Download - Curs 2 Asistenti
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Poluanti
asfixianti
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definitie• sunt acei poluanti al caror ef. patogen
predominant este hipoxia/anoxia – prin blocarea – aportului– transportului – utilizarii oxigenului
• CO, CO2, H2S, acid cianhidric si cianuri, etc
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• CO2 – exceptional concentratii toxice
• CO – cel mai raspandit
• H2S &cianuri = accidental, din industrie
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surse de CO
• procese de combustie incomplete- cand O este insuficient ---nu apare CO2 , ci CO
• surse naturale – din descompunera metanului(oxidare)
• surse antropogene – vehicule, arderea combustibililor, industrie
• CO din CO2 sub UV --- foarte redusa
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riscuri apar :
• cand CO nu poate sa se ridice si disperseze, in ciuda densitatii sale mici– din vehicule– din functionarea defectuoasa a sistemelor de
incalzire din incaperi
• !! fumul de tigara: 4% CO( p la 15% COHb)
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mecanism de actiune
• O2 este deplasat de pe Hb – COHb – se blocheaza capacitatea de a lega O (afinitatea pt CO este mult mai mare decat fata de O)
• cantitatea de CoHb formata depinde de concentratia CO
• in raport de concentratiile CO si O2 din aer: concentratie de echilibru de COHb in sange
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• procesul de formare a COHb – reversibil – daca CO din aer scade, se poate forma din nou O2Hb
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• CO compromite eliberarea oxigenului catre tesuturi(sufera cele care necesita mult oxigen: cord, creier)
• la nivel celular: CO se leaga de hemoproteine:– mioglobina,– citocromoxidaza – citocrom P450 – dopamin-hidroxilaza
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1.efecte acute
• in mod normal:exista un procent de COHb (din surse exogene si endogene)=
0,5-0,8%
• p la 2% - nu s-au semnalat modificari (fizio/patogene)
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2-10%
• primele semne de hipoxie – tolerate fara manifestari subiective
• uneori: modificari psihomotorii si senzoriale- scad – acuitatea vizuala – sensibilitatea cromatica – dexteritatea manuala – performantele intelectuale
• efecte evidente: – cei cu tulburari de circulatie cerebrala– alcool – sedative– hipotensoare
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>2,5%
• creste nevoia de O2 a muschilor striati supusi la efort
• normal- nimic• !!cardiopatie ischemica....ischemie ----
angor----infarct• creste numarul&complexitatea aritmiilor• creste nr. de internari pentru IC
congestiva
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10-20%
• cefalee
• scaderea evidenta a performantelor fizice si intelectuale
• dispnee
• tahicardie
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20-40%- fenomene de intoxicatie acuta
• cefalee intensa
• ameteli
• greturi
• adinamie
• tulburari senzoriale
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extrem
• >40% pierdere de constienta
• >60% moarte
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pentru fetus
• CO difuzeaza prin placenta• Hb fetala are o afinitate mai mare fata de
CO fata de Hb materna• t de ½ este de 3 ori mai mare pt COHb
fetala fata de adult• f. gravida se hiperventileaza +are o
productie dubla de CO• 0,7-2,5%COHb din sangele fetal – nasteri
“small for date”
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2. efecte cronice
• alterari miocardice
• Ateromatoza (alterarea irigarii intimei vasculare)
• efecte pe embrion si fat: creste frecventa malformatiilor +’small for date’
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Grupe populationale la risc
• Bolnavii cardiaci cu ischemie pe miocard. La 2.4% COHb pot face angor pectoris sau infact de miocard. – Cel mai important grup de risc,
• anemicii• copiii• femeile gravide• anumite profesiuni (care necesita activitate in exterior
sau anumite procese industriale – mai ales daca se asociaza cu efort fizic crescut)
• persoanele cu BPOC ( Nu foarte important)
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