"An gano makwabcina yana da Covid-tabbatacce kuma an kwantar da shi a asibiti kusa," in ji wani memba na WhatsApp kwanakin baya.Wani memba ya tambaya ko tana kan iska?Memba ta farko ta amsa cewa tana kan 'Oxygen Therapy'.Wani memba na uku ya jiyo, yana cewa, “Oh!hakan bai yi muni ba.Mahaifiyata tana amfani da iskar Oxygen kusan shekaru 2 yanzu."Wani mamba mai ilimi ya yi sharhi, “Ba ɗaya ba ne.Oxygen maida hankali ne Low Flow Oxygen Therapy da abin da asibitoci ke amfani da su don kula da m marasa lafiya, shi ne High Flow Oxygen far. "
Kowa ya yi mamaki, menene ainihin bambanci tsakanin injin daskarewa da maganin oxygen - High Flow ko Low Flow ?!
Kowa ya san kasancewa a kan injin iska yana da mahimmanci.Yaya tsanani yake kasancewa akan maganin oxygen?
Oxygen Therapy vs Ventilation a cikin COVID19
Maganin oxygen ya zama kalmar buzz-word a cikin kula da marasa lafiya na COVID19 a cikin 'yan watannin nan.Maris-Mayu 2020 ya ga wani mahaukacin tashin hankali ga masu ba da iska a Indiya da duk faɗin duniya.Gwamnatoci da mutane a duk faɗin duniya sun koyi yadda COVID19 zai iya haifar da raguwar iskar oxygen a cikin jiki cikin nutsuwa.An lura cewa wasu marasa lafiya marasa numfashi suna da isasshen iskar oxygen ko matakan SpO2 sun ragu zuwa ko da 50-60%, lokacin da suka isa dakin gaggawa na Asibiti ba tare da jin daɗi ba.
Matsakaicin adadin oxygen na yau da kullun shine 94-100%.Oxygen saturation <94% an kwatanta shi da 'Hypoxia'.Hypoxia ko Hypoxemia na iya haifar da rashin numfashi da kuma haifar da Maƙarƙashiyar Numfashi.Kowa ya ɗauka da yawa Ventilator sune amsar ga masu fama da cutar ta Covid19.Koyaya, ƙididdiga na baya-bayan nan sun nuna cewa kusan kashi 14% na mutanen da ke da COVID-19 suna haɓaka matsakaici zuwa matsananciyar cuta kuma suna buƙatar asibiti da tallafin oxygen, tare da ƙarin 5% kawai waɗanda ke buƙatar shigar da Sashin Kulawa na Musamman da hanyoyin kwantar da hankali gami da intubation. samun iska.
A wasu kalmomi kashi 86% na waɗanda suka gwada inganci don COVID19 ko dai asymptomatic ne ko kuma suna nuna alamun matsakaici zuwa matsakaici.
Waɗannan mutanen ba sa buƙatar maganin oxygen ko samun iska, amma 14% da aka ambata a sama suna yi.WHO ta ba da shawarar ƙarin maganin iskar oxygen nan da nan ga marasa lafiya da ke da wahalar numfashi, hypoxia/hypoxemia ko girgiza.Manufar maganin oxygen shine don dawo da matakin jikewar oxygen zuwa> 94%.
Abin da kuke buƙatar sani game da High Flow Oxygen Therapy
Kawai idan kai ko wanda kake ƙauna ya kasance a cikin kashi 14% da aka ambata a sama - ƙila ka so ƙarin sani game da maganin oxygen.
Kuna iya son sanin yadda maganin iskar oxygen ya bambanta da na'urar iska.
Menene nau'ikan na'urorin oxygen daban-daban da tsarin bayarwa?
Ta yaya suke aiki?Menene sassa daban-daban?
Yaya waɗannan na'urori suka bambanta a iyawarsu?
Ta yaya suka bambanta a fa'idodinsu da kasadarsu?
Menene alamun - Wanene ke buƙatar maganin oxygen kuma wanene ke buƙatar Ventilator?
Ci gaba da sanin ƙarin…
Ta yaya na'urar maganin oxygen ta bambanta da na'urar iska?
Don fahimtar yadda na'urar kwantar da iskar oxygen ta bambanta da na'urar hurawa, dole ne mu fara fahimtar bambanci tsakanin iska da Oxygenation.
Samun iska vs oxygenation
Samun iska - Samun iska shine aiki na al'ada, numfashi ba tare da bata lokaci ba, gami da hanyoyin numfashi da numfashi.Idan majiyyaci ba zai iya yin waɗannan hanyoyin da kansu ba, ana iya sanya su a kan injin iska, wanda ke yi musu.
