Tom qab mob hlwb (xws li mob hlwb raug mob, mob stroke, hypoxic-ischemic encephalopathy, thiab lwm yam), cov teeb meem tseem ceeb ntawm cov kab mob feem ntau tshwm sim nyob ib puag ncig "hypoxia" thiab "kev kho mob tsis zoo". Raws li ib qho tshwj xeeb ntawm kev kho cov pa oxygen, kev kho mob hyperbaric oxygen chamber ua rau lub cev cov ntaub so ntswg kom tau txais cov pa oxygen txaus los ntawm cov neeg mob nqus cov pa ntshiab lossis siab - concentration oxygen hauv ib puag ncig saum huab cua. Yog li, nws plays ntau lub luag haujlwm tseem ceeb hauv cov txheej txheem kho ntawm lub hlwb raug mob. Cov txheej txheem tshwj xeeb thiab cov teebmeem tuaj yeem piav qhia hauv cov hauv qab no.
一,Kev kho sai ntawm lub paj hlwb hypoxia thiab nteg lub hauv paus rau kev kho mob hlwb raug mob.
Lub hlwb yog lub cev uas muaj cov pa oxygen ntau tshaj plaws hauv tib neeg lub cev, suav txog kwv yees li 20% -30% ntawm tag nrho cov pa oxygen ntawm tag nrho lub cev. Txawm li cas los xij, cov ntaub so ntswg hauv hlwb yuav luag tsis muaj oxygen cia. Thaum raug mob (xws li vascular occlusion los ntawm cerebral infarction, cov ntshav ntws hauv zos cuam tshuam los ntawm kev puas hlwb raug mob), nws yog qhov ua rau ischemia thiab hypoxia. Hypoxia rau ntau tshaj 4-6 feeb yuav ua rau irreversible puas rau paj hlwb. Lub ntsiab kom zoo dua ntawm hyperbaric oxygen chambers yog ua txhaum los ntawm qhov kev txwv ntawm kev sib cais ntawm cov pa oxygen nyob rau hauv ib txwm siab thiab ua kom cov pa oxygen hauv cov ntshav thiab cov ntaub so ntswg:
Ua kom ntshav Oxygen Ib Feem Siab Siab thiab Oxygen Saturation: Nyob rau hauv ib puag ncig hyperbaric ntawm 0.2-0.3MPa, arterial ntshav oxygen ib nrab siab ntawm tib neeg lub cev tuaj yeem nce los ntawm 13.3kPa nyob rau hauv ib txwm siab mus rau 100-200kPa. Cov ntsiab lus ntawm lub cev yaj cov pa oxygen hauv cov ntshav yog 10-20 npaug siab dua li qhov nqus pa oxygen nyob rau hauv ib txwm muaj siab. Txawm tias nyob rau hauv cov cheeb tsam uas muaj cerebrovascular occlusion thiab tsis txaus cov ntshav perfusion, yaj oxygen tuaj yeem nkag mus rau hauv hypoxic hlwb cov ntaub so ntswg los ntawm diffusion, sai sai txo lub xeev hypoxic ntawm paj hlwb, thiab tiv thaiv kom tsis txhob muaj kev puas tsuaj ntxiv.
Restoring lub Function ntawm Ischemic Penumbra: Tom qab mob stroke lossis mob hlwb raug mob, muaj "ischemic penumbra" nyob ib ncig ntawm thaj chaw raug mob - cov paj hlwb ntawm no tau ua haujlwm tsis zoo tab sis tsis yog necrotic kiag li. Hyperbaric oxygen tuaj yeem txhim kho cov pa oxygen hauv thaj chaw no, muab lub zog txaus rau kev kho cov paj hlwb, txhawb kev rov ua haujlwm ntawm cov paj hlwb hauv penumbra, yog li txo qhov kev mob ntawm qhov txhab thiab txo qhov ua tau ntawm sequelae.
II. Regulating Pathological Microenvironment thiab Alleviating Secondary Injury
Tom qab lub hlwb raug mob, ntxiv rau thawj qhov kev raug mob hypoxic, cov tshuaj tiv thaiv kab mob thib ob (xws li cerebral edema, inflammatory teb, oxidative stress, thiab lwm yam) yuav tshwm sim, uas yuav ua rau lub hlwb raug mob ntxiv. Hyperbaric oxygen chambers tuaj yeem cuam tshuam kev loj hlob ntawm kev raug mob thib ob los ntawm kev tswj cov kab mob microenvironment ntawm qhov chaw raug mob:
Alleviating Cerebral Edema thiab Intracranial Siab: Hypoxia tuaj yeem ua rau cerebrovascular dilation thiab nce vascular permeability, uas ua rau cerebral edema thiab nce intracranial siab. Nyob rau hauv qhov kev pom zoo ntawm kev ua kom cov pa oxygen, hyperbaric oxygen tuaj yeem ua rau cov hlab ntsha hauv hlwb, txo cov ntshav hauv hlwb, thiab tib lub sij hawm txhawb nqa cov dej ntau dhau hauv cov ntaub so ntswg hauv hlwb, yog li txo qis cerebral edema, txo intracranial siab, thiab relieving compression ntawm ib puag ncig cov paj hlwb.
