Cov pa roj carbon monoxide (CO) lom yog ib hom tshuaj lom neeg mob lom, uas tshwm sim los ntawm kev mob hnyav thiab kev loj hlob sai. Hauv cov xwm txheej hnyav, nws tuaj yeem ua rau coma, ntau lub cev tsis ua haujlwm, thiab txawm tuag. Raws li kev kho mob tseem ceeb rau cov pa roj carbon monoxide lom, hyperbaric oxygen chamber kho, nrog nws cov txheej txheem tshwj xeeb ntawm kev ua, tuaj yeem txhim kho qhov kev ua tiav ntawm kev kho mob thiab txo qhov tshwm sim ntawm sequelae, tuav txoj haujlwm tsis tuaj yeem hloov kho hauv kev kho mob. Cov nram qab no piav qhia ntxaws txog cov txiaj ntsig kho mob ntawm hyperbaric oxygen chamber los ntawm cov yam ntxwv ntawm cov txheej txheem ntawm kev txiav txim, tus nqi kho mob tseem ceeb, thaj tsam ntawm daim ntawv thov thiab kev ceev faj.
I. Core Mechanism of Action: Targeting the Essence of Poisoning kom tshem tawm toxicity sai sai
Lub ntsiab lus ntawm cov pa roj carbon monoxide lom yog tias CO muaj kev sib raug zoo nrog tib neeg hemoglobin (Hb) (txog 240 npaug ntawm cov pa nrog Hb), thiab carboxyhemoglobin (COHb) tsim tom qab khi dissociates qeeb heev (tsuas yog 1/3600 ntawm qhov sib txawv ntawm oxyhemoglobin). Qhov no yuav ua rau Hb poob nws cov pa oxygen- nqa lub peev xwm, ua rau cov ntaub so ntswg hypoxia ntawm lub cev. Tshwj xeeb tshaj yog cov ntaub so ntswg ntawm lub paj hlwb thiab myocardium, uas yog heev rhiab heev rau hypoxia, yuav xub ntsib kev puas tsuaj. Hyperbaric oxygen chamber therapy pab daws cov txheej txheem pathological no los ntawm ob qho kev cuam tshuam ntawm "hyperbaric ib puag ncig + siab-concentration oxygen":
1. Accelerating Dissociation of Carboxyhemoglobin thiab Restoring Oxygen-Kev Ua Haujlwm ntawm hemoglobin
Qhov ib puag ncig cov pa oxygen hyperbaric tuaj yeem ua rau kom muaj zog ntawm lub cev yaj cov pa oxygen hauv cov ntshav (nyob rau hauv ib txwm siab, txog 0.3 mL ntawm oxygen yog yaj hauv 100 mL ntawm cov ntshav, uas tuaj yeem nce mus rau ntau dua 6 mL hauv qab 2.5 ATA hyperbaric oxygen), ua rau muaj kev nce siab ntawm cov ntshav oxygen. Cov ntshav siab oxygen ib nrab siab tuaj yeem sib tw khi rau Hb thiab ua kom nrawm nrawm ntawm COHb. Cov kev tshawb fawb tau pom tias thaum nqus tau pa hauv lub siab ib txwm, ib nrab - lub neej ntawm COHb yog li 4 mus rau 6 teev, thaum nyob rau hauv 2 ATA hyperbaric oxygen ib puag ncig, ib nrab- lub neej tuaj yeem luv rau 20 mus rau 30 feeb, uas tuaj yeem kho cov pa oxygen sai sai - nqa lub peev xwm ntawm Hb thiab txo lub xeev ntawm cov ntaub so ntswg hypoxia.
2. Txhim kho cov nqaij mos Hypoxia thiab thim rov qab kev puas tsuaj
Hyperbaric oxygen tsis tuaj yeem txhim kho cov pa oxygen - nqa lub peev xwm ntawm cov ntshav, tab sis kuj nce qhov sib txawv ntawm cov pa oxygen (nyob rau hauv lub siab ib txwm, qhov diffusion radius ntawm oxygen yog li 30 μm, uas tuaj yeem nce mus rau ntau dua 100 μm hauv qab hyperbaric oxygen), ua kom cov pa nkag mus rau hauv cov ntaub so ntswg ntau dua, tshwj xeeb tshaj yog cov hlwb hlwb thiab myocardial rhiab heev. Cov nyhuv no tuaj yeem kho cov cellular hypoxia sai sai, inhibit cov txheej txheem kev puas tsuaj xws li dawb radical tiam thiab lipid peroxidation los ntawm hypoxia, txo cov kev hloov pauv pathological xws li cerebral edema thiab myocardial puas tsuaj, thiab txo qis kev tuag ntawm cov neeg mob hnyav.
3. inhibiting Inhibitory nyhuv ntawm carbon monoxide rau Cytochrome Oxidase
Ntxiv nrog rau kev khi rau Hb, CO kuj tuaj yeem khi rau cytochrome oxidase hauv hlwb, inhibit oxidative phosphorylation txheej txheem ntawm mitochondria, thiab thaiv lub zog metabolism ntawm cov hlwb. Hyperbaric oxygen tuaj yeem sib tw khi rau cytochrome oxidase los ntawm cov pa oxygen siab ib nrab, txo qhov inhibition ntawm cov enzyme no los ntawm CO, rov ua kom lub zog synthesis ntawm cov hlwb, thiab zam cov cell necrosis vim lub zog qaug zog.
