"I roto i te rongoā tiaki nui, kei te mau tonu te hypoxemia puku hei āhuatanga haumanu kāore i te tino mōhiotia me ngā pānga kino. Ko te āhuatanga o tēnei āhuatanga he whakahekenga hāora me te kore he dyspnea ōrite (e kiia ana ko te 'hypoxia puku'), ko tēnei whakaaturanga taupatupatu he tohu nui mō te ngoikore o te manawa e tata mai ana. Ko ngā taunakitanga e piki haere ana e whakaū ana i tōna tūranga hei tikanga pathophysiological huna, me te whakaroa o te tātaritanga e whai wāhi ana ki te mate ka taea te ārai puta noa i te niumōnia, te COVID-19, me ngā mate pūkahukahu mau tonu. Nō nā tata nei i whakanuia e te New England Journal of Medicine tēnei 'taupatupatu a te taote' - kei reira te kaha manawa noa e huna ana i te korenga o te hāora kino, e hiahia ana kia whakahoutia te mataara haumanu me te aroturuki i ngā whakarerekētanga kawa."
He aha te hypoxemia?;
"Ko te hypoxemia, e tautuhia ana ko te korenga o te mātotoru o te hāora i roto i te toto uaua (PaO2 < 80 mmHg i te taumata moana i roto i ngā pakeke), ka puta ina heke te pēhanga wāhanga i raro i ngā paepae paerewa kua whakaritea e te tau (AARC Clinical Practice Guideline 2021). Ka whakaatuhia e ngā rōpū mōrearea teitei ngā kōtaha pathophysiological motuhake:
- Te kore ōrite o te hauhautanga/te rere toto: Ko ngā tūroro niumōnia kino me ngā urutā alveolar e whakararu ana i te kaha rere toto
- Ngā tikanga o te ngākau: Ngā rōpū ngoikore o te ngākau maui/matau e whakaatu ana i te edema pūkahukahu i puta mai i te pēhanga (PCWP >18 mmHg)
- Te ngoikore o te io me te uaua: Ngā tamariki kāore i te tino whanake ngā uaua i waenganui i te ihu me ngā pakeke he ngoikore te mahi a te uaua o te puku
- Te pānga mau tonu: Ka puta he panoni hanganga o te pukahukahu i ngā kaiwhakamahi tupeka (emphysema, COPD-GOLD stage ≥2)
- Ngā mea whakaoho iatrogenic: Ngā tūroro whai muri i te pokanga e pāngia ana e te pouri manawa i puta mai i te opioid (RR <12/min) me te atelectasis
He mea nui kia mōhiotia, 38% o ngā tūroro i pokanga uma ka pāngia e te hypoxemia i roto i ngā haora 24 i muri i te tango i te ngongo (ASA Closed Claims Data 2022), e whakaatu ana i te hiahia kia aroturukitia tonutia te pulse oximetry i roto i ēnei taupori.
He aha ngā tūponotanga o te hypoxia?
E ai ki ngā tatauranga haumanu, ka eke te reiti mate o ngā tūroro e pāngia ana e te hypoxemia kino ki te 27%, ā, i ngā take kino rawa atu, ka eke te reiti mate ki te neke atu i te 50%. Mēnā kāore e mahia he wawaotanga i te wā tika i ngā wāhanga tōmua o te mate, tera pea ka puta he pānga kino.
- Pānga ki te roro: Ina heke te taumata hāora i roto i te toto (hypoxemia), ka kore te hāora i roto i te roro. Ka puta pea ngā tohu pēnei i te ānini roa, te whanoke ohorere, me te ngaro o te mahara. Ki te kore e rongoatia, ka kino pea ngā pūtau roro i te korenga o te hāora mō te wā roa, ka arahi pea ki ngā whiu i puta mai i te aukati i te rere o te toto (infarction roro) te pakaru rānei o ngā oko toto (he toto roro). He mea nui te mōhio wawe ki ēnei tohu whakatūpato hei ārai i te kino tuturu o te pūnaha io.
