Mt s ch s v Oxy mu ng mch c bn

FiO2 (fraction of inspired oxygen) FiO2 l thut ng y hc ch nng oxy trong hn hp kh th vo (fraction of inspired oxygen).

Ch nh:

Th thm oxy tc liu php oxy (tng FiO2) c ch nh trong nhiu bnh v mt s bnh nhn (nht l sau m) gip phng v iu tr thiu oxy mu (do tng p lc ring phn oxy trong ph nang lm tng tc khuych tn oxy t vo mao mch phi). Th thm oxy khng iu tr c cn nguyn m ch gip ci thin mc oxy trong mu ng mch. Mt s nghin cu gn y thy th oxy lm gim t l nhim trng vt m v gim nn, bun nn sau m. iu chnh FiO2: FiO2 thay i t 0 (0%) n 1 (100%). FiO2 trong khng kh l 0.21 (21%). trn cao, FiO2 vn l 0.21 nhng v p lc kh quyn gim nn p lc ring phn oxy (FiO2 p lc kh quyn) cng gim, dn n thiu oxy mu. FiO2 trong my th c t v o chnh xc bng b vi x l. Trong liu php oxy, bnh nhn t th nn ht c oxy ln kh tri, dn n FiO2 thay i qua cc dng c th oxy v lu lng oxy: Cc nguyn tc dng oxy liu php: + Tr khi suy h hp nng, lun bt u dng h thng n gin nht. + Cc mt n, nht l mt n c ti d tr oxy, ch c dng bnh nhn rt thiu oxy mu nhng t th tt. + Kim sot hiu qu th oxy bng o bo ho oxy mu ngoi vi (SpO2) hoc p lc ring phn oxy mu ng mch (PaO2). iu chnh lu lng oxy sao cho SpO2 94% hoc PaO2 70 mmHg. + Theo di hiu qu v s dung np oxy liuk php da trn tnh trng tri gic, nhp tim, nhp th v kh mu. + bnh nhn c bnh ph qun phi tc nghn mn tnh hoc hen, lun bt u bng lu lng oxy thp 1-2 lt/pht phng u thn v toan h hp do oxy c ch th. + Khng dng oxy lm ngun p lc to kh dung. + Kh th vo c th khng cn lm m v m nu dng < 6 lt/pht ngi ln nhng lun cn lm m v m tr em.

+ Cc b phn kh dung v lm m l ngun gy nhim trng phi nng nn cn dng mt ln hoc c tit trng bo m. Cc bin chng ca oxy: + Xp phi do hp thu oxy trong ph nang + Chy n + Gim thng kh gy u thn + Gim hot ng lm sch ca nim mc nhy ng th khi tip xc lu vi FiO2 > 50% (gim hotongj 40% khi tip xc 9 gi vi FiO2 70%). + Vim kh ph qun (au sau xng c, ho, th nhanh) khi tip xc > 12 gi vi FiO*2* cao. + Lon sn ph qun phi v x ho vng mc tr s sinh + Ri lon chc nng thn kinh trung ng khi th oxy cao p + Ng c oxy phi do x phi k lm thiu oxy mu nng thm khi th FiO2 > 50% ko di trn 48 gi. SpO2 = Saturation of Peripheral Oxygen: >90% (94-100%) T l HbO2/ (HbO2+Hb) gi l bo ha oxy trong mu SpO2, ni cch khc l t l phn trm hemoglobine ca mu kt hp vi Oxy.

o bo ho oxy mu da vo nguyn l l hemoglobin gn oxy (oxyhemoglobin: HbO2) v hemoglobin kh (deoxyhemoglobin) khc nhau v s hp th cc di bc sng hng ngoi. Do vy, thay i v hp th nh sng trong cc nhp p ca ng mch l c s ca o bo ho oxy. T l hp th cc di bc sng hng ngoi khc nhau c mt b vi x l phn tch cho mc bo ho oxy (SpO2) v nhp p ca ng mch c xc nh bng o thay i th tch mu trong lng mch. SpO2 c mi tng quan cht ch vi SaO2 (bo ho oxy o bng xt nghim kh mu ng mch). ng biu din s phn ly oxy-hemoglobin tc mi tng quan gia SpO2 v p lc ring phn oxy mu ng mch (PaO2) c dng xch ma. SpO2 < 90% tng ng vi PaO2 < 65 mmHg nhng SpO2 99-100% th khng r PaO2 l bao nhiu trong khong 100-500 mmHg.

PaO2 (pressure of arterial oxygen) :phn p oxy mu ng mch: - Bnh thng ngi tr, ngi trng thnh PaO2 = 85 100mmHg, chim 95 98% tng lng oxy c trong mu. - PaO2 tng: khi p lc ring phn O2 mu ph nang tng.