II. Tus nqi kho mob tseem ceeb: Txhim kho kev kho mob thiab txo qhov kev pheej hmoo ntawm Sequelae
1. Txo cov neeg tuag coob heev thiab txhim kho kev kwv yees ntawm cov neeg mob hnyav
Rau cov neeg mob uas muaj cov pa roj carbon monoxide nyob rau nruab nrab mus rau hnyav (nrog cov tsos mob xws li coma, convulsions, dyspnea, thiab hypotension), kev kho mob hyperbaric oxygen tau sai sai kho cov ntaub so ntswg hypoxia, tiv thaiv kev loj hlob ntawm tus kab mob mus rau ntau lub cev tsis ua hauj lwm, thiab txo cov neeg tuag. Cov ntaub ntawv kho mob qhia tau hais tias yog tias cov neeg mob uas muaj mob me me mus rau hnyav heev tau txais kev kho mob hyperbaric oxygen nyob rau hauv 6 teev tom qab tshuaj lom, cov neeg tuag tuaj yeem txo qis dua 50%.
2. Txo qhov tshwm sim ntawm qeeb Encephalopathy
Kev ncua encephalopathy tom qab cov pa roj carbon monoxide lom yog feem ntau sequela, xa mus rau qhov rov tshwm sim ntawm cov tsos mob ntawm kev puas hlwb xws li dementia, Parkinson's syndrome, hemiplegia, thiab kev puas siab puas ntsws hauv cov neeg mob tom qab tshem tawm cov tsos mob lom (lub sij hawm latent, feem ntau 2 txog 60 hnub). Nws lub ntsiab inducement yog cerebrovascular endothelial puas, microcirculatory cuam tshuam thiab demyelination ntawm lub hlwb cov ntaub so ntswg tshwm sim los ntawm mob hypoxia. Hyperbaric oxygen therapy tuaj yeem txo qhov tshwm sim ntawm qeeb encephalopathy los ntawm kev txhim kho cerebral microcirculation, kho cov kab mob cerebrovascular endothelium, thiab inhibiting neuronal apoptosis. Cov kev tshawb fawb tau pom tias tus qauv kev kho mob hyperbaric oxygen tuaj yeem txo qhov tshwm sim ntawm kev ncua encephalopathy kom tsawg dua 5%, thiab muaj qee qhov cuam tshuam rov qab rau cov tsos mob ntawm lub paj hlwb thaum ntxov uas tau tshwm sim.
3. Shortening the Hour of Disease and Improving Rehabilitation Efficiency
Piv nrog rau cov pa pa nqus pa therapy, hyperbaric oxygen tuaj yeem txo cov tsos mob lom (xws li mob taub hau, kiv taub hau, xeev siab, tsis meej pem, thiab lwm yam) sai dua, thiab ua kom lub sijhawm tsis nco qab thiab nyob hauv tsev kho mob ntawm cov neeg mob. Rau cov neeg mob uas muaj mob me me, kev kho mob hyperbaric oxygen tuaj yeem tshem tawm CO hauv lub cev sai sai thiab zam cov tsos mob tshwm sim; rau cov neeg mob uas muaj mob hnyav heev, nws tuaj yeem tau txais lub sijhawm rau kev kho cov hlab ntsha tom qab thiab kev kho lub cev ua haujlwm, thiab txhim kho tag nrho cov kev ua haujlwm zoo.
III. Scope ntawm Daim Ntawv Thov: Npog Txhua Yam Kev Ua Phem Txhaum Cai, Hais Txog Kev Tiv Thaiv Thaum Ntxov
Hyperbaric oxygen chamber therapy yog siv tau rau cov neeg mob uas muaj ntau qib ntawm cov pa roj carbon monoxide lom, tshwj xeeb tshaj yog cov neeg uas muaj cov lus qhia meej hauv qab no:
Cov neeg mob uas muaj tshuaj lom nyob nruab nrab mus rau hnyav: nthuav tawm nrog kev tsis nco qab (coma, somnolence, tsis meej pem), convulsions, dyspnea, arrhythmia, txawv txav ntshav siab thiab lwm yam tsos mob, los yog ntshav COHb concentration ＞ 20%;
Cov neeg mob uas muaj tshuaj lom me me tab sis muaj kev pheej hmoo siab ntau: xws li cov neeg laus, cov menyuam mos thiab cov menyuam yaus, cov poj niam cev xeeb tub (CO tuaj yeem cuam tshuam rau tus menyuam hauv plab, ua rau fetal hypoxia), thiab cov neeg mob uas muaj kab mob hauv qab xws li cardio- kab mob cerebrovascular thiab ntshav qab zib;
Cov neeg mob uas yuav tsum tau tiv thaiv kev ncua sij hawm encephalopathy tom qab tshem tawm cov tsos mob lom lom: tshwj xeeb tshaj yog cov neeg uas tau ntsib kev tsis nco qab, tsis nco qab, qaug zog thiab lwm yam tsos mob tom qab lom;
Cov neeg mob uas muaj cov pa roj carbon monoxide lom muaj teeb meem nrog lwm yam kev raug mob ntawm lub cev (xws li mob ntsws mob, mob raum mob, thiab lwm yam).