老顽童家用制氧机-推动氧疗-欧美译文系列十一

 
                
                  
老顽童家用制氧机氧疗团队，研究欧美最新氧疗科技、临床应用效果，更加注重家庭氧疗的方向、方法。通过翻译解读大量文章，希望站在氧疗科学的前沿。同时也把这些文章呈现给大家，共同分享。
家庭氧疗的适应症和急救
文章来源：手术百科全书，美国
定义
氧气可以归类为一个元素、一种气体、甚至一种药物。氧气疗法的氧浓度大于空气，用于治疗或预防血氧不足(没有足够的血液氧气)。氧气机分为固定式、非固定式、便携式。实施起来可以由鼻插管、氧气面罩、吸氧空间完成（高压氧疗法需要让病人进入密闭的高压氧舱）。
目的
    身体不断吸收氧气，释放二氧化碳。如果这个过程是不充分的（疾病、污染），血液中的氧含量降低，人们可能需要补充氧气。氧气疗法是治疗呼吸道疾病的关键。因为疾病或是受伤，导致身体组织氧饱和水平太低，吸氧的目的是为了提高身体组织的氧饱和度。吸氧增加血液中氧气的含量，减少心脏的额外工作，缓解呼吸急促。氧气疗法经常被要求在家里实施，同时也能起到紧急情况救治的作用。
    氧气疗法用于一般治疗，包括：
1.血氧不足
2.严重的呼吸窘迫(例如急性哮喘和肺炎)
3.严重的创伤
4.慢性阻塞性肺疾病(COPD、包括慢性支气管炎、肺气肿和慢性哮喘)
5.肺动脉高压
6.肺心病
7.急性心肌梗死(心脏病发作)
8.短期治疗，例如麻醉后复苏
氧气也可以用于治疗慢性肺病患者。
高压氧疗法用于治疗以下病症：
1.气性坏疽
2.减压病
3.空气栓塞
4.烟雾吸入
5.一氧化碳中毒
    氦氧疗法可以治疗大脑缺氧，也可用于严重的气道阻塞患者。氦气和氧气的结合，称为氦氧混合气，降低了气体的密度，可以降低患者呼吸时的力度，改善气道阻塞。这种类型的治疗，可以在紧急情况下使用，用于严重哮喘的紧急情况。
描述
    氧输送(不同于呼吸机和高压氧舱)
    医院里每个病人的床头，墙壁上有一个出气口，从中心氧气源头，通过管道设施送氧，提供氧气给患者。一个流量计连接了电源插座，有调节阀调节氧流量，附属装置可以给氧气提供水分。在家里，氧气通常是一个罐或是一个空气压缩机。无论是在家里或者医院里，病人都是通过塑料呼吸管呼吸氧气。
    病人吸氧最常见的方式是通过鼻插管或氧气面罩。选择鼻插管是因为它是耐受性良好，不干扰病人的沟通能力，可以吃可以喝。吸入氧气的浓度取决于规定的氧流量和每分钟的通气量。
    另一个氧气疗法需要经过气管，将一个小软导管插入气管，或是通过手术插入气管。这种方法氧气绕过了嘴、鼻子、喉咙，需要添加增湿器，增湿器的流量1升/每分钟或以上。其它氧气输送方法包括氧气帐篷和专门针对婴儿的氧输送系统。
 
                
                              
氧气输送系统的种类
氧气输送系统的类型包括：
压缩氧—气体存储在一个氧气瓶内。流量计和调节阀是附加的，可以调整氧气流。氧气瓶大小不同，从大到小，也包含便携式氧气瓶。氧气瓶供氧不要求连续、不间断，(例如只需要在活动时吸氧)。
    液氧存储在一个大的固定的容器内。出门时便携式液氧储气罐是可用的，可以从固定的容器里填充。液氧的温度很低，遇热时，液态氧变成气体氧输送给病人。
    氧气机大约一个箱子的大小。氧气机从房间里提取一些空气，将氧气分离出来，通过鼻插管输送给病人。机器内部有一个圆柱体的氧气瓶，如果发生电源故障，作为氧气备份提供给患者使用，可移动满足外出旅行。这个系统通常是患者需要不间断补充氧气，或睡觉时必须使用它。
准备
    患者需要氧气疗法，除了在紧急情况下使用。也是为了缓解氧饱和度不足，诊断血氧不足通过血液气体测量、脉搏血氧、或临床观察。医生将规定病人所需的氧气的具体数量。一些病人需要补充氧气一天24小时，而其他人可能只需要在运动或睡眠时氧疗。
吸氧不会上瘾，按照规定使用时没有副作用。如果出现以下症状，应当通知医生或叫救护车。
1.经常头痛
2.焦虑
3.青紫的嘴唇或指甲
4.嗜睡
5.精神混乱
6.情绪不安
7.呼吸困难，呼吸浅、慢，呼吸不规则
正常的结果
对于病人来说一个正常的结果是，通过脉搏血氧定量法，血液气体测试和临床观察，证明身体足够的氧合。氧合不足的症状和体征，包括黄萎病、嗜睡、困惑、不安、焦虑、呼吸慢、呼吸浅、呼吸困难、呼吸不规则。阻塞性气道疾病患者可能出现“吞气症”(空气饥饿)，他们努力的将空气吸入肺部。吸入一氧化碳的情况下，氧饱和度可以虚假地升高。
参考文章：
Branson, Richard, et al. Respiratory Care Equipment 2nd. ed. Philadelphia: Lippincott Williams and Wilkins Publishers, 1999.
Hyatt, Robert E., Paul D. Scanlon, Masao Nakamura,. Interpretation of Pulmonary Function Tests: A Practical Guide, 2nd ed. Philadelphia: Lippincott Williams and Wilkins Publishers, 2003.
Wilkins, Robert, et al. Clinical Assessment in Respiratory Care, 2nd ed. St. Louis: Mosby, 2000.
Wilkins, Robert, et al. Egan's Fundamentals of Respiratory Care, 8th ed. St. Louis: Mosby, 2003.