Oxygenation - Samun iska yana da mahimmanci don tsarin musayar iskar gas watau isar da iskar oxygen zuwa huhu da kuma cire carbon dioxide daga huhu.Oxygenation shine kawai ɓangaren farko na tsarin musayar iskar gas watau isar da iskar oxygen zuwa kyallen takarda.
Bambanci tsakanin High Flow Oxygen far da Ventilator a zahiri shine mai zuwa.Maganin iskar oxygen ya haɗa da ba ku ƙarin iskar oxygen kawai - huhun ku har yanzu yana aikin ɗaukar iskar iskar oxygen a ciki da shakar iskar carbon-di-oxide.Na'urar iska ba wai kawai tana ba ku ƙarin iskar oxygen ba, har ila yau yana yin aikin huhun ku - shaka & fita.
Wanene (wane irin majiyyaci) ke buƙatar maganin Oxygen & wa ke buƙatar samun iska?
Don yin amfani da maganin da ya dace, mutum yana buƙatar sanin ko batun tare da mai haƙuri shine rashin isashshen oxygen ko rashin iska.
Rashin numfashi na iya faruwa saboda
Batun oxygenation yana haifar da ƙarancin oxygen amma na al'ada - ƙananan matakan carbon dioxide.Har ila yau, an san shi da gazawar numfashi na hypoxaemic - wannan yana faruwa a lokacin da huhu ba su iya samun iskar oxygen sosai, gabaɗaya saboda cututtukan huhu masu tsanani waɗanda ke haifar da ruwa ko sputum ya mamaye alveoli (Ƙananan jaka-kamar tsarin huhu wanda ke musayar iskar gas).Matakan carbon dioxide na iya zama na al'ada ko ƙasa yayin da majiyyaci ke iya yin numfashi da kyau.Mai haƙuri da irin wannan yanayin - Hypoxemia, ana kula da shi gabaɗaya tare da maganin oxygen.
batun samun iska yana haifar da ƙarancin iskar oxygen da kuma yawan adadin carbon dioxide.Har ila yau, an san shi da gazawar numfashi na hypercapnic - wannan yanayin yana faruwa ne ta hanyar rashin iyawar majiyyaci ko numfashi, yana haifar da tarin carbon-di-oxide.Tarin CO2 sannan yana hana su numfashi-a cikin isasshen iskar oxygen.Wannan yanayin gabaɗaya yana buƙatar tallafi na injin iska don kula da marasa lafiya.
Me yasa na'urorin Kula da Lafiyar Oxygen Low Flow ba su isa ga lokuta masu tsanani ba?
A cikin m lokuta me ya sa muke bukatar high kwarara oxygen far maimakon amfani da sauki oxygen concentrators?
Nama a jikinmu na buƙatar iskar oxygen don rayuwa.Rashin iskar oxygen ko hypoxia a cikin kyallen takarda na dogon lokaci (fiye da mintuna 4) na iya haifar da mummunan rauni a ƙarshe wanda zai haifar da mutuwa.Yayin da likita zai iya ɗaukar lokaci don kimanta abubuwan da ke haifar da, ƙara yawan isar da iskar oxygen a halin yanzu zai iya hana mutuwa ko nakasa.
Baligi na yau da kullun yana numfashi a cikin lita 20-30 na iska a cikin minti ɗaya ƙarƙashin matsakaicin matakin aiki.Kashi 21% na iskar da muke shaka shine iskar oxygen, watau kusan lita 4-6/minti.FiO2 ko juzu'in wahayin oxygen a cikin wannan yanayin shine 21%.
Duk da haka, a cikin lokuta masu tsanani, solubility na oxygen a cikin jini zai iya zama ƙasa.Ko da lokacin da iskar oxygen da aka yi wahayi/shakar ya kasance 100%, narkar da iskar oxygen na iya samar da kashi ɗaya bisa uku na buƙatun iskar oxygen na nama.Sabili da haka, hanya ɗaya don magance hypoxia nama shine ƙara ɗan ƙaramin iskar oxygen (Fio2) daga al'ada 21%.A cikin matsanancin yanayi da yawa, haɓakar iskar oxygen na 60-100% na ɗan gajeren lokaci (har zuwa sa'o'i 48) na iya ceton rayuwa har sai an yanke shawara da ba da ƙarin takamaiman magani.
