高棻 銀髮復健運動與健康老化部落格(Gofen geriatric physiotherapy and healthy ageing blog)

在澳洲很常見所謂慢性肺阻塞(COPD)的病人,有些病人在復健期間也同時接受氧氣治療(Oxygen Therapy). 因此, 物理治療師在心肺訓練期間,對於氧氣的給予和觀測病人的受氧程度和狀態就十分重要.

以下節錄昆士蘭政府在心肺物理治療訓練手冊中提到的重點,和大家做分享:

Under normal circumstances, a rise in CO₂ will be detected by the central chemoreceptors in the body and they will alert the respiratory centre to increase respiration. However, in the presence of chronic CO₂ retention the CO₂ regulation of respiration is diminished. Instead, peripheral chemoreceptors take over control of respiratory drive through detection of low oxygen concentrations of PaO₂. Therefore, a patient with hypoxic drive needs a low PaO₂ to maintain their respiratory drive. Administration of oxygen to these patients may suppress their respiratory drive.

Therefore in patients with COPD, an acceptable goal for oxygen delivery is an FiO₂ titrated for a PaO₂ range between 60 - 70 mmHg or SpO₂ 88 – 92%.

(Reference: Queensland Government- Clinical Skills Development Service)

簡單翻譯+補充如下: 正常狀態中,人體的呼吸中樞會依照體內CO2濃度來改變適合的呼吸狀態. 然而,慢性肺阻塞的病人,因為體內本身已滯留過多的二氧化碳,導致此中樞調節系統作用減弱. 在這種狀況下, 周邊的化學感受器開始主導呼吸調節,利用感測低氧氣濃度來刺激呼吸. 因此,一旦病人接受氧氣治療,而氧氣治療濃度過高時,就容易導致周邊化學感受器的調節失靈,因此呼吸過慢,導致Hypercapnic narcosis.) 

所以,物理治療師要隨時注意, 病人的目標SpO2應該在: 88-92%安全範圍內!