Home oxygen therapy for chronic obstructive pulmonary disease, emphasis on reasonable
With the development of China’s economy and the continuous improvement of oxygen supply devices and oxygen inhalation tools, home oxygen therapy has gradually become an important tool in family and community rehabilitation. For patients with moderate or severe COPD combined with hypoxemia, long-term home oxygen therapy can increase the partial pressure of arterial blood oxygen and oxygen saturation, improve the hypoxic state of tissues and organs, prevent the deterioration of pulmonary heart disease, prolong the survival time and improve the quality of life.
So, what should patients receiving oxygen therapy know? What issues should be noted?
A. Blood gas analysis is indispensable Some patients, especially those with chronic obstructive pulmonary disease, are often required to undergo arterial blood gas analysis to measure the partial pressure of arterial blood oxygen and oxygen saturation when they are ready to be discharged home for oxygen therapy, why is this?
As we know, human blood contains oxygen, nitrogen, carbon dioxide and other gases. The amount of these gases in the blood varies and plays different roles for the organism. When suffering from a certain disease, especially when chronic obstructive pulmonary disease causes respiratory distress, the partial pressure of oxygen in the blood decreases, while the partial pressure of carbon dioxide increases. If this change is large, it can endanger the patient’s life. At this time, the partial pressure of oxygen and carbon dioxide in blood can be measured to understand the respiratory function of the patient’s lungs in time for the doctor to take appropriate measures. This test is called a blood gas analysis (arterial blood gas analysis), which measures the partial pressure of oxygen and carbon dioxide from arterial blood.
Arterial partial pressure of oxygen is the pressure generated by the oxygen molecules dissolved in the plasma, and oxygen saturation is the percentage of oxygen bound by hemoglobin, both of which are important indicators of whether the patient is hypoxic or not, and are best measured before oxygen therapy. In a normal adult at normal rest, the partial pressure of arterial oxygen should be 80-100 mmHg, the partial pressure of carbon dioxide is 35-45 mmHg, and the oxygen saturation is 92%-99%, with an average of 96%. The partial pressure of arterial blood oxygen decreases with age. The partial pressure of arterial oxygen in adults of different ages can be calculated according to the following formula.
Arterial partial pressure of oxygen (mmHg) = 102-(0.33*age years). Hypoxemia is defined as a lower than normal arterial partial pressure of oxygen: 60-79 mm Hg for mild hypoxemia, 40-59 mm Hg for moderate hypoxemia, and below 40 mm Hg for severe hypoxemia.
Patients with chronic obstructive pulmonary disease in remission who have had a blood gas analysis should have long-term home oxygen therapy if they have.
(1) Arterial partial pressure of oxygen is less than 55 mmHg or arterial oxygen saturation is less than 88%.
(2) Arterial partial pressure of oxygen is 55-59 mmHg with erythrocytosis, pulmonary hypertension or right heart failure in pulmonary heart disease.
(3) Hypoxemia at night or hypoxemia during exercise.
Second, the correct use is beneficial home for oxygen therapy should be carried out under the correct guidance of medical personnel. At present, some countries and regions have established home oxygen therapy associations, and patients are regularly instructed by medical personnel. To achieve better results, patients should pay attention to the following aspects.
1, before the home oxygen therapy to solve the problem of the source of oxygen. There are three oxygen therapy devices available for patients to choose from.
(1) compressed oxygen cylinders: there are various specifications, the bottle is filled with pure oxygen, equipped with pressure reducer and flow meter.
(2) Oxygen concentrator: It separates oxygen from nitrogen and other inert gases in the air, and the oxygen flow rate is generally within the range of 1-3 l/min. Indoor use is convenient, no need for regular replacement, suitable for long-term oxygen therapy in the family.
(3) Liquid oxygen tank: This tank is mostly a titanium alloy device, light weight (3 kg), easy to carry out, and the oxygen supply time is 6-8 hours. When using the above-mentioned oxygen supply device, we must pay attention to safety, within 2 meters of the oxygen intake is strictly prohibited open fire, such as lighting candles, burning liquefied gas, etc.. Oxygen cylinders need to be fixed properly, to prevent exposure and vibration.
2, the correct grasp of the use of various oxygen tools.
(1) home oxygen therapy commonly used are nasal catheter method and mask method. The nasal catheter method is divided into unilateral and bilateral nasal catheter and nasal plug method.
If you use nasal plugs or nasal catheters to inhale oxygen, you should shut up, if you breathe through your mouth, it will affect the concentration of inhaled oxygen and cause dry mouth and tongue. In addition, the nasal catheter should be checked frequently to see if it is clear and if there is any secretion blockage.
(2) Long-term use of unilateral nasal catheter is more irritating to the nasopharynx and may feel uncomfortable.
If a nasal plug is placed in the anterior nostril to absorb oxygen, the patient will feel more comfortable and light, and it will not affect speech and eating, but the disadvantage is that it is not easy to fix, and it is easy to fall off during sleep.
(3) Bilateral nasal cannula can be inserted into both sides of the nasal vestibule, which is less likely to cause dislodgement and is easily tolerated.
Although the mask oxygenation is effective, it affects the speech and feeding, and the long-term use can also cause facial pressure injury, so it can only be used for a short time.
3.Master oxygen therapy time and oxygen flow.
For patients with chronic obstructive pulmonary disease hypoxemia, in order to obtain better oxygen therapy results, oxygen should be administered for at least 15 hours a day, and the effect is better if oxygen is administered for 24 hours a day. Do not shorten the duration of oxygen intake according to the symptoms. Generally, low-flow oxygen inhalation is advocated, i.e., the oxygen inhalation flow is 0.5-3 l/min. Inhaled oxygen concentration less than 35% is appropriate. The calculation method is: inhalation oxygen concentration (%) = 21 (oxygen concentration in air) + 4*oxygen flow rate (l/min).
It can be adjusted according to the condition under the guidance of medical personnel. In patients with hypoxemia during exercise or sleep, the oxygen flow rate can be increased by 1 liter/min on its usual basis.
4.Master the method of cleaning and disinfecting oxygen inhalation tools.
The nasal cannula and mask are usually washed once a day, usually with household detergent first, then washed with water and dried. The wetting bottle is washed daily with water, and the cold boiled water of the wetting bottle is usually changed once a day. The nasal cannula and wetting bottle is replaced once a week.
5, learn to determine whether there is oxygen airflow.
To determine whether there is oxygen escaping from the nasal cannula, the easiest way is to bend the nasal cannula, and then release it to feel whether there is oxygen entering the nasal cavity. You can also put the opening of the nasal cannula into the cup of water, if there are bubbles overflowing, it means that there is oxygen airflow.
6, the correct use of oxygen flow meter, the correct reading.
Home oxygen therapy patients are required to use the oxygen flow meter to regulate the flow of inhaled oxygen. The flow meter reading should be accurate, the correct method is: if it is a spherical indicator needle, the eye line, the ball center line and the flow meter scale should be in the same horizontal line: if it is a conical indicator needle, the eye line, the upper edge of the cone and the flow meter scale should be in the same horizontal line. This way the read out oxygen flow is the real inhalation oxygen flow.
7. Learn to observe the effect of oxygen inhalation.
If after oxygen inhalation, cyanosis is reduced or disappears, respiration is slowed down and stable, heart rate is slowed down, partial pressure of oxygen and oxygen saturation is increased, it means the oxygen therapy effect is good. On the contrary, if there is impaired consciousness and increased respiratory distress, medical staff should be asked to guide.