Dace da Ƙananan Na'urorin Oxygen don Kulawa Mai Girma
Tsarin ƙananan kwarara yana da ƙasa da ƙasa fiye da ƙimar kwarara mai ban sha'awa (Gudun daɗaɗɗa na al'ada yana tsakanin 20-30lits / minti kamar yadda aka ambata a sama).Ƙananan tsarin tafiyar da ruwa irin su oxygen concentrators suna haifar da sauye-sauye na 5-10 lita / m.Ko da yake suna ba da ƙwayar iskar oxygen har zuwa ko da 90%, tun da mai haƙuri yana buƙatar shakar iska don yin gyara don ma'auni mai ban sha'awa - FiO2 gaba ɗaya na iya zama mafi kyau fiye da 21% amma har yanzu bai isa ba.Bugu da ƙari, a ƙarancin iskar iskar oxygen (<5 l/min) na iya haifar da iskar da ba ta da kyau ta sake numfashi saboda iskar da aka fitar ba ta da kyau sosai daga abin rufe fuska.Wannan yana haifar da riƙewar carbon dioxide mafi girma kuma yana rage ƙarin ci na iska / oxygen.
Hakanan lokacin da aka isar da iskar oxygen a cikin adadin 1-4 l / min ta hanyar abin rufe fuska ko hanci, oropharynx ko nasopharynx (hanyoyin iska) suna ba da isasshen humidification.A mafi girman adadin kwarara ko lokacin isar da iskar oxygen kai tsaye zuwa trachea, ana buƙatar ƙarin humidification na waje.Ƙananan tsarin kwarara ba su da kayan aiki don yin haka.Bugu da ƙari, FiO2 ba za a iya saita shi daidai a cikin LF ba.
Gabaɗayan ƙananan tsarin iskar oxygen bazai dace da lokuta masu tsanani na hypoxia ba.
Dace da Babban Na'urorin Oxygen don Kulawa Mai Sauƙi
Tsarukan yawo mai girma sune waɗanda zasu iya daidaita ko wuce ƙimar kwararar kuzari - watau 20-30 lita / minti.Tsarukan yawo mai girma da ake samu a yau na iya haifar da ƙimar kwarara a ko'ina tsakanin lita 2-120 / minti kamar masu ba da iska.FiO2 za a iya saita shi daidai da kulawa.FiO2 na iya kusan kusan 90-100%, tunda mara lafiya baya buƙatar shaka kowane iska kuma asarar gas ba komai bane.Sake numfashin iskar gas ɗin da ya ƙare ba matsala ba ne saboda abin rufe fuska yana jujjuya shi ta hanyar yawan kwararar ruwa.Hakanan suna haɓaka jin daɗin haƙuri ta hanyar kiyaye danshi da isasshen zafi a cikin iskar don sa mai a cikin hanci.
Gabaɗaya, babban tsarin kwarara ba zai iya haɓaka iskar oxygen kawai kamar yadda ake buƙata a cikin manyan lokuta ba, har ma yana rage aikin numfashi, yana haifar da ƙarancin damuwa ga huhu masu haƙuri.Saboda haka sun dace da wannan dalili a cikin lokuta masu tsanani na damuwa na numfashi.
Menene Abubuwan Abubuwan Haɓakawa na Cannula Mai Ruwa na Nasal vs Ventilator?
Mun ga cewa aƙalla ana buƙatar tsarin maganin oxygen mai girma (HFOT) don magance matsalolin gazawar numfashi.Bari mu bincika yadda tsarin High Flow (HF) ya bambanta da na'urar iska.Menene bangarori daban-daban na duka injinan kuma ta yaya suka bambanta a aikinsu?
Duk injinan biyu suna buƙatar haɗa su zuwa tushen iskar oxygen a cikin asibiti kamar bututun ko silinda.Tsarin maganin iskar oxygen mai girma yana da sauƙi - ya ƙunshi a
kwarara janareta,
wani iska-oxygen blender,
mai humidifier,
tube mai zafi da
na'urar bayarwa misali cannula na hanci.
Aikin iska
Na'urar iska a daya bangaren ya fi fadi.Ba wai kawai ya ƙunshi duk abubuwan haɗin HFNC ba, yana kuma da tsarin numfashi, sarrafawa da tsarin sa ido tare da ƙararrawa don yin amintaccen, sarrafawa, iskar da aka tsara don majiyyaci.
Mafi mahimmancin ma'auni don tsarawa a cikin iskar inji sune:
Yanayin samun iska, (ƙara, matsa lamba ko dual),
Modality (sarrafawa, taimako, goyan bayan samun iska), da
Siffofin numfashi.Babban sigogi shine ƙarar tidal da ƙarar mintuna a cikin yanayin girma, matsa lamba mafi girma (a cikin yanayin matsa lamba), mitar numfashi, tabbataccen ƙarfin ƙarewar ƙarewa, lokacin wahayi, kwararar kuzari, rabo mai ban sha'awa-zuwa ƙarewa, lokacin dakatarwa, jawo hankali, tallafi. matsa lamba, da expiratory jawo hankali da dai sauransu.
Ƙararrawa - Don gano matsaloli a cikin na'urar iska da canje-canje a cikin majiyyaci, ƙararrawa don ƙarar ruwa da ƙarar minti, matsa lamba mafi girma, mitar numfashi, FiO2, da apnea suna samuwa.