- Pānga ki te ngākau: Ina kore te ngākau e whiwhi i te nui o te hāora, ka uaua ki te pupuhi pai. Ka taea e tēnei momo mate te whakaputa i ngā tohu whakatūpato pēnei i te tere o te ngakau, te koretake rānei o te ngakau, te kikī o te uma (angina), me te ngenge rerekē. I roto i te wā, ka ngoikore pea te uaua o te ngākau i te korenga o te hāora kāore i rongoatia, ka arahi pea ki ngā raruraru morearea pēnei i te ngoikore o te ngakau, te wāhi e kore ai e taea e te ngākau te whakatutuki i ngā hiahia o te tinana.
- Pānga ki ngā pukahukahu: Ka akiakihia ngā pukahukahu e te iti o te hāora kia kaha ake te mahi kia mau tonu ai. I roto i te wā, ka taea e tēnei momo mate te kino i ngā ara manawa me ngā kiko pukahukahu, ka piki ake te tūponotanga o te whakawhanake i ngā mate manawa pēnei i te COPD (mate pūkahukahu aukati mau tonu). I ngā take kino, ka taea e te korenga hāora roa te ngoikore o te taha matau o te ngākau i a ia e tohe ana ki te pupuhi toto i roto i ngā pukahukahu kua mārō, he āhuatanga e mōhiotia ana ko te cor pulmonale.
- Ngā pānga ki te tinana katoa: Ka pēhia ngā okana katoa e te korenga o te hāora, pērā i te motuka e oma ana me te iti o te wahie. Ka iti haere te kaha o ngā whatukuhu me te ate ki te tātari i ngā paitini, ka ngoikore te pūnaha ārai mate, ka uaua ake te whawhai ki ngā mate noa. I roto i te wā, ka nui ake te tūponotanga o te kino o ngā okana i tēnei nama hāora puku, ā, ka waiho te tinana kia ngoikore ki ngā raruraru hauora e pā mai ana – mai i ngā mate maha ki ngā whara okana roa. Nā tēnei ka nui te aro turuki i te taumata hāora i te wā tuatahi hei ārai i ngā raruraru maha-okana.
Me pēhea te whakatau mēnā he hypoxia tōu?
He mea nui ngā taumata hāora i roto i te toto hei ine i te korenga o te hāora. Mō ngā tāngata hauora, ko ngā tatauranga noa kei waenganui i te 95% ki te 100%. Ko ngā taumata i waenga i te 90-94% e tohu ana i te korenga o te hāora ngawari, kāore pea e kitea ngā tohu. Ko te hekenga ki te 80-89% e tohu ana i te korenga o te hāora ngawari, ka uaua te manawa, ka pōhēhē rānei. Ko ngā tatauranga i raro iho i te 80% he āhuatanga ohorere nui, ka tūpono te kino o ngā whekau nui nā te korenga o te hāora nui, ā, me aro tonu ki te hauora.
Me pēhea te pupuri i te taumata noa o te hāora i roto i te toto?
- Whakatuwheratia ngā matapihi hei whakapūhaumāota
Whakahouhia te hau o roto mā te whakatuwhera i ngā matapihi i ia rā kia rere ai te hāora hou. Mō ngā hua pai ake, toro atu ki ngā pāka, ki ngā wāhi taiao rānei i waho o ngā tāone nui, kia manawa hōhonu, kia ma hoki hei āwhina i te whakahou i ngā taumata hāora o tō tinana.
- Ngā mahi āerobic
Mā ngā mahi ā-tinana pērā i te hikoi tere, te kaukau, te eke pahikara rānei ka tere ake te rere o te toto me te tohanga o te hāora. Kōwhiria ngā mahi iti te kaha pērā i te ā-tinana wai, te oma puhoi rānei mēnā he hou koe ki te whakakori tinana – mā ēnei mahi ngāwari ka pai ake te tuku hāora me te whakapakari i te manawanui i roto i te wā.
- Te rongoā hāora kāinga
Mō te hunga e pāngia ana e ngā mate manawa roa e raru ana ki te iti o te hāora, mā te whakamahi i tētahi taputapu hāora kāinga ka āwhina i te pupuri i te hāora tika. He maha ngā tākuta e kī ana kia tīmata ki ngā taputapu whakaemi hāora kawe i te wā e moe ana, i ngā mahi o ia rā rānei – ina whakamahia kia rite ki ngā tohutohu, ka taea e tēnei rongoā te whakapai ake i ngā taumata pūngao, te whakaiti i te manawa pōuri, me te tautoko i te kounga moe pai ake.
Wā tuku: Paenga-whāwhā-25-2025