Inhibiting Inflammatory Response thiab Oxidative Stress: Tom qab lub hlwb raug mob, lub cev lub cev tiv thaiv kab mob yog qhib, tsim ib tug loj tus naj npawb ntawm inflammatory yam (xws li qog necrosis factor, interleukin, thiab lwm yam) thiab reactive oxygen dawb radicals, uas ua rau ib tug "secondary tshuab" rau paj hlwb. Hyperbaric oxygen tuaj yeem cuam tshuam kev nkag mus ntawm cov hlwb inflammatory (xws li neutrophils) thiab tso tawm ntawm cov kab mob inflammatory, thiab tib lub sij hawm txhim khu kev ua haujlwm ntawm antioxidant enzymes xws li superoxide dismutase, tshem tawm cov dawb radicals ntau dhau, txo oxidative kev nyuaj siab puas tsuaj, thiab tsim ib qho chaw zoo rau kev kho paj hlwb.
III. Txhawb kev kho paj hlwb thiab kev ua haujlwm rov tsim kho
Raws li kev kho hypoxia thiab txo qis kev raug mob, hyperbaric oxygen chambers tseem tuaj yeem txhawb kev kho cov paj hlwb puas thiab rov tsim kho cov paj hlwb los ntawm ntau txoj hauv kev, uas yog qhov txuas tseem ceeb hauv kev txhim kho cov neeg mob:
Stimulating Nerve Cell Regeneration thiab Synapse Tsim: Hyperbaric oxygen tuaj yeem ua kom cov pa oxygen mus rau cov ntaub so ntswg ntawm lub hlwb, muab lub zog txaus thiab kev noj zaub mov zoo rau kev loj hlob thiab kev sib txawv ntawm cov kab mob neural qia hlwb, thiab txhawb kev hloov pauv ntawm neural qia hlwb rau hauv cov paj hlwb paub tab. Nyob rau tib lub sijhawm, cov pa oxygen txaus kuj tseem tuaj yeem txhawb kev tsim kho ntawm cov hlab ntsha puas tsuaj (xws li axon regeneration) thiab kho cov synapses, txhim kho cov teeb liab sib kis ntawm cov paj hlwb, thiab pab kho cov hlab ntsha puas tsuaj (xws li lub cev muaj zog, kev ua haujlwm ntawm cov lus, kev txawj ntse, thiab lwm yam).
Txhim kho Cerebral Microcirculation thiab Tissue Metabolism: Hyperbaric oxygen tuaj yeem txhawb nqa lub neovascularization ntawm cov hlab ntsha hauv hlwb thiab tsim kom muaj kev sib koom ua ke, txhim kho cov ntshav perfusion hauv qhov raug mob, thiab muab cov khoom noj muaj txiaj ntsig zoo (xws li qabzib) rau cov ntaub so ntswg hlwb. Nyob rau tib lub sijhawm, qhov nce hauv cov pa oxygen tuaj yeem ua rau muaj kev ua haujlwm mitochondrial, txhim kho cov metabolism hauv cell, ua kom cov ntaub so ntswg puas thiab tshem tawm cov tshuaj necrotic, thiab txhawb kev rov ua haujlwm ntawm lub hlwb.
IV. Siv tau Scenarios thiab ceev faj
Hyperbaric oxygen chamber kev kho mob tsis haum rau txhua tus neeg mob uas raug mob lub hlwb, thiab nws cov kev ua tau zoo kuj tseem cuam tshuam nrog lub sijhawm kho thiab hom kev raug mob. Feem ntau hais lus, kev kho mob tau ua thaum lub sijhawm "kub kho mob" tom qab raug mob hlwb (feem ntau hauv 1-3 lub hlis tom qab raug mob) zoo dua. Nws muaj feem xyuam rau cov xwm txheej xws li coma lossis cuam tshuam ntawm kev nco qab tom qab raug mob lub hlwb, mob ischemic stroke (tom qab tsis suav nrog contraindications), hypoxic-ischemic encephalopathy (xws li lub hlwb raug mob los ntawm neonatal asphyxia, poob dej), thiab kev txawj ntse lossis lub cev muaj zog tom qab lub hlwb raug mob.
Txawm li cas los xij, nws yuav tsum tau muab sau tseg tias kev kho mob hyperbaric oxygen muaj qee yam contraindications, xws li tsis kho pneumothorax, mediastinal emphysema, mob hnyav emphysema, mob intracranial hemorrhage (tsis tswj), thiab lwm yam. Cov neeg mob yuav tsum tau soj ntsuam los ntawm kws kho mob los txiav txim seb lawv puas tsim nyog rau kev kho mob. Nyob rau tib lub sijhawm, thaum lub sijhawm kho, cov lus qhia kho mob yuav tsum tau ua raws li nruj me ntsis, thiab cov kev txwv xws li kev kho lub siab thiab lub sijhawm nqus pa oxygen yuav tsum tau tswj kom tsis txhob muaj kev phiv xws li oxygen lom thiab barotrauma.
V. Summary
Tus nqi tseem ceeb ntawm hyperbaric oxygen chamber nyob rau hauv kev kho mob ntawm lub hlwb raug mob yog nyob rau hauv "siv oxygen raws li ib tug kho neeg sawv cev". Los ntawm cov pa oxygen zoo nyob rau hauv ib puag ncig hyperbaric, nws ua rau nws cov teebmeem los ntawm peb yam: kho hypoxia, txo qis kev raug mob, thiab txhawb kev kho cov hlab ntsha, muab ib qho tseem ceeb pab txhais tau tias rau kev kho mob ntawm cov neeg mob hlwb raug mob. Txawm li cas los xij, nws yuav tsum tau hais meej meej tias kev kho mob hyperbaric oxygen tsis yog "panacea". Nws yuav tsum tau ua ke nrog lwm txoj kev kho mob xws li kev kho tshuaj, kev cob qhia kev kho mob, thiab kev phais phais kom tsim tau ib txoj kev kho mob, kom ua kom tus neeg mob txoj kev kho mob zoo tshaj plaws thiab pab tus neeg mob kho lawv lub neej zoo.