- PaO2 gim: do gim thng kh, gim khuch tn v mt cn bng t l Va/Q (thng kh/lu lng mu). SaO2(arterial oxygen saturation): bo ha oxy chc nng (functional oxygen saturation): - SaO2 l dng kt hp ca oxy vi hemoglobin. - Bnh thng: SaO2 = 95 97% (95 99% nu pH = 7,38 7,42; PaO2= 97%, PaCO2 = 40 mmHg). - Khi SaO2 gim, nh hn 50% th i lc gn ca oxy vi Hb gim mnh. > Tm li FiO2 (fraction of inspired oxygen): nng oxy trong hn hp kh th vo (quan tm n vic th Oxy bao nhiu cho ph hp) (0-100%) SpO2(Saturation of Peripheral Oxygen): (94% 100%) bo ha Oxy mu ngoi bin (mao mch) (c o gin tip bng mch p) c mi lin quan vi SaO2, thng c s dng tuy nhin trong nhng trng hp BN shock, Hb thp, HA tm thu thp , SHH nng th SpO2 t c gi tr, cn lm kh mu ng mch SaO2(arterial oxygen saturation) (>94%) : bo ha Oxy trong mu ng mch (o bng kh mu ng mch) PaO2 (pressure of arterial oxygen) (85-100 mmHg): p lc ring phn Oxy mu ng mch, khc vi SpO2 v SaO2 l PaO2: cho bit lng Oxy c trong mu (to ra 1 p lc) (ha tan trong mu kh nng ly Oxy t mi trng ca h h hp) cn 2 thng s kia cho bit v Oxy gn vi Hb (bo ha), tc l i khi p lc Oxy trong mu ln nhng khng phi lc no cng gn cvi Hb chng hn. po2 is hemoglobin saturation, pao2 is plasma saturation Edit: SpO2 is the Saturation (peripheral) of Haemoglobin with Oxygen, expressed as a percentage ration compared to fully saturated Haemoglobin (Hb). i.e. when the Haemoglobin (the main oxygen carrying component of blood, found in red blood cells) is fully loaded with oxygen, then is it 100% saturated. It is SpO2, because this is normally measured by placing a probe on the finger which shines red light of two different types through the finger, and a calculation is carried out based on how much of each type of light is absorbed, which tells us how much the Hb is loaded up or saturated. PaO2 is the Partial pressure (arterial) of oxygen in the blood. That is, if you took the oxygen gas in all the blood, and put it into a box by itself, what pressure would it exert on the walls. This is normally measured by using a special probe which uses electric currents to determine how much oxygen is actually present in the blood. It is normally expressed in mmHg (millimetres of Mercury), or (more commonly outside the USA) as kPa (kilopascals), which are units of pressure. 1

atmosphere of pressure is roughly 101kPa, which is roughly 760 mmHg or 760 Torr, which is roughly 1 bar. There are more precise values available on the internet for these. Whilst SpO2 and PaO2 are closely related, they do not actually measure the same thing.

Oxygen saturation (SO2) measures the percentage of hemoglobin binding sites in the bloodstream occupied by oxygen. At low partial pressures of oxygen, most hemoglobin is deoxygenated. At around 90% (the value varies according to the clinical context) oxygen saturation increases according to an oxygen-hemoglobin dissociation curve and approaches 100% at partial oxygen pressures of >10 kPa. A pulse oximeter relies on the light absorption characteristics of saturated hemoglobin to give an indication of oxygen saturation. 1. SaO2 (Arterial oxygen saturation) value below 90% causes hypoxemia (which can also be caused by anemia). Hypoxemia due to low SaO2 is indicated by cyanosis. 2. SvO2 (Venous oxygen saturation) is measured to see how much oxygen the body consumes. Under clinical treatment, a SvO2 below 60%, indicates that the body is in lack of oxygen, and ischemic diseases occur. This measurement is often used under treatment with a heart-lung machine (Extra Corporal Circulation), and can give the perfusionist an idea of how much flow the patient needs to stay healthy. 3. StO2 (Tissue oxygen saturation) can be measured by near infrared spectroscopy. Although the measurements are still widely discussed, they give an idea of tissue oxygenation in various conditions. 4. SpO2 (Saturation of Peripheral Oxygen) is an estimation of the oxygen saturation level usually measured with a pulse oximeter device. It can be calculated with the Pulse oximetry according to the following formula : SpO2 = HbO2/(HbO2 + HbCO2)

SO2 ( bo ha oxy) SO2 c tnh bng phn trm Hb kt hp vi Oxy. Khi p sut ring phn ca Oxy thp, hu ht Hb dng kh Oxy. Do bo ha Oxy khc 90% (gi tr c th giao ng ty trng hp lm sng) v bo ha Oxy tng theo ng cong phn ly Oxy Hb, t c 100% khi p sut ring phn Oxy > 10kPa. My o bo ha Oxy mao mch qua c ch nh c tnh hp th nh sng ca Hb c bo ha. 1. SaO2 ( bo ha Oxy trong mu ng mch) Nu SaO2 < 90% co the la do suy ho hap ha oxy mau (cng c th l do thiu mu). Ha oxy mau do SaO2 thap se gay xanh tm. 2. SvO2 ( bo ha Oxy trong mu tnh mch) Da vo thng s SvO2 de danh gia co bao nhieu oxy da duoc co the su dung. ng dng lm sng: SvO2 < 60% th hin tnh trng thiu Oxy ca c th v thiu mu cc b xy ra. SvO2 thng c dng trong trng hp bnh nhn c s dng my tim phi (tun hon ngoi c th) v c th gip bit c lu lng m bnh nhn cn. 3. StO2 ( bo ha Oxy m c th) StO2 c o bng quang ph hng ngoi. Mc d vic o lng ny cn cn xem xt nhiu hn na nhng n gp phn nh gi tnh trng Oxy m. 4. SpO2 ( bo ha Oxy mao mch) SpO2 c o lng qua thit b o Oxy mao mch (Oxymeter). N c tnh qua cng thc: SpO2 = HbO2/(HbO2 + HbCO2)