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Patient Chapter 7 Hypoxia
Patient Chapter 7 Hypoxia. Hypoxia is a disease such as chronic obstructive pulmonary disease, acute respiratory distress syndrome, severe acute respiratory syndrome (SARS), myocardial infarction, ischemic stroke, shock, cyanide poisoning, CO poisoning, etc. common pathological changes.
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Patient Chapter 7 Hypoxia
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- Outline
hypoxia
concept
Pathological changes that reduce tissue oxygen supply or fail to fully utilize oxygen, leading to abnormal changes in tissue metabolism, function, and morphological structure, are called hypoxia.
Hypoxia is a common pathological change in diseases such as chronic obstructive pulmonary disease, acute respiratory distress syndrome, severe acute respiratory syndrome (SARS), myocardial infarction, ischemic stroke, shock, cyanide poisoning, and CO poisoning.
Commonly used blood oxygen indicators
Blood oxygen partial pressure (PO2)
It is the tension produced by oxygen physically dissolved in the blood, also known as blood sample tension.
The normal partial pressure of arterial oxygen (PaO2) is about 100mmHg. (The level mainly depends on the oxygen partial pressure of the inspired air and the ventilation and diffusion functions of the lungs)
The normal partial pressure of venous oxygen (PvO2) is about 40mmHg. (It reflects the oxygen uptake and utilization status of tissues and cells)
Blood oxygen capacity (CO2max)
It refers to the amount of oxygen bound to hemoglobin in 100 ml of blood outside the body under standard conditions (oxygen partial pressure is 150mmHg, carbon dioxide partial pressure is 40mmHg, and temperature is 38 degrees), that is, the maximum oxygen-carrying capacity of Hb that is fully combined with oxygen.
Normal adult Hb is 15g/dl and blood oxygen capacity is 20ml/dl
Depends on the content of Hb and its ability to combine with oxygen
Blood oxygen content (CO2)
It is the amount of oxygen actually contained in 100ml of blood (including physically dissolved (only 0.3ml/dl, negligible) and chemically combined oxygen)
Normal arterial blood oxygen content (CaO2) is about 19ml/dl, normal venous blood oxygen content (CvO2) is about 14ml/dl The arterial and venous oxygen content difference (CDO2) reflects the oxygen uptake content of the tissue. Normally it is about 5ml/dl.
Depends on blood oxygen partial pressure and blood oxygen volume
Hemoglobin oxygen saturation (SO2)
Blood oxygen saturation, referred to as blood oxygen saturation, refers to the percentage of oxygenated Hb in the blood to the total Hb, which is approximately equal to the ratio of blood oxygen content to blood oxygen capacity.
Normal arterial oxygen saturation (SaO2) is 95-98%, normal venous oxygen saturation (SvO2) is 70-75%
Mainly depends on PO2, (the relationship between the two is an "S" shaped curve, called the oxyhemoglobin dissociation curve, the left is close to the right but not the right) Also related to blood pH, temperature, CO2 partial pressure, and 2,3-bisphosphoglycerate in red blood cells
The affinity between CO2 and oxygen is reflected by P50 (referring to the blood oxygen partial pressure when the hemoglobin oxygen saturation is 50%, normal is 26-27mmHg). A high P50 has a low affinity.
Causes, classification and characteristics of blood oxygen changes of hypoxia
hypotonic hypoxia
Hypoxia is characterized by a decrease in the partial pressure of arterial oxygen and a decrease in blood oxygen content.
reason
Inhaled oxygen partial pressure is too low
External respiratory dysfunction (also known as respiratory hypoxia)
Venous blood shunts into arteries (shunt hypoxia)
Characteristics of blood oxygen changes and mechanism of hypoxia
PaO2 is reduced, CO2max is normal (or increased), CaO2 is reduced, CDO2 is reduced (or normal), SaO2 is reduced (It appears in people born on plateaus that CO2max is increased but CDO2 is normal)
blood hypoxia
Hypoxia caused by a decrease in hemoglobin content or a change in the properties of hemoglobin, which reduces the oxygen-carrying capacity of the blood or makes it difficult for the oxygen bound to hemoglobin to be released
reason
Decreased hemoglobin content
poisoned by carbon monoxide
Methemoglobinemia
Abnormally increased affinity of hemoglobin for oxygen
Characteristics of blood oxygen changes and mechanism of hypoxia
PaO2 is normal, CO2max is reduced (or normal), CaO2 is reduced, CDO2 is reduced, SaO2 is reduced (or normal) (CO2max is normal in carbon monoxide poisoning, and SaO2 is normal in methemoglobin)
circulatory hypoxia
Refers to hypoxia caused by reduced tissue blood flow and reduced tissue oxygen supply. It is also called low blood flow hypoxia or hypodynamic hypoxia.
reason
systemic circulatory disorder
local circulatory disorder
Characteristics of blood oxygen changes and mechanism of hypoxia
PaO2 is normal, CO2max is normal, CaO2 is normal, CDO2 is elevated, SaO2 is normal
organizational hypoxia
When tissue oxygen supply is normal, ATP production is reduced due to tissue and cell oxygen utilization impairment, also known as oxygen utilization impairment hypoxia.
reason
Drug inhibition of mitochondrial oxidative phosphorylation (cyanide poisoning)
Decreased synthesis of respiratory enzymes (vitamin B deficiency patients)
Mitochondrial damage (high temperature, large-dose radiation exposure)
Characteristics of blood oxygen changes and mechanism of hypoxia
PaO2 is normal, CO2max is normal, CaO2 is normal, CDO2 is reduced, SaO2 is normal