Kwatancen ɓangaren asali na injin iska da HFNC
Kwatancen fasali tsakanin Ventilator da HFNC
Kwatancen fasalin HFNC da Ventilator
Samun iska vs HFNC - Fa'idodi da Hatsari
Samun iska na iya zama mai cin zali ko mara lalacewa.Idan akwai iska mai cutarwa ana shigar da bututu ta baki zuwa huhu don taimakawa wajen samun iska.Likitoci suna so su guje wa yin amfani da intubation gwargwadon iko saboda yuwuwar illar illa ga majiyyaci da wahalar sarrafa su.
Intubation yayin da ba mai tsanani a kanta ba, na iya haifar da
Raunin huhu, trachea ko makogwaro da dai sauransu da/ko
Ana iya samun haɗarin haɓakar ruwa,
Buri ko
Ciwon huhu.
Samun iska mara lalacewa
Samun iska mara lalacewa shine zaɓin da aka fi so gwargwadon yiwuwa.NIV tana ba da taimako na iskar da ba zato ba tsammani ta hanyar amfani da matsi mai kyau a cikin huhu a waje, ta hanyar abin rufe fuska da aka saba amfani da shi da ke da alaƙa da tsarin humidification, mai zafi mai zafi ko na'urar musayar zafi da danshi, da na'urar iska.Yanayin da aka fi amfani da shi ya haɗu da tallafin matsa lamba (PS) samun iska tare da matsi na ƙarshe na ƙarshe (PEEP), ko kawai a yi amfani da matsi mai kyau na iska (CPAP).Taimakon matsin lamba yana canzawa dangane da ko majiyyaci yana numfashi a ciki ko waje da ƙoƙarin numfashinsu.
NIV yana inganta musayar iskar gas kuma yana rage ƙoƙari mai ban sha'awa ta hanyar matsi mai kyau.Ana kiran shi "marasa cin zarafi" saboda ana isar da shi ba tare da wani intubation ba.NIV na iya haifar da babban ɗigon ruwa da aka inganta ta hanyar tallafin matsin lamba kuma hakan na iya haifar da rauni na huhu da ya kasance a baya.
Abubuwan da aka bayar na HFNC
Sauran fa'idar isar da iskar oxygen mai girma ta hanyar cannula na hanci shine ci gaba da fitar da matattun sararin samaniyar hanyar iska ta mafi kyawun izinin CO2.Wannan yana rage aikin numfashi ga mai haƙuri kuma yana inganta oxygenation.Bugu da ƙari, babban maganin oxygen yana tabbatar da babban FiO2.HFNC yana ba da ta'aziyya mai kyau na haƙuri ta hanyar iskar iskar gas mai zafi da ƙaƙƙarfan da ake bayarwa ta hanyar hanci a tsayayyen ƙima.Matsakaicin yawan kwararar iskar gas a cikin tsarin HFNC yana haifar da matsi masu canzawa a cikin hanyoyin iska gwargwadon ƙoƙarin numfashin mara lafiya.Idan aka kwatanta da na al'ada (Low Flow) maganin iskar oxygen ko iskar da ba ta da iska, amfani da iskar iskar oxygen mai girma na iya rage buƙatar intubation.
Fa'idodin HFNC
Dabarun jiyya ga majiyyaci tare da matsanancin yanayin numfashi suna nufin samar da isasshen iskar oxygen.A lokaci guda yana da mahimmanci don adanawa ko ƙarfafa aikin huhu na majiyyaci ba tare da takura tsokoki na numfashi ba.
Don haka ana iya ɗaukar HFOT azaman dabarun layin farko na iskar oxygen a cikin waɗannan marasa lafiya.Koyaya, don guje wa kowane lahani saboda jinkirin samun iska / intubation, kulawa akai-akai yana da mahimmanci.
Takaitaccen fa'idodi da kasada na HFNC vs Ventilation
Fa'idodi vs haɗari don injin iska da HFNC
Amfani da HFNC da na'urorin hura iska don maganin COVID
Kusan kashi 15% na shari'o'in COVID19 an kiyasta suna buƙatar maganin oxygen kuma ƙasa da kashi 1/3 na su na iya matsawa zuwa samun iska.Kamar yadda aka ambata a baya masu ba da kulawa mai mahimmanci suna guje wa intubation gwargwadon iko.Ana ɗaukar maganin iskar oxygen a layin farko na tallafin numfashi don lokuta na hypoxia.Don haka bukatar HFNC ta haura a cikin 'yan watannin nan.Shahararrun samfuran HFNC a kasuwa sune Fisher & Paykel, Hamilton, Resmed, BMC da sauransu.
Lokacin aikawa: Fabrairu-03-2022