ga gabobin da ke wajen huhu. Wani babban bincike na baya-bayan nan na multicenter ya nuna haɗin gwiwa tsakanin karuwar mace-mace da matakan oxygen mai yawa bayan nasarar farfadowa na zuciya (CPR). Binciken ya gano cewa marasa lafiya tare da PaO2 fiye da 300 mm Hg bayan CPR suna da haɗarin mace-mace a asibiti na 1.8 (95% CI, 1.8-2.2) idan aka kwatanta da marasa lafiya tare da oxygen na jini na al'ada ko hypoxemia. Dalilin karuwar yawan mace-mace shine tabarbarewar tsarin jijiya na tsakiya bayan kamawar zuciya da ROS ya haifar da rauni mai saurin iskar oxygen. Wani binciken da aka yi a baya-bayan nan kuma ya kwatanta yawan mace-mace a cikin marasa lafiya tare da hypoxemia bayan intubation a cikin sashen gaggawa, wanda ke da alaka da girman girman PaO2.

Ga marasa lafiya da ke fama da raunin kwakwalwa da bugun jini, samar da iskar oxygen ga waɗanda ba tare da hypoxemia ba kamar ba su da wani amfani. Wani binciken da wata cibiyar rauni ta gudanar ya gano cewa idan aka kwatanta da marasa lafiya da matakan oxygen na jini na al'ada, marasa lafiya da ke fama da rauni a cikin kwakwalwa waɗanda suka sami babban iskar oxygen (PaO2> 200 mm Hg) suna da yawan mace-mace da ƙananan Glasgow Coma Score a kan fitarwa. Wani binciken da aka yi kan marasa lafiya da ke karɓar maganin oxygen na hyperbaric ya nuna rashin jin dadi. A cikin babban gwaji na multicenter, ƙaddamar da iskar oxygen zuwa marasa lafiya masu fama da bugun jini ba tare da hypoxemia (jikewa fiye da 96%) ba shi da wani amfani a cikin mace-mace ko tsinkayen aiki.

A cikin ciwon zuciya mai tsanani (AMI), karin iskar oxygen shine maganin da aka saba amfani dashi, amma darajar maganin oxygen ga irin waɗannan marasa lafiya har yanzu yana da rikici. Oxygen ya zama dole don kula da marasa lafiya masu fama da ciwon zuciya mai tsanani tare da hypoxemia mai haɗuwa, saboda yana iya ceton rayuka. Duk da haka, amfanin kariyar oxygen na gargajiya a cikin rashin hypoxemia ba a bayyana ba tukuna. A cikin ƙarshen 1970s, gwajin bazuwar makafi sau biyu ya shigar da marasa lafiya 157 tare da raunin ƙwayar cuta mai saurin gaske kuma idan aka kwatanta da iskar oxygen (6 L / min) ba tare da iskar oxygen ba. An gano cewa marasa lafiya da ke karbar maganin iskar oxygen sun kasance mafi girma na sinus tachycardia da karuwa a cikin enzymes na myocardial, amma babu bambanci a cikin yawan mace-mace.

A cikin haɓakar kashi na ST m marasa lafiya na infarction na zuciya ba tare da hypoxemia ba, maganin iskar oxygen na cannula na hanci a 8 L / min ba shi da amfani idan aka kwatanta da shakar iska na yanayi. A cikin wani binciken game da iskar oxygen a 6 L / min da inhalation na iska na yanayi, babu bambanci a cikin mutuwar shekaru 1 da kuma sake dawowa tsakanin marasa lafiya da ciwon zuciya mai tsanani. Sarrafa jikewar iskar oxygen na jini tsakanin 98% zuwa 100% da 90% zuwa 94% bashi da wani fa'ida ga marasa lafiya da ke fama da bugun zuciya a wajen asibiti. Abubuwan da za su iya haifar da cutarwa na babban iskar oxygen a kan myocardial infarction sun hada da rikice-rikice na jijiyoyin jini, rushewar rarrabawar jini na microcirculation, ƙara yawan aikin iskar oxygen, rage yawan iskar oxygen, da kuma ƙara lalacewar ROS a cikin nasarar sake farfadowa.

A ƙarshe, gwaje-gwaje na asibiti da ƙididdigar meta-bincike sun binciki ƙimar ƙimar SpO2 da ta dace don marasa lafiya marasa lafiya a asibiti. Cibiyar guda ɗaya, gwajin bazuwar lakabin da aka kwatanta da kwatanta maganin oxygen mai ra'ayin mazan jiya (SpO2 manufa 94% ~ 98%) tare da maganin gargajiya (SpO2 darajar 97% ~ 100%) an gudanar da shi akan marasa lafiya 434 a cikin sashin kulawa mai zurfi. Adadin mace-mace a cikin sashin kulawa mai zurfi na marasa lafiya da aka ba da izini don karɓar maganin iskar oxygen mai ra'ayin mazan jiya ya inganta, tare da ƙarancin girgiza, gazawar hanta, da ƙwayoyin cuta. Binciken meta-bincike na gaba ya haɗa da gwaje-gwajen asibiti guda 25 waɗanda suka ɗauki majinyata sama da 16000 da ke asibiti tare da cututtuka daban-daban, gami da bugun jini, rauni, sepsis, ciwon zuciya, da tiyata na gaggawa. Sakamakon wannan meta-bincike ya nuna cewa marasa lafiya da ke karɓar dabarun maganin oxygen na ra'ayin mazan jiya sun sami karuwar yawan mace-mace a asibiti (haɗarin dangi, 1.21; 95% CI, 1.03-1.43).

Koyaya, manyan gwaje-gwaje guda biyu da suka biyo baya sun kasa nuna duk wani tasiri na dabarun kula da iskar oxygen na ra'ayin mazan jiya akan adadin kwanakin ba tare da na'urar iska ba a cikin marasa lafiya da cututtukan huhu ko adadin rayuwa na kwanaki 28 a cikin marasa lafiya na ARDS. Kwanan nan, binciken da aka yi na 2541 marasa lafiya da ke karɓar iskar injiniya sun gano cewa ƙaddamar da iskar oxygen a cikin nau'o'in SpO2 daban-daban guda uku (88% ~ 92%, 92% ~ 96%, 96% ~ 100%) bai shafi sakamakon irin su kwanakin rayuwa ba, mace-mace, kama zuciya, arrhythmia, myocardial ko bugun jini a cikin kwanaki 8 na inji. Dangane da waɗannan bayanan, ƙa'idodin Societyungiyar Thoracic ta Biritaniya sun ba da shawarar manufa SpO2 kewayon 94% zuwa 98% don yawancin manya marasa lafiya na asibiti. Wannan yana da ma'ana saboda SpO2 a cikin wannan kewayon (la'akari da ± 2% ~ 3% kuskuren bugun jini oximeters) yayi daidai da kewayon PaO2 na 65-100 mm Hg, wanda ke da aminci kuma ya isa ga matakan oxygen na jini. Ga marasa lafiya da ke cikin haɗarin gazawar numfashi na hypercapnic, 88% zuwa 92% shine maƙasudi mafi aminci don guje wa hypercapnia da O2 ke haifarwa.