Yutsis, Pavel I. Oxygen to the Rescue: Oxygen Therapies and How They Help Overcome Disease, Promote Repair, and Improve Overall Function. Basic Health Publications, Inc., 2003.
英文原文
Oxygen therapy
Definition
Oxygen may be classified as an element, a gas, and a drug. Oxygen therapy is the administration of oxygen at concentrations greater than that in room air to treat or prevent hypoxemia (not enough oxygen in the blood). Oxygen delivery systems are classified as stationary, portable, or ambulatory. Oxygen can be administered by nasal cannula, mask, and tent. Hyperbaric oxygen therapy involves placing the patient in an airtight chamber with oxygen under pressure.
Purpose
The body is constantly taking in oxygen and releasing carbon dioxide. If this process is inadequate, oxygen levels in the blood decrease, and the patient may need supplemental oxygen. Oxygen therapy is a key treatment in respiratory care. The purpose is to increase oxygen saturation in tissues where the saturation levels are too low due to illness or injury. Breathing prescribed oxygen increases the amount of oxygen in the blood, reduces the extra work of the heart, and decreases shortness of breath. Oxygen therapy is frequently ordered in the home care setting, as well as in acute (urgent) care facilities.
Some of the conditions oxygen therapy is used to treat include:
• documented hypoxemia
• severe respiratory distress (e.g., acute asthma or pneumonia)
• severe trauma
• chronic obstructive pulmonary disease (COPD, including chronic bronchitis, emphysema, and chronic asthma)
• pulmonary hypertension
• cor pulmonale
• acute myocardial infarction (heart attack)
• short-term therapy, such as post-anesthesia recovery
Oxygen may also be used to treat chronic lung disease patients during exercise .
Hyperbaric oxygen therapy is used to treat the following conditions:
• gas gangrene
• decompression sickness
• air embolism
• smoke inhalation
• carbon monoxide poisoning
• cerebral hypoxic event
Helium-oxygen therapy is a treatment that may be used for patients with severe airway obstruction. The combination of helium and oxygen, known as heliox, reduces the density of the delivered gas, and has been shown to reduce the effort of breathing and improve ventilation when an airway obstruction is present. This type of treatment may be used in an emergency room for patients with acute, severe asthma.
Description
Oxygen delivery (other than mechanical ventilators and hyperbaric chambers)
In the hospital, oxygen is supplied to each patient room via an outlet in the wall. Oxygen is delivered from a central source through a pipeline in the facility. A flow meter attached to the wall outlet accesses the oxygen. A valve regulates the oxygen flow, and attachments may be connected to provide moisture. In the home, the oxygen source is usually a canister or air compressor. Whether in home or hospital, plastic tubing connects the oxygen source to the patient.
Oxygen is most commonly delivered to the patient via a nasal cannula or mask attached to the tubing. The nasal cannula is usually the delivery device of choice since it is well tolerated and doesn't interfere with the patient's ability to communicate, eat, or drink. The concentration of oxygen inhaled depends upon the prescribed flow rate and the ventilatory minute volume (MV).
Another delivery option is transtracheal oxygen therapy, which involves a small flexible catheter inserted in the trachea or windpipe through a tracheostomy tube. In this method, the oxygen bypasses the mouth, nose, and throat, and a humidifier is required at flow rates of 1 liter (2.1 pt) per minute and above. Other oxygen delivery methods include tents and specialized infant oxygen delivery systems.
TYPES OF OXYGEN DELIVERY SYSTEMS.
The types of oxygen delivery systems include:
• Compressed oxygen—oxygen that is stored as a gas in a tank. A flow meter and regulator are attached to the oxygen tank to adjust oxygen flow. Tanks vary in size from very large to smaller, portable tanks. This system is generally prescribed when oxygen is not needed constantly (e.g., when it is only needed when performing physical activity).
• Liquid oxygen—oxygen that is stored in a large stationary tank that stays in the home. A portable tank is available that can be filled from the stationary tank for trips outside the home. Oxygen is liquid at very cold temperatures. When warmed, liquid oxygen changes to a gas for delivery to the patient.
• Oxygen concentrator—electric oxygen delivery system approximately the size of a large suitcase. The concentrator extracts some of the air from the room, separates the oxygen, and delivers it to the patient via a nasal cannula. A cylinder of oxygen is provided as a backup in the event of a power failure, and a portable tank is available for trips outside the home. This system is generally prescribed for patients who require constant supplemental oxygen or who must use it when sleeping.
Preparation
A physician's order is required for oxygen therapy, except in emergency use. The need for supplemental oxygen is determined by inadequate oxygen saturation, indicated in blood gas measurements, pulse oximetry, or clinical observations. The physician will prescribe the specific amount of oxygen needed by the patient. Some patients require supplemental oxygen 24 hours a day, while others may only need treatments during exercise or sleep.
Risks
Oxygen is not addictive and causes no side effects when used as prescribed. A physician should be notified and emergency services may be required if the following symptoms develop:
• frequent headaches
• anxiety
• cyanotic (blue) lips or fingernails
• drowsiness
• confusion
• restlessness
• slow, shallow, difficult, or irregular breathing
Normal results
A normal result is a patient that demonstrates adequate oxygenation through pulse oximetry, blood gas tests, and clinical observation. Signs and symptoms of inadequate oxygenation include cyanosis, drowsiness, confusion, restlessness, anxiety, or slow, shallow, difficult, or irregular breathing. Patients with obstructive airway disease may exhibit "aerophagia" (air hunger) as they work to pull air into the lungs. In cases of carbon monoxide inhalation, the oxygen saturation can be falsely elevated.
Resources
Branson, Richard, et al. Respiratory Care Equipment 2nd. ed. Philadelphia: Lippincott Williams and Wilkins Publishers, 1999.
Hyatt, Robert E., Paul D. Scanlon, Masao Nakamura,. Interpretation of Pulmonary Function Tests: A Practical Guide, 2nd ed. Philadelphia: Lippincott Williams and Wilkins Publishers, 2003.
Wilkins, Robert, et al. Clinical Assessment in Respiratory Care, 2nd ed. St. Louis: Mosby, 2000.
Wilkins, Robert, et al. Egan's Fundamentals of Respiratory Care, 8th ed. St. Louis: Mosby, 2003.
Yutsis, Pavel I. Oxygen to the Rescue: Oxygen Therapies and How They Help Overcome Disease, Promote Repair, and Improve Overall Function. Basic Health Publications, Inc